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HANDBOOK 



OF 



MATERIA MEDICA, PHARMACY, AND 
THERAPEUTICS. 



POTTER. 



NOTICES OF THE PRESS 

OF PREVIOUS EDITIONS OF 

DR. POTTER'S HANDBOOK 



From the American Journal of the Medical Sciences : 

" The author has very skilfully steered his course between the pessimism that marks 
a system of therapeutics based solely on the results given by experiments and observations 
in the chemical and physiological laboratories, and the optimism of hasty empirical general- 
izations upon meagre clinical data, and upon this we consider that the greatest claim can 
be made, that this book is a safe one for the junior practitioner. . . . The author, 
then, has fully attained the purpose which he set before him at the commencement." 

From the Medical Record : 

1 ' This is an old and valued friend which needs no commendation, much less an 
introduction. It ought to be in the library of every physician and student. It is the 
most convenient and most concise work on therapeutics and materia medica in the English 
language, and is at the same time thoroughly reliable. Though necessarily largely a 
compilation, nevertheless there is much that is original, the author being one of the most 
prominent of American therapeutists." 

From the Australasian Medical Gazette : 

" We have pleasure in commending the fourth edition of this excellent work to our 
readers. It is a monument of persistent industry. There is no better book in the 
English language for the student and practitioner. . . . Dr. Potter's book is thor- 
oughly practical, and Part III contains an enormous amount of information, for which the 
student ought to be grateful. . . . The chapter on prescriptions is especially well 
done, in fact the best we have seen." 

From the Journal of the American Medical Association : 

" Dr. Potter has embodied many original ideas in the preparation of this work, 
some, if not all of which will prove of very great value to the reader." 

From the Medical Bulletin : 

" The author's statements are concise, exact, compact, and his diction faultless ; no 
one, perhaps, in this country at least, excels him in the perspicuity of his condensations 
and the completeness of his work in respect to the many details involved in authorship." 

From the New York Medical Journal : 

" Dr. Potter's Handbook will find a place, and a very important one, in our colleges 
and the libraries of our practitioners. It contains almost everything that can be found in 
the larger works in a more concise form and brought up to a rather more recent date. 
. Under the head of prescription writing considerable attention is paid to the sub- 
ject of incompatibilities, and the student will here find many valuable hints for his guidance 
in this difficult subject. Besides this, there are, under the head of special therapeutics, very 
many formulas for the treatment of particular diseases and abnormal conditions, arranged 
alphabetically for easy reference. This will be especially valuable to young practitioners, 
and will frequently save the trouble of looking through large works and monographs for 
suitable formulae in the treatment of special cases. This department is fuller in this 
book than in any with which we are acquainted." 

From the Therapeutic Gazette : 

" The author has aimed to embrace in a single volume the essentials of practical 
materia medica and therapeutics, and has produced a book small enough for easy carriage 
and easy reference, large enough to contain a carefully-digested, but full, clear, and well- 
arranged mass of information. No new remedy of any acknowledged value is omitted 
from this list. Under each the section on physiological action and therapeutics has been 
written with care. ... In the enumeration of drugs suited to different disorders a 
very successful effort at discrimination has been made, both in the stage of disease and in 
the cases peculiarly suited to the remedy. It is no mere list of diseases followed by a 
catalogue of drugs, but is a digest of modern therapeutics, and as such will prove of 
immense use to its possessor." 

*£*The price of this book is $5.00, net, in cloth binding, or $6.00, net, in full 
leather ; for which it will be delivered free to any address. Thumb Index in each copy. 



A HANDBOOK 



OF '- 



MATERIA MEDICA, PHARMACY 
AND THERAPEUTICS 



INCLUDING THE 



PHYSIOLOGICAL ACTION OF DRUGS, THE SPECIAL THERA- 
PEUTICS OF DISEASE, OFFICIAL AND PRACTICAL 
PHARMACY, AND MINUTE DIRECTIONS FOR 
PRESCRIPTION WRITING: 



• BY 

SAM'L O. L. POTTER, A.M., M.D., M.R.C.P. Lond., 

FORMERLY PROFESSOR OF THE PRINCIPLES AND PRACTICE OF MEDICINE IN THE COOPER MEDICAL 

COLLEGE OF SAN FRANCISCO ; AUTHOR OF THE " QUIZ-COMPENDS OF ANATOMY AND 

, MATERIA MEDICA," " AN INDEX OF COMPARATIVE THERAPEUTICS," SEVERAL 

ARTICLES IN FOSTER'S " PRACTICAL THERAPEUTICS," AND " SPEECH 

AND ITS DEFECTS " ; LATE MAJOR AND BRIGADE-SURGEON 

OF VOLUNTEERS, U. S. ARMY. 



Bi^btb BMtton, 1Rev>isefc anfc Enlarged 



PHILADELPHIA: 

P. BLAKISTON'S SON & CO. 

IOI2 WALNUT STREET. 
I9OI. 



Library of Concrres.e 

Two Copies Received 
FEB 2 1901 

rf Copyright entry 

SECOND COPY 



1> 



A 



.-> 



\ 



Copyright, 1 90 1, 
By P. BLAKISTON'S SON & CO. 



Press of Wm. F. Fell & Co., 
1220-24 SANSOM ST., 

PHILADELPHIA. _ 



TO MY WIFE 

WHOSE DEVOTED CARE AND 

PATIENT ENCOURAGEMENT. 

DURING THE PAST TWENTY-TWO YEARS, 

HAVE SUPPORTED THE AUTHOR 

IX EVERY EXIGENCY OF 

HIS PROFESSIONAL LIFE. 



PREFACE TO THE EIGHTH EDITION. 



This revision was commenced at Manila, Philippine Islands, while the 
author was serving as Attending Surgeon at the Headquarters of the 
Department of the Pacific and Eighth Army Corps. The present edition 
contains material gathered from the writer's experience in active pro- 
fessional practice in a tropical climate, among soldiers and civilians, 
men, women, and children, during a period of nearly two years' duration. 

The text throughout the book has again been subjected to a thorough 
and critical revision, has been largely rewritten, and has been expanded 
by the introduction of much new matter. The latter has to some extent 
taken the place of material considered obsolete or comparatively unim- 
portant, so that the increased size of the book over the previous edition 
is only twenty pages. 

In the section on Materia Medica twelve articles have been rewritten 
and thirty-eight new articles have been inserted. The rewritten ones are 
those on Argentum, Cinchona, Coca, Coffea, Digitalis, Dulcin, Ergot, 
Ferrum, Ipecacuanha, Myrrha, Saccharinum and Veratrum Viride. The 
new matter includes paragraphs on Actol, Airol, Argentamin, Argentol, 
Argonin, Chinosol, Creosotal, Dionine, Eucaine, Eudoxin, Glycero- 
phosphates, Heroine, Holocaine, Iodothyrin, Itrol, Largin, Nosophen, 
Orphol, Orthoform, Passiflora, Pellotine, Peronine, Phloridzin, Piperidin, 
Protargol, Tuberculin-R, Urotropin and Xeroform. 

In the section on Therapeutics new articles are inserted on Local 
Anesthesia, Beriberi, Dhobie Itch, Tropical Fevers, Heat-stroke, Hemo- 
globinuric Fever, Lymphadenoma, Miliaria, Bubonic Plague, Sprue, 
Tinea Imbricata, Tinea Versicolor and Toxemia. Twenty-eight articles 
in this portion of the book have been rewritten, including those on 
Amenorrhea, Asthma, Boils, Cholera, Diabetes, Dysentery, Dyspnea, 
Gonorrhea, Insomnia, Leprosy, Leucocythemia, Lichen, Myxedema, 
Pemphigus, Phthisis, Remittent Fever, Typhoid Fever, Septicemia, 
Shock, Suppuration, Ulcers, Uremia, Variola and Wounds. The text 
of many other articles has been expanded by the incorporation of more 
than two hundred items from current medical literature and from the 
author's personal experience in practice. The articles on Poisoning, 
on Temperature in Disease, and on the Clinical Examination of the 
Urine have been transferred to this part of the book from the Appendix, 

vii 



Vlll PREFACE. 

in the belief that they will be more frequently consulted when found in 
their alphabetical order in the section on Therapeutics. 

The favor with which this book has been received during the last 
thirteen years by medical teachers, students and practitioners is very 
gratifying to the author, and will stimulate him to renewed effort to the 
end that his work may continue to maintain its position in professional 
esteem and confidence. 

Samuel O. L. Potter. 

i 220 Sutter Street, San Francisco, 
California, January, 1901. 



EXTRACTS FROM THE 
PREFACE TO THE FIRST EDITION. 



The author's intention has been to produce a book which would em- 
brace in a single volume the Essentials of practical Materia Medica and 
Therapeutics, treating of each subject in as concise phraseology as possible 
consistent with the delineation of every important feature. He has also 
endeavored to formulate such minute and definite directions for the fram- 
• ing of Prescriptions as might elucidate what to many is a very difficult 
problem. Furthermore, he has tried to present as much information 
upon the subject of Pharmacy as every physician should possess, in order 
to handle the implements of his profession with confidence and to direct 
their use by others with pharmaceutical accuracy. 

The complete fulfilment of these aims would be realized if the book 
should take rank as a working companion to the advanced student and 
the junior practitioner, and be deemed by them a reliable guide through 
the forest of observations and experiments on drug actions and uses, which 
make progress slow for the already over-burdened mind, when ploughing 
through the more exhaustive and exhausting text-books. 

Although this book is essentially a compilation, as all books of its class 
must be, there will be found in its pages much original matter derived from 
the writer's own experience in professional life. The arrangement of the 
matter will be found to be in some respects unique. After full consider- 
ation of the many arrangements of the Materia Medica in vogue, a modified 



PREFACE. IX 

alphabetical plan was adopted, by which the advantages of the alphabetical 
order might be retained, while permitting the grouping together of agents 
which are closely related, physiologically and therapeutically, under the 
title of the principal member of the class — the chief, as it were, of that 
particular clan. Thus, under the title Amyl Nitris will be found mention 
also of the Ethyl, Sodium and Potassium Nitrites, and their congener Nitro- 
Glycerin, all of which are closely allied to the first-named and to each 
other, in respect of their actions and uses. A very elaborate section on 
Drug Classification is placed before the Materia Medica, in order to 
supplement such deficiencies in grouping as are inevitable in an alpha- 
betical arrangement. 

In detailing the characteristics of an important drug, its physical pro- 
perties and chemical constituents are first briefly enumerated, then its 
preparations are described in the official language of the pharmacopoeia, 
usually somewhat abbreviated ; any important unofficial preparations are 
also noted, and all the compounds into which it enters are enumerated. 
Next the physiological action is taken up, its characteristic features being 
first described ; then the actions resulting from an ordinary medicinal dose, 
next those produced by small doses continued, and finally those from a 
toxic dose. These are followed by a brief account of its antagonists, 
antidotes and incompatibles, if any, and a concise summary of its thera- 
peutical applications closes the article ; — the whole presenting, it is hoped, 
a clearly defined word-picture of the drug under consideration. Every 
article and preparation comprised in the last edition of the U. S. Pharma- 
copoeia is fully noticed, while all the prominent unofficial agents receive 
such mention as their respective importance seems to demand. 

The second part of the book is devoted to Pharmacy, and has been 
written from the standpoint of, a conviction that many young practitioners 
would gladly dispense their own medicines, if provided with a few prac- 
tical directions on the subject ; thereby saving many a dollar from the 
drug store, preventing in their own practices at least the "renewals" 
which constitute so bad a feature of modern pharmaceutics, and gaining 
for themselves a practical acquaintance with their professional weapons 
which cannot but make them better physicians and more accurate pre- 
scribes. In this section of the book Prescription Writing receives full 
consideration, and many standard formulae are given as samples of pre- 
scriptions of each kind in extemporaneous use. 

In the third part the subject of Special Therapeutics is treated of elab- 
orately, in the form of an alphabetically arranged Index to the treat- 
ment of diseases, as laid down by the most recent authorities. Every 
indication for the use of a drug is referred to its author by his name or 
initial, and to the most prominent articles are appended a few selected 
formulae, to serve as guides to the neophyte in prescribing. 



X PREFACE. 

Nearly all the regular text-books have been laid under contribution in 
the preparation of the book, but especial use has been made of the works 
of Brunton, Ringer, Wood, Phillips, Waring and Bartholow, in their 
latest editions; as well as of the writer's verbatim notes of two courses of 
didactic and clinical lectures delivered by Professors Da Costa and Bartho- 
low in the Jefferson Medical College and Hospital and in the auditorium 
of the Pennsylvania Hospital. On page 603 will be found a list of the 
authorities referred to by initials in the section on Special Therapeutics. 

The Appendix contains numerous Tables, comprising diagnostic hints, 
Latin terms and phrases, formulae for hypodermic use, metric equivalents, 
and specific gravities and volumes; also Formulae representing the most 
noted patent medicines. 

The Index has received special attention, from a conviction that, if well 
made, it is the best part of a good book. Every title, synonym and other 
reference of importance is included therein, double and treble entries 
being made in every instance which seemed to require such repetition. 

The term "officinal," as applied to drugs recognized by the pharma- 
copoeia, has been discarded, the word " official " being used instead; for 
the simple reason that the idea to be conveyed is expressed more correctly 
by the latter term than by the former one. When none but official drugs 
and preparations were kept in the officina or drug store, it was eminently 
proper to call them " officinal," but inasmuch as this class does not now- 
adays constitute much over one-fourth part of the officinal stock, it is a 
wilful debasement of our professional weapons, as well as an inexcusable 
misnomer, to apply the shop-title to them any longer. 

Cooper Medical College, San Francisco, 
December, 1886. 



TABLE OF CONTENTS 



PAGE 

INTRODUCTION, 17 

Pharmacy, 17 

Materia Medica, 17 

Therapeutics, 17 

Empirical Therapeutics, 18 

Rational Therapeutics, 19 

Constituents of Organic Drugs, 21 

Active Principles, 21 

Carbohydrates, 21 

Alkaloids, . 22 

Glucosides, 23 

Neutral Principles, 24 

Organic Acids, 25 

Coloring Matters, 25 

Resins, 25 

Fixed Oils and Fats, 26 

Waxes, 26 

Volatile or Essential Oils, 27 

Camphors, 27 

Miscellaneous Compounds, 27 

Albuminoids or Protein Bodies, 28 

Ferments, 28 

Classification of Medicines (alphabetically arranged), 29-67 

Administration of Medicines 67 

Transfusion, 69 

The Hypodermic Method, 69 

Dosage of Medicines, 72 

Average Adult Doses of Official Preparations, 73 

PART I.— MATERIA MEDICA AND THERAPEUTICS, 75 

Abrus to Zingiber (alphabetically arranged), 75~53° 

PART II.— PHARMACY AND PRESCRIPTION WRITING, ... 531 

Pharmacopoeias and Dispensatories, 531 

Weights and Measures, 532 

Metric System, • . 534 

Approximate or Domestic Measures, 535 

Specific Gravity and Specific Volume, . 53^ 

xi 



Xll TABLE OF CONTENTS. 

PAGE 

Prescriptions, 536 

Analysis of a Prescription, 537 

Procedure in Writing a Prescription, 537 

Use of Latin in Prescriptions, 541 

Principles of Combination, 542 

Metric Prescriptions, 544 

Abbreviations, 545 

Renewals of Prescriptions, 546 

Prescription Blanks, 548 

Incompatibility, 548 

Chemical Incompatibility, 548 

Pharmaceutical Incompatibility, 551 

Therapeutical Incompatibility, 552 

Rules for the Avoidance of the Dangers of Incompatibility, 552 

Extemporaneous Pharmacy, 554 

Filling a Prescription, • • 554 

Stock Solutions, 556 

Rules for the Pharmaceutical Student, 556 

Official Pharmacy, 556 

Official Operations, 556 

Pharmaceutical Operations, 557 

Preparations, 565 

Official Preparations, 565 

Pharmaceutical Preparations, 565 

Aceta, to Vina, in alphabetical order, 565-602 

Excipients for Emulsions, 577 

Excipients for Mixtures, 582 

Excipients for Pills, , . 587 

PART III.— SPECIAL THERAPEUTICS, 603 

References and Bibliography, 603 

Applied Therapeutics, 604 

Abasia to Yellow Fever, 604-882 

Poisoning, 803 

General Principles of Treatment, 803 

Antagonists, 804 

Antidotes, 804 

Poisons, their Antidotes and Antagonists, 808 

Temperature in Disease, 850 

Average Normal Temperature, 850 

Clinical Thermometry, 850 

Abnormal Temperature, 851 

Temperature in Phthisis, 851 

Temperature in Typhoid Fever, 851 

Temperature in Scarlatina, 851 

Temperature in Measles, 852 

Temperature in Diphtheria, 852 

Co-relation of Pulse and Temperature, 852 



TABLE OF CONTENTS. Xlll 

' PAGE 

Clinical Examination of the Urine, 868 

Color, Specific Gravity, etc., 868 

Tests for Albumin, 868 

Tests for Bile, Chlorides, Sugar, etc., 869 

Mucus and Pus, 870 

Deposits in Urine, 870 

Necessary Apparatus, 870 

APPENDIX, 883 

Latin Phrases, Contractions, etc. , used in Prescriptions, , . . 883 

Latin Numerals, 895 

Latin Verbs, Participles, Prepositions, etc., 896 

Genitive Case-endings, 896 

Hypodermic Formulae, 897 

Patent Medicines, 899 

Tables of Differential Diagnosis. 

Forms of Bright' s Disease 903 

Cancer, 904 

Carditis, Endo- and Peri-, 904 

Cerebral Concussion and Compression, 904 

Chancre and Chancroid, 904 

Cholera, 905 

Croup and Diphtheria, 905 

Epilepsy and Hysteria, , 905 

Gout and Rheumatism, 905 

Pleurisy and Pneumonia, 906 

Scarlet Fever, Measles and Smallpox, 906 

Typhus and Typhoid Fevers, 907 

Vomiting, Cerebral and Gastric, . 907 

Yellow Fever and Bilious Remittent Fever, 907 

Tables. 

Table of Specific Gravities and Volumes, • 908 

Chlorodyne, A Comparison of Ten Formulae therefor, ....... 909 

Table of Drops in and Weights of a Fluidrachm, 910 

Table of Weights and Measures, 910 

Table for Metric Conversions, 91 1 

Table of Equivalent Weights and Measures, Inside of Cover. 

Table of Prescription Doses and Quantities, Inside of Cover. 

INDEX, 913 



EXPLANATION. 

Numerals unqualified, under the subtitles Preparations in Part I, denote grammes for 
solids and cubic centimeters for liquids. 

For Signs and Abbreviations used, see pages 533 to 545. 



ERRATA. 

Page 122, line 17, — for "thrown" read "thrown down." 

Page 141, line 26, — for "occur" read "occurs." 

Page 210, line 13, — for "many " read " some." 

Page 248, — for " Cardamon " wherever it occurs read " Cardamom." 

Page 249, line 4, — for " Carui" read " Carvi." 

Page 477, line 8 from bottom, — for " taction " read "action." 

Page 581, line 23, — for "reason" read "reasons." 

Page 614, line 27, — for "291" read "292"; and. on line 29, — for "278" read 

"280." 
Page 765, line 4 from bottom, — for " Risien and Russell " read " Risien Russell." 



INTRODUCTION 



Drugs (drugan, to dry), — is a term which was formerly applied to dried 
medicinal plants, and is still employed by writers and others in that sense. 
By extension, however, it has been made to cover all material substances 
used for the treatment of disease, including remedial agents from the 
animal and mineral kingdoms as well as those from the vegetable king- 
dom. 

Pharmacology {pharmakon, a drug, logos, a discourse), — is the science 
which treats of drugs and therefore properly embraces in its scope all of 
materia medica and therapeutics relating to drugs. By some writers this 
term is employed in a more restricted sense, including only the physio- 
logical action of drugs, a subject which is more correctly designated by 
the word Pharifiacodynamics (see below). 

Pharmacy is the name of the art which supplements the science of 
pharmacology, namely — the art of preparing drugs according to the re- 
quirements of the pharmacologist and of dispensing them on the pre- 
scriptions of the therapeutist. It includes a thorough knowledge of the 
materia medica, an acquaintance with the theories and manipulations of 
chemistry and an intimate practical experience in many operations pecu- 
liar to itself. 

Materia Medica is the branch of Pharmacology which treats of the 
substances used as medicines and describes their origin, composition, phys- 
ical characteristics, chemical properties, modes of preparation and admin- 
istration, also their physiological and toxicological actions. Two of its 
divisions are — 

Pharmacodynamics (pkarmakon, a drug, dunamis, power), which means the dis- 
cussion of the physiological action of drugs, their modifying power upon the normal 
physiological activity of the human organism. 

Toxicology (toxikon, a poison, logos, a discourse), describes the effects of drugs ad- 
ministered in poisonous doses, and treats of the antagonists and antidotes by which their 
effects may be neutralized or the poisons themselves rendered innocuous and removed 
from the organism. 

Therapeutics (Jherapeuein, to attend upon), comprises all the science 
and art of healing, and includes the use of medicines and all other agents 

17 



1 8 INTRODUCTION. 

and measures which are known to alleviate or cure disease. The opera- 
tions of Nature herself are properly embraced in the general term Thera- 
peutics, which may be subdivided as follows: — 

Natural Therapeutics, includes the operations of the Vis Medicatrix 
Naturce, the healing power of Nature, — those modes and processes of heal- 
ing which occur independently of art and tend to the spontaneous decline 
and cure of disease. There is no scientific dogma better established than 
this, that the living organism is in itself adequate to the cure of all its 
curable disorders. This natural law sustains the medical skeptic in his 
infidelity as to the value of medicines, enables the homeopathist to report 
his sugar-cures, and helps all physicians out of more close places in prac- 
tice than they are generally willing to acknowledge. This part of the 
subject is taught only casually in the schools, in connection with pathology 
and the other subjects embraced in the chair of Principles and Practice 
of Medicine, but it deserves a special chair and more systematic treat- 
ment than it receives. 

Applied Therapeutics embraces the application by Art of agents for- 
eign to the living organism, for the purpose of aiding Nature to restore 
the body to a healthy condition. This division is the portion of the 
subject which is taught separately and systematically in the schools, and 
therefore is alone considered in the following pages. 

Other divisions of the general subject employed in professional litera- 
ture and conversation are those entitled Empirical Therapeutics and 
Rational Therapeutics. 

Empirical Therapeutics is a term applied to the use of medicinal 
or other therapeutical agents for the sole reason that they have been tried 
previously with successful results in cases apparently identical with the 
one under treatment. By those who advocate this method it is styled 
the Therapeutics of Experience, and is claimed to be an accumulation 
of means of combating disease simply by observation and experiment 
independently of physio-pathological reasoning (Hartshorne). It was 
necessarily the original method in therapeutics, has conferred many rich 
gifts upon medical science, and has been advocated by many great physi- 
cians, its latest and ablest expounder being the eminent and lamented 
Niemeyer. 

The use of Opium to relieve pain, of Cinchona for malarial fevers, of Colchicum in 
gout, of Potassium Iodide in syphilis, of the Bromides in epilepsy, and of Cod-liver Oil 
in phthisis, are examples of the empirical use of remedies. But, after all has been said 
for it that can be said, the fact remains that it is essentially an unscientific method, a 
mere elaboration of the prevailing popular habit of recommending Mrs. A. to use pepper 
tea, because it cured Mrs. B. of " the very same trouble." Permitted to reign supreme, 
it would be destructive to all exactness in therapeutical progress The so-called 
"experience" of one observer is too often overbalanced by the experience of another 
equally competent and trustworthy ; and as few are encouraged to record their failures 
with remedies, there can be no scientific comparison of the failures with the reported 



INTRODUCTION. 1 9 

successes. For this reason empirical methods would tend to a minimum degree of 
accuracy in a science which, in the very nature of things, can never be- an exact one ; — 
though undoubtedly such methods will always prevail to some extent. 

Rational Therapeutics means the use of remedies for reasons based 
on a knowledge of the pathological conditions present in the subject and 
the physiological action of the agent employed. This method is the very 
antithesis of empiricism, and has been the leading idea in every revolt 
against empirical therapeutics in the past. Humoralism, Chemicism, 
Solidism, Stimulism, Galenism in the 2d century, Paracelcism in the 16th, 
and Hahnemannism in the 19th, all originated in efforts to find a more 
rational system of administering medicines than the prevailing empiricism 
of the day. 

The illustrious Albrecht von Haller, the father of Physiology and the 
author of the doctrine of Irritability, was the real originator of modern 
physiological therapeutics. In the preface to his Swiss Pharmacopoeia 
{circa A.D. 1755), o ccur tne following remarkable directions, — the first 
recorded of their kind : — 

" Nempe primum in corpore sano medela tentanda est, sine peregrina ulla miscella; 
odoreque et sapore ejus exploratis, exigua illius dosis ingerenda et ad omnes quae hide 
contingunt affectiones, quis pulsus, quis calor, quae respiratio, quaenam excretiones 
attendendum. Inde adductum phaenominorum in sano obviorum, transeas ad experi- 
menta in corpore aegroto." 

" In the first place the remedy is to be tried on the healthy body, without any foreign 
substance mixed with it ; having been examined as to its odor and taste, a small dose is to 
be taken, and the attention directed to all effects which thereupon occur ; such as tipon the 
pulse, the temperature , the respiration, the excretions. Having thereby adduced their 
obvious phenomena in health, you may pass on to experiment upon the sick body.'''' 

Forty or more years after these rules were laid down ex cathedra by 
Haller, the central idea therein was incorporated as one of the main 
pillars into a medical edifice then being erected in Germany. In the 
course of construction this pillar became so hidden beneath a super- 
structure of palpable absurdities, that the medical profession, in its 
anxiety to steer clear of the whole mass, almost forgot the corner-stone 
of truth appropriated from the teachings of one of its own greatest 
teachers. While, however, the mass of the medical profession, blinded 
by prejudice, turned away from everything which savored of drug- 
experiment, a few physicians were quietly working on the lines of Haller's 
dogma that drug-proving is the only true basis of drug-using. As a result 
of their labors the present generation sees the development of an idea, 
announced nearly 140 years ago, but now inspiring the minds of teachers 
and students all over the civilized world. Medical colleges are recog- 
nizing physiological drug-experimentation as a part of their regular cur- 
ricula ; laboratories are fitted up in many of the schools with costly 
instruments of precision, for the more exact prosecution of this study ; 



20 INTRODUCTION. 

and under the direction of such men as Wood, Ringer, Murrell, Brun- 
ton, Hildebrandt, Fraser, Binz, Liebermeister, Husemann, Schmiedeberg, 
etc., systematic researches are being conducted upon animals to ascertain 
the physiological action of every agent hitherto used in medicine. The 
alkaloids and other active principles of vegetable drugs, together with 
the numerous synthetic compounds which chemistry is giving to medi- 
cine, are subjected to the same rigid experimentation. The medical 
press of every civilized country is filled with the results of these labors, 
and no medical student is permitted to pass the graduating ordeal until 
he has mastered the essential characteristics of the physiological action 
of the important medicaments so far as established. What has hitherto 
been the conviction of but a few, is daily growing into a fixed canon of 
professional belief, that physiological experimentation with drugs must 
be the basis of their therapeutical employment, and that all real advance 
towards the establishment of therapeutics as a science, must be made 
upon the lines laid down by Haller, namely, drug-proving upon the 
healthy human organism. Still, in the words of Brown-Sequard, 
"Therapeutics will cease to be empirical, only when this last kind of 
knowledge shall be fully obtained;" but its fulness will never be fully 
realized unless the results have been thoroughly considered with regard 
to the differences due to the action of drugs in different doses on the 
human organism in health and disease. 

A thoroughly-prepared materia medica of half-a-dozen standard drugs, 
such as Aconite, Arsenic, Belladonna, Mercury, Opium and Quinine, 
based upon their actions and uses in different doses and under different 
states of the organism, would be of more real value to the physician who 
wishes to do his work accurately and with his eyes open, than all the 
contents of the dispensatories, plus the entire literature of the "new 
remedies," and every symptom in the ten quarto volumes of the largely 
discredited and partly repudiated homeopathic materia medica. If 
medical students would devote but one month of their annual college 
vacation to the personal investigation of some one feature of the action 
of some one drug, under such safe-guards against error as would secure 
the acceptance of the resulting observations, a mine of therapeutic gold 
would soon yield its solid truth to eager eyes. Formally laid down by 
Haller in 1755, cultivated to some extent by Alexander in 1768, Crumpe 
in 1793, Thommassini, Curtis, etc., urged by John Hunter, Sir Thomas 
Watson, Dr. King Chambers, and many other luminaries of the medical 
profession, the scientifically guarded proving of drugs on the human 
organism has lain, like the similar work of Jenner, neglected these many 
years, waiting for another Koch to re-inaugurate the work. 



CONSTITUENTS OF ORGANIC DRUGS. 21 



CONSTITUENTS OF ORGANIC DRUGS. 



Drugs are derived from all the three kingdoms of nature. Those 
which belong to the mineral kingdom may be termed inorganic drugs and 
are resolved by chemical analysis directly into their ultimate principles, 
the elementary bodies of which they are composed. Organic drugs are 
those which are taken from the animal and vegetable kingdoms. They 
are to some extent composed of inorganic materials (water, gases, salts, 
etc.), but chiefly consist of organic compounds (proximate principles) 
obtained by a proximate analysis. The further reduction of these proxi- 
mate principles to their elementary constituents shows that Carbon plays 
the leading role therein, associated with Hydrogen, Oxygen, Nitrogen 
and other elements. The proximate principles of vegetable drugs may 
be divided into insoluble and soluble groups ; the first containing those 
which resist the action of ordinary solvents, the second including those 
which may be dissolved in suitable menstrua and thereby separated from 
those which are not soluble in a particular menstruum. 

The Insoluble Constituents are substances which make up the cell- walls of vegetable 
drugs, namely — Cellulin (Cellulose), Lignin and Sclerogen. They are extremely intract- 
able to the action of solvents and yet find places in the materia medica under various 
forms. Cellulin in the form of Cotton is used extensively by both the surgeon and the 
pharmacist, and by the action of strong acids or alkalies thereon there is obtained 
Pyroxylin (Gun-cotton), which dissolved in ether makes Collodion. By the destructive 
distillation of cellulin and lignin a large number of solid, liquid and gaseous products 
are obtained, including acetic acid, methylic alcohol, phenol, creosote and tar. From 
their natural decomposition result amber, coal, coal-tar and the many derivatives of the 
latter substance. The Soluble Constituents include some principles which are medicinally 
inert and also many active principles. 

The Active Principles include carbohydrates, alkaloids, glucosides, 
neutral principles, organic acids, resins, fixed oils and fats, waxes, volatile 
oils, camphors, miscellaneous principles (phenols, ketones, etc.), protein 
bodies (albuminoids) and ferments. Some of these are not proximate 
principles from the strict chemical point of view, as they are not simple 
bodies (e. g., fixed oils, fats, waxes, and many of the volatile oils), but for 
the purposes of the materia medica it is convenient to so classify them. 
Others are active chiefly as foods, though in some cases they are employed 
as medicinal agents. For the methods of extracting the soluble princi- 
ples from drugs see the articles entitled Maceration and Percolation, 
in Part II of this book. 

Carbohydrates are properly regarded as foods rather than as medi- 
cines, yet many of them possess remedial qualities due to their neutral, 



22 CONSTITUENTS OF ORGANIC DRUGS. 

bland, demulcent, lubricant, protective or soothing action. They in- 
clude the Amyloids, cellulose, starch, dextrin, inulin, etc., the Sugars, as 
glucose, levulose, lactose (milk sugar), maltose (malt sugar), saccharose 
(cane sugar), etc., and the Gums and Pectin Bodies, as arabin, pectin, 
bassorin, cerasin, etc. 

Gums are not proximate principles but amorphous, transparent substances which are 
widely disseminated in plants and yield Mucic Acid when treated with nitric acid. They 
form sticky preparations with water and are precipitated by alcohol. Arabin is the main 
constituent of soluble gums. Bassorin, which swells up in water, is one of the constitu- 
ents of gum tragacanth, also of cherry and plum gums. [Compare the articles entitled 
Acacia and Tragacantha, in Part I.] 

Alkaloids {alkali, eidos, resemblance) — are organic basic substances 
existing in many plants, usually in combination with organic acids. They 
readily combine with acids to form crystalline salts which are soluble in 
water, the alkaloids themselves being almost insoluble therein though dis- 
solving in alcohol. They are odorless, of more or less bitter taste, and 
generally possess powerful physiological actions. They are easily decom- 
posed by alkalies or alkaline carbonates, and are precipitated from their 
solutions by several reagents, including iodine in a solution of potassium 
iodide, potassio-mercuric iodide, auric chloride, also picric, tannic, phos- 
pho-molybdic and phospho-tungstic acids. Their Latin names terminate 
in — ina, their English names in — ine, as Morphina, Morphine. 

Chemically the alkaloids may be regarded as derivatives of Ammonia (NH 3 ) or ammo- 
nias in which one or more atoms of H are replaced by various radicles. They are 
believed to be decomposition products of vegetable albumin occurring in the plant-cells 
during the process of growth. They all contain the elements C, H and N ; most of 
them also contain O (amides) and usually occur as crystalline solids which (except Ber- 
berine) are colorless. A few containing O occur as liquids, namely — Lobeline, Lupu- 
line. Muscarine, Pelletierine and Pilocarpine. Some are devoid of O (amines) and 
occur as volatile, oily liquids, namely — Coniine, Nicotine, Piperidine, Pyridine, Sparteine 
and Trimethylamine. In their chemical composition the latter are closely related to 
Pyridine, C 5 H 5 N, an alkaloid which seems to underlie the molecular structure of many 
others. Some of them may be synthetically prepared from the pyridine bases (picoline, 
collidine, etc.). By changing the chemical constitution of an alkaloid its physiological 
action can be completely altered. 

Alkaloids are sometimes called organic or vegetable alkalies, to distin- 
guish them from the inorganic or mineral alkalies, which they resemble 
in little except their reaction and basic qualities. The term artificial 
alkaloid is applied to secondary alkaloids derived from natural ones, as 
Apomorphine. The term synthetic alkaloid should be restricted to those 
which occur in nature but have been prepared synthetically, and should 
never be applied to bases which are only obtained by synthesis and do not 
occur naturally, as Antipyrin, Thallin, etc. 

Many so-called alkaloids are in reality mixtures of different alkaloids, e. g., Vera- 
trine. Some plants contain more alkaloids than one, including a second which may be 
similar in action to the first but weaker (as Brucine) or antagonistic in action to the 
principal one (as Calabarine). 



CONSTITUENTS OF ORGANIC DRUGS. 2$ 

The first alkaloid discovered was Morphine, isolated and described by the apothecary 
Sertiirner in 1816. Within sixteen years after that date Strychnine, Brucine, Quinine, 
Cinchonine, Narcotine, Codeine, Veratrine, Coniine, Atropine, Nicotine, Aconitine and 
Hyoscyamine were discovered by different chemists. 

Of the alkaloids 15 are official, under either their own names or those 
of their salts, besides Veratrine which is described as a mixture of alka- 
loids. Of the official salts of alkaloids there are 10 Sulphates, 6 Hydro- 
chlorates, 3 Hydrobromates, and 1 each Bisulphate, Acetate, Salicylate 
and Valerianate. The official alkaloids are the following named : — 

Apomorphina, Apomorphine, — a derivative of the alkaloid Morphine. 
Atropina, Atropine, — from Belladonna and some allied plants. 
Caffeina, Caffeine, — the active principle of Caffea, the coffee-plant. 
Cinehonina, Cinchonine, — a minor alkaloid from Cinchona (Peruvian Bark) . 
Cinchonidina, Cinchonidine, — another alkaloid from Cinchona. 
Cocaina, Cocaine, — from the plant Erythroxylon Coca. 
Codeina, Codeine, — the second in rank of the Opium alkaloids. 
Hyoscina, Hyoscine, — one of the alkaloids of Hyoscyamus (Henbane). 
Hyoscyamina, Hyoscyamine, — another alkaloid from Hyoscyamus. 
Morphina, Morphine, — the principal alkaloid of Opium. 
Physostigmina, Physostigmine, — also called Eserine, — from Physostigma. 
Pilocarpina, Pilocarpine, — the principal alkaloid of Pilocarpus (Jaborandi). 
Quinina, Quinine, — the chief alkaloid of Cinchona (Peruvian Bark). 
Quinidina, Quinidine, — a powerful but scanty ingredient of Cinchona. 
Strychnina, Strychnine, — the principal alkaloid of Nux Vomica. 
Veratrina, Veratrine, — a mixture of alkaloids from Asagraea officinalis. 

Unofficial but Important Alkaloids are the following : — 

Aconitina, Acomtine, — the active principle of Aconite. 

Berberina, Berberine, — from Berberis, Hydrastis, Calumba, and other plants. 

Brucina, Brucine, — the second alkaloid of Nux Vomica. 

Colchicina, Colchicine, — the active principle of Colchicum. 

Coniina, Coniine, — the principal alkaloid of Conium (Hemlock). 

Curarina, Curarine, — the active ingredient of Curare (Woorara). 

Duboisina, Duboisine, — from Duboisia ; identical with Hyoscyamine. 

Emetina, Emetine, — the alkaloid of Ipecacuanha. 

Gelsemina, Gelsemine, — the active principle of Gelsemium. 

Homatropina, Ho?natropine, — a derivative of the alkaloid Atropine. 

Muscarina, Muscarine, — from the Fly-agaric, a poisonous mushroom. 

Pelletierina, Pelletierine, — from Punica Granatum, the Pomegranate. 

Sparteina, Sparteine, — a volatile alkaloid obtained from Scoparius. 

Allied to the alkaloids are the organic products termed Leucomaines and Ptomaines, 
the former being alkaloidal substances produced by the decomposition of albuminous 
matter in the living animal tissues during the normal destructive metamorphosis, the 
latter being similar substances produced by the process of putrefaction. Many of the 
ptomaines are identical with certain vegetable alkaloids. 

Glucosides (g/uhtse, sweet), — form a group of organic principles exist- 
ing in plants and generally neutral in character. They may be resolved 
by boiling with dilute acids or alkalies, or by the action of ferments, into 
glucoses (chiefly dextrose) or other bodies (mannite, phloroglucin) which 
themselves yield glucoses, also one or more other bodies (alcohols, alde- 
hydes, phenols, etc.) which are different in each case. Thus Salicin, 
C 13 H 1S 7 , which is a glucoside, by the action of a dilute acid is split 



24 CONSTITUENTS OF ORGANIC DRUGS. 

up into glucose and saligenin, according to the following reaction, 
C 13 H 18 7 + H 2 == C 6 H 12 6 (glucose) + C 7 H 2 2 (saligenin). Under the 
supposition that glucose and its congeners are alcohols it is probable 
that glucosides are the corresponding ethers. Few of them, if any, con- 
tain N, but they all contain C, H and O. They are often the most 
active of the principles in the plants containing them, but they are more 
frequently associated with other active principles, as alkaloids, oils, 
resins, etc. Like other neutral principles, the glucosides have Latin 
names which end in — inum, and English names ending in — in. The 
official glucosides are two, namely — 

Glycyrrhizinum, Glycyrrhizin, — from Liquorice-root. 
Salicinum, Salicin, — obtained from Willow and other barks. 

Unofficial but important Glucosides are those named in the following 
list : — 

Adonidinum, Adonidin, — from Adonis vernalis. 

Arbutinum, Arbutin, — from Bearberry leaves. 

Cathartic Acid, — one of three glucosides in Senna leaves. 

Colocynthinum, Colocynthin, — the active principle of Colocynth. 

Convallamarinum, Convallamarin, — from Convallaria majalis. 

Digitalin, Digitaleln, Digitoxin and Digitonin, — the four active principles contained 

in Digitalis, the last-named one antagonizing the other three. 
Ipecacuanhic Acid, — existing in Ipecacuanha. 
Jalapinum, Jalapin, — the active principle of Scammony. 
Saponinum. Saponin, — obtained from Quillaja, the Soap-bark. 
Strophanthinum , Strophanthin, — the active principle of Strophanthus, and one of the 

most powerful poisons known. 
Tannins, except Tannic Acid, which is an organic acid, are considered to be glucosides ; 

the chief ones being Caffetannic Acid, Chinotannic Acid and Quercitannic Acid. 

Neutral Principles, — are all neutral in character, of various com- 
position and powers, and characterized by the absence of basic or other 
properties which would place them in the other groups. Many have a 
very bitter taste and have been therefore called Amaroids or Bitter Prin- 
ciples. Like the glucosides their Latin names end in — inum, their 
English names in — in. Those which are official are the following- 
named : — 

Aloinum, A/oin, — from various species of Aloes. 

Chrysarobinum, CJuysarobin, — a mixture of proximate principles obtained from 

Goa-powder. 
Elaterinum, Elaterin, — extracted from Elaterium. 
Picrotoxinum, Picrotoxin, — obtained from Cocculus Indicus. 
Piperinum, Piperin, — from Black Pepper. 
Santoninum, Santonin, — the active principle of Wormseed. 

Unofficial, but important Neutral Principles, are — 

Anemoninum, Anemonin, — a camphoraceous principle from Pulsatilla. 
Cantharidinum, Cantharidin, — the active principle of Spanish Flies. 
Cotoinum, Cotoin, — an acrid principle in Coto Bark. 
Quassinum, Quassin, — a bitter principle in Quassia-wood. . 



CONSTITUENTS OF ORGANIC DRUGS. 25 

Besides the above-mentioned principles, there are several other sub- 
stances bearing pharmacopoeial names ending in — inurn or — in, which 
have no relationship to either of the groups previously described. 
Among them are — 

Chinoidinum, Chinoidin, — a mixture of alkaloids from Cinchona. 

Glycerinum, Glycerin, — the sweet principle of fats and fixed oils. 

Lupulinum, Lupulin, — the glandular powder of the Hop plant. 

Also Abrin, a toxic albumose in Jequirity-seeds ; Ricin, a poisonous ferment in Castor- 
oil seeds; and Antipyrin, Eenzin, Chinolin, Kairin, Lactophenin, Naphtalin, Pancreatin, 
Pepsin, Phenacetin, Piperazin, Pyroxylin, Resorcin, Thallin and other organic com- 
pounds which are not derived from either the animal or vegetable kingdoms, but are 
manufactured in the chemical laboratory. 

Organic Acids or Carbon-acids, contain the unilavent group C0 2 H 
(carboxyl) linked with a hydrocarbon residue. They contain no N, but 
have acid properties, forming salts with bases. The principal organic 
acids are — 

Official. Unofficial. 

Acetic Acid. . Oleic Acid. Agaricic Acid. Formic Acid. 

Benzoic Acid. Salicylic Acid. Angelic Acid. Malic Acid. 

Citric Acid. Stearic Acid. Butyric Acid. Meconic Acid. 

Gallic Acid. Tannic Acid. Camphoric Acid. Oxalic Acid. 

Lactic Acid. Tartaric Acid. Cerotic Acid. Succinic Acid. 

Coloring Matters form a group of bodies having very different prop- 
erties and the nature of many being not yet understood. Among them 
are — Carminic Acid, in the cochineal insect, also in some plants ; Cariha- 
min, from the safflower; Chlorophyll, in all green parts of plants ; Curcu- 
min, the coloring matter of turmeric; and Hematoxylin, from logwood. 

Resins. The proximate principles called by this name are neither the 
commercial resins nor the resins of pharmacy (see under Resin^e in Part 
II), all of which are complex bodies, but include only the chemical indi- 
viduals of resinous character existing in nature, as those in Copaiba, 
Cannabis, Gamboge, Guaiac, Gurgun, etc. Even these, in their commer- 
cial form, are accompanied by other principles. It is difficult to define 
the resins correctly, but they are generally considered to be oxidation 
products of hydrocarbons, such as terpenes. They are mostly brittle, 
amorphous, uncrystallizable solids, insoluble in water but soluble in alco- 
hol, ether, chloroform, benzin, etc. Most of them are of acid character, 
combining with alkalies to form a kind of soap, these " resin-soaps " being 
soluble in water and giving up their resins again to the action of acids. 
They soften or melt when heated and solidify again on cooling. They 
may be obtained from oleo-resins, as turpentine, by simple distillation, 
the volatile oil passing over and the resin remaining behind ; or by heat-. 
ing the part of the plant in which they are contained, as in the case of 
guaiacum resin. 



26 CONSTITUENTS OF ORGANIC DRUGS. 

The substances ordinai-ily called Resins are usually classified as follows : — 

True Resins are hard, compact products of oxidation, and are made up chiefly of 
resin acids. Such are Copal, Damar, Mastic, Sandarach, Dragon's blood, Gum-lac and 
Amber. 

Gum-resins are natural mixtures of gum and resin. When they are rubbed up with 
water the gummy matter dissolves and the resin is suspended in the form of an emulsion. 
[Compare the title Emulsa, in Part II, also the subtitle Gums, ante, p. 22.] Such are 
Olibanum (frankincense), Myrrh, Ammoniac, Asafetida, Galbanum and Tragacanth. 

Oleo-resins include all mixtures of volatile oils and resins of whatever consistency, 
also the Balsams or mixtures of resins with benzoic and cinnamic acids. Such are 
Copaiba, crude Turpentine, Storax, and the true balsams — Benzoin, Balsam of Peru and 
Balsam of Tolu.* There are six official oleo-resins, which are described under the title 
Oleoresin^E in Part II 

Pharmaceutical Resins are solid preparations obtained by precipitating the resinous 
principles of plants from their alcoholic solutions by the agency of water. Three such 
preparations are official in the U. S. Pharmacopoeia, and are described under the title 
RESIN^E in Part II. 

Fixed Oils and Fats, though usually placed among the constituents 
of animal and vegetable drugs, are not proximate principles, being com- 
pound bodies containing the radicle Glyceryl, C 2 H 5 in combination with 
anhydrides of the various fatty acids. The decomposition of these 
bodies by heating with water and an alkali yields the triatomic alcohol 
Glycerin, C 2 H 5 (OH) 3 and one or more fatty acids (stearic, palmitic, 
oleic, etc.). The latter combine with the alkali, forming soaps, and the 
glyceryl is converted into glycerin, a portion of the water being consumed 
in the reaction. [See the subtitle Saponification under the title Sapo, in 
Part I.] An exception to this rule is the case of Cod-liver Oil, which 
does not yield glycerin when saponified but oxide of propyl. The fol- 
lowing-named official fixed oils and fats are those which are chiefly 
employed in medicine, viz. — 

Adeps, Lard, — the abdominal fat of the hog. 

Adeps Lanae Hydrosus, Hydrous Wool Fat, — the purified fat of the wool of the 

sheep. 
Sevum, Suet, — the abdominal fat of the sheep. 
Cetaceum, Spermaceti, — obtained from the sperm whale. 
Oleum Adipis, Lard Oil, — expressed from lard. 
Oleum Amygdalae, Almond Oil, — expressed from almonds. 
Oleum Gossypii Seminis, Cottonseed Oil, — from cottonseed. 
Oleum Lini, Linseed Oil, — expressed from flaxseed. 
Oleum Morrhuae, Cod-liver Oil, — from the liver of the cod-fish. 
Oleum Olives, Olive Oil, — expressed from ripe olives. 
Oleum Ricini, Castor Oil, — from the seed of the castor-oil plant. 
Oleum Sesami, Sesamum Oil, — from the seed of the Benne plant. 
Oleum Theobromatis, Oil of Theobroma, Cacao-butter, — expressed from the seed 

of the Chocolate-tree. 
Oleum Tiglii, Croton Oil, — expressed from the seed of Croton Tiglium, an Indian 

plant. 

Waxes are also compound bodies, closely allied to fats but containing 
no glyceryl, and are usually placed among the proximate principles for 
sake of convenience. The official wax (Cera) is prepared by the honey- 
bee. Chinese insect wax is the secretion of a coccus upon a variety of 



CONSTITUENTS OF ORGANIC DRUGS. 2J 

ash. Japanese wax is obtained from the fruits of several varieties of 
Rhus. Myrtle wax is obtained from the fruits of various species of Myrica. 
Wax is used in pharmacy ; internally it is practically inert and harmless. 

Volatile or Essential Oils form a large group of organic bodies 
existing in plants, from which they are usually extracted by distillation 
with water, being volatilizable at the temperature of boiling water. 
They are generally liquid at ordinary temperatures, and when exposed 
to cold many of them separate into a solid, crystalline portion, called 
stearopten, and a liquid portion, called elceofiten. They are highly odor- 
ous, oily, sparingly soluble in water, more or less soluble in alcohol and 
in ether, colorless, or yellowish, inflammable, and prone to become 
resinous on exposure to the air. A few consist of but a single proximate 
principle, for example — Oil of Betida, which is wholly methyl salicylate. 
Most of them are complex bodies, consisting of two or more principles 
which can be separated from each other. The list of the volatile oils is 
quite an extensive one, 36 being official in the U. S. Pharmacopoeia and 
described in Part I of this book under the titles of their respective 
sources. The group may be subdivided into the following classes, viz. — 

Hydrocarbon Oils (or Terpenes), — consist of C and H, most of them having the 
formula C ]0 H 16 and being therefore isomeric with rectified Oil of Turpentine, which is 
the type of this class. 

Oxygenated Oils, — contain C, H and O, are highly aromatic and usually consist of 
a terpene mixed with an oxygenated principle (an acid, an aldehyde, etc.). The oils of 
Cinnamon and Peppermint are examples of this class. 

Sulphuretted Oils, — contain Sulphur in addition to their other elementary constitu- 
ents, and are pungent and disagreeable in odor and taste ; as the oils of Garlic and 
Mustard. In the latter case the oil is formed by the reaction of the constituent princi- 
ples in the presence of water and does not preexist in the plant. 

Nitrogenous Oils,— contain N, as the compound Cyanogen, CN, in the form of 
Hydrocyanic Acid, which is formed only after maceration with water. Examples are 
the oils of Bitter Almond, Peach-kernels, etc. 

Camphors are volatile, aromatic principles, composed of ten atoms 
of C with various proportions of H and O. They are solid and crys- 
talline at ordinary temperatures, and closely related to the terpenes, 
with which they are associated in plants and by the oxidation of which 
they seem to be formed. The principal member of the group is the 
official Camphora, C 10 H 16 O, which is described under its own title in 
Part I. Stearoptens obtained from various essential oils are often, though 
incorrectly, called camphors, as Borneol, Menthol, Eucalyptol, etc. 

Borneol, or Borneo-ca?npkor t C 10 H 18 O, — is a secondary alcohol occurring in a tree 
which grows in Borneo and Sumatra. It may be formed artificially by heating common 
camphor with alcoholic potash or by treating it with sodium. 

Menthol, or Mint-ca??iphor, C ]0 H 20 O, occurs in Oil of Peppermint together with a 
terpene and separates in crystals on cooling the oil. It is a secondary alcohol, is official, 
and is described under the title Mentha Piperita in Part I. 



> 



25 CONSTITUENTS OF ORGANIC DRUGS. 

Miscellaneous Compounds include several organic bodies (phenols, 
ketones, etc.) which occur as proximate principles in plants but are not 
referable to the other groups. Among them are — 

— from the oils of Anise and Fennel, 
-from the Oil of Parsley, 
-from the Oil of Caraway. 

-a liquid obtained from the volatile oils of 
several species of Eucalyptus, also from the oils of Cajuput, Myrtle, Rosemary, 
Sage and Wormseed. 
Etigenol, C 10 H 12 O, — from Oil of Cloves and other volatile oils. 
Guaiacol, C 7 H 8 2 , — the essential constituent of Creosote. 
Safrol, C 10 H 10 O 2 , — obtained from the oils of Sassafras and Camphor and the bark of 

several plants. 
Thymol, C 10 H u O, — a phenol from Oil of Thyme and other volatile oils. 

Albuminoids or Protein Bodies all contain N, as well as C, O, H 
and Sulphur. They are formed exclusively in plants, in every part of 
which they occur in small amounts but in larger quantities in the seeds. 
When consumed and assimilated by animals they undergo little alteration 
but enter into the animal tissues and form the chief part of the solid 
constituents of the blood, muscles, nerves, glands and other organs. 
They are chiefly valuable as foods, and may be conveniently divided into 
the following classes : — 

Native Albumins, are soluble in water; as Serum-albumin, Egg-albumin, Plant- 
albumin (in the juices of plants). 

Derived Albumins or Albuminates, are insoluble in water but soluble in very 
dilute acids or alkalies; as Syntonin (acid-albumin), Alkali-albumin, Casein, the chief 
proteid in milk, Legumin or plant-casein. Gluten, the chief nitrogenous constituent of 
the seeds of cereals (wheat, rye, etc. ), is believed to be a combination of four albuminoids, 
gluten-fibrin, gluten-casein, gliadin and mucedin. 

Globulins, are insoluble in water but soluble in dilute saline solutions and in very 
dilute acids or alkalies, and include — Globulin (Crystallin), Myosin, Fibrinogen, Vitellin, 
Para-globulin and Globin (residue of Hemoglobin, which forms the chief part of the red 
blond-corpuscles; contains Iron and is closely related to the proteids). 

Fibrin (Animal Gluten), is insoluble in water and sparingly soluble in neutral saline 
solutions and in dilute acids and alkalies. It has a filamentous structure and possesses 
remarkable elasticity. 

Coagulated Proteid, is formed from albumin, fibrin, etc. by the action of heat or 
alcohol, and is insoluble in water or alcohol but soluble in strong hydrochloric acid and 
gradually in acetic acid. 

Peptones, are formed from albumins by the action of the acid gastric juice. They 
are highly diffusible and readily soluble in water, but are insoluble in alcohol or ether. 

Amyloid Substances, include Ichthin, Ichthidin, Ichthulin and Emydin, which 
occur in the eggs of fishes and amphibii, also' Lardacein or Amyloid Substance, a patho- 
logical infiltration into various organs. 

Collagenes and Mucilaginous Bodies, include Ossein, Collagen (and their deriva- 
tive Gelatin), also Elastin, Chondrin, Keratin and Mucin. 

Ferments are known only by their power of effecting peculiar 
changes in other organic bodies. The true ferment-substances have not 
yet been isolated, but they are present in certain preparations obtained 
from animals and plants, the most important of which are named in the 
following list, viz. — 



CLASSIFICATION OF MEDICINES. 29 

Pepsin, — contained in the gastric juice of animals. 

Pancreatin, — obtained from the pancreas of animals. 

Papayotin (Papain), — from the sap of Carica papaya. 

Bromelin, — contained in the juice of the Pineapple. 

Ptyalin, — the peculiar ferment of animal saliva. 

Diastase, — formed during the germination of seeds. 

Emulsin, — the ferment occurring in almonds. 

Myrosin, — the ferment contained in mustard-seeds. 

The first four above-named are fully described under the title Pepsinum, Diastase 
under Maltum, Emulsin under Amgdala, and Myrosin under Sinapis, in Part I of 
this book. 



CLASSIFICATION OF MEDICINES. 



In the present state of knowledge respecting the actions and uses of 
medicinal agents, no really scientific classification of these substances is 
possible. Some writers have adopted a system based on the natural rela- 
tions of the various articles to each other, while many classify them 
according to their effects on the human system, and others make no 
attempt at arrangement but treat of them in alphabetical order. The 
latter method has been chiefly followed in this work, from a conviction 
that every medicine should first be studied as an individual, both with 
respect to its physiological actions and its therapeutical applications. 
When the student has thus made himself familiar with the characteristic 
features of each article of the materia medica, he may begin, by compar- 
ing one with another, to seek acquaintance with their more delicate lights 
and shades. Some system of classification then becomes imperative as an 
aid to the memory, and as the titles of the groups to which the various 
agents belong in any physiological classification are also used to express 
their actions and uses, the following synopsis is inserted as an appropriate 
introduction to the section on Materia Medica and Therapeutics. 

Accommodation of the Eye is impaired or paralyzed by the fol- 
lowing named drugs, acting upon the ciliary muscle, viz. — 



Atropine. 


Homatropine. 


Cocaine. 


Daturine. 


Physostigmine. 


Gelsemine 


Hyoscyamine. 


Pilocarpine. 





Intraocular tension is increased by Atropine (large-doses), Hyoscyamine and Daturine ; 
and is decreased by Physostigmine and by Cocaine. Gelsemine paralyzes the external 
ocular muscles, especially the levator palpebrae and external rectus, by its action on the 
terminal nerve filaments. 

Acids, considered therapeutically and physiologically, are medicines 
which in concentrated form act usually as caustics to destroy the tissues y 
but when administered internally in medicinal doses they check the pro- 



> 



30 CLASSIFICATION OF MEDICINES. 

duction of glands having acid secretions if coming in contact with the 
mouths of their ducts, — and increase the production of those having 
alkaline secretions. Thus, a dilute acid given before meals will check the 
production of the acid gastric juice, but will stimulate that of the alkaline 
pancreatic juice. They should always be largely diluted for internal 
administration. The principal Acids are Acetic, Citric and Benzoic, from 
the vegetable kingdom, and Nitric, Phosphoric, Sulphuric and Hydro- 
chloric, from the mineral kingdom. 

Alkalies, or Ant-acids, from the same standpoint, (see above), are 
agents which neutralize acids, also act as escharotics on the tissues, arid 
check alkaline and stimulate acid secretions, when in contact with the 
mouths of the ducts of the glands producing them. Thus, a dilute alkali 
given before meals will stimulate the production of the acid gastric juice, 
and if applied to the mouth of the pancreatic duct will check the secretion 
of the alkaline pancreatic juice. Alkalies may be subdivided into two 
groups, named, from their physiological actions, Direct Antacids, those 
which lessen acidity in the stomach, and Indirect or Remote Antacids, 
which have no power over acidity in the stomach, but are oxidized in the 
blood, and excreted as carbonates in the urine, and lessen its acidity. 
The following List of Alkalies comprises the chief members of both 
groups, and also some which have the actions of both. They should all 
be largely diluted before administration. 

Direct Antacids. Remote Antacids. 

[Lessen Acidity in the Stomach.) [Lessen Acidity of the Urine.') 

Liquor Potassse, Liquor Sodae. Potassium Acetate. 

Carbonates and Bicarbonates of Potas- Potassium Citrate. 

sium, Sodium, Lithium, Magnesium Potassium Tartrate. 

and Ammonium. Potassium Bitartrate. 

Calcined Magnesia (Magnesia). Sodium Acetate. 

Lime-water. Chalk. Sodium Citrate. 

Aromatic Spirit of Ammonia. Lithium Citrate. 

Alteratives are remedies which alter the course of morbid conditions 
in some way not yet understood, perhaps by promoting metabolism. 
They certainly modify the nutritive processes and thereby cure many dis- 
eases of chronic type. Mercury and Iodine are the most prominent agents 
of this class, the former being endowed with the power of breaking up 
newly deposited fibrin and disorganizing syphilitic deposits, while the 
latter acts energetically upon the lymphatic system and promotes absorp- 
tion. Arsenic also is almost specific in many chronic skin affections, and 
has remarkable power over chronic pulmonary consolidations, probably 
producing fatty degeneration and softening of the effusion, so that it may 
be absorbed or expectorated. The principal alteratives are — 



CLASSIFICATION OF MEDICINES. 



31 



Arsenic. 
Antimony. 
Aurum. 
Mezereum. 

Sulphur. 
Sulphides. 



Mercury. 

Colchicum. 

Guaiacum. 

Sanguinaria. 

Xanthoxylum. 

Calcium Chloride. 



Iodine. 

Iodides. 

Stillingia. 

Sarsaparilla, 

Cod-liver Oil. 

Phosphorus. 



Certain therapeutists of laboratory type have, of late years, seen fit to denounce the 
term Alterative as " a cloak for ignorance," but have never been able to present a better 
designation for a class of agents whose effects are among the most thoroughly established 
of clinical facts. 

Amblyopia, or impairment of vision from nerve-changes, is produced 
temporarily by Quinine, and may be permanently induced by Tobacco 
and Alcohol, also by Lead and Urea poisoning. 

The sensibility of the eye is increased by Strychnine, the field of vision becoming 
enlarged, and the vision rendered more acute. If the drug be administered hypodermi- 
cally the improvement will be more marked in the eye corresponding to the side of the 
body where the injection was made. The sensibility for color is affected by drugs, 
Strychnine increasing the field for blue, Eserine diminishing it for red and green, and 
Santonin causing objects to appear at first of a violet and afterwards of a greenish-yellow 
color. 



Analgesics or Anodynes (an, without, algos, pain, odunay, pain), — 
are remedies which relieve pain either by direct depression of the centres 
of perception and sensation in the cerebrum, or by impairing the con- 
ductivity of the sensory nerve fibres. Opium is the most efficient of all 
analgesics, because it arrests the afferent impressions at every step of their 
track — at their formation, along the course of their conduction, and at 
the point where they impinge on the sensorium. The Local Anodynes are 
described under Anesthetics ; the list of Genei'al Anodynes includes the 
following-named agents : — 



Opium, Morphine. 
Belladonna, Atropine. 
Cannabis Indica. 
Stramonium. 
Hyoscyamus. 
Gelsemium. 



Antipyrin. 

Acetanilid. 

Phenacetin. 

Phenocoll. 

Exalgin. 



Aconite. 

Chloroform, Ether, etc. 

Conium. 

Chloral Hydrate. 

Croton-chloral. 

Lupulus. 



Anaphrodisiacs (an, without, Aphrohdeetay, Venus), — are medi- 
cines and measures which lower the sexual function and diminish the 
sexual appetite. They act by lessening the excitability of the nerves of 
the genital organs, by depressing the genital centres in the brain and 
cord, or by decreasing the local circulation. The principal anaphrodisiacs 
are named in the following list. [Compare Aphrodisiacs.] 



Bromides. 
Potassium Iodide. 
Camphor (at last). 
Opium (at last). 
Lupulin. 
Cocaine. 



Tobacco. 

Digitalis. 

Conium. 

Belladonna. 

Stramonium. 

Gelsemium. 



Nauseants. 
Purgation. 
Venesection. 
Ice, locally. 
Cold Baths. 
Vegetable Diet. 



> 



32 CLASSIFICATION OF MEDICINES. 

A few drops of a 4 per cent, solution of Cocaine upon the glans penis will destroy all 
erection-power for a quarter to half an hour. 

Anesthetics (an, without, aisthaysis, perception), — are agents which 
temporarily destroy sensation. The Local Anesthetics are described 
below. The General Anesthetics include certain volatile substances, 
mostly belonging to the chemical groups named alcohols and ethers, 
which when inhaled sufficiently produce complete unconsciousness and 
loss of sensation (anesthesia), also lessened motor power. Narcotics also 
produce more or less anesthesia, but this term is usually restricted to the 
effects of the volatile agents referred to above. The principal members 
of this group are — 

Ether (Ethyl Oxide). Chloroform. 

Methylene Bichloride. Chlorinated Ethyl Chloride. 

Ethylene Bichloride. Ethyl Bromide. 

Nitrous Oxide. Pental (Tri-methyl-ethylene). 

The list of General Anesthetics also includes Alcohol and many substitution products 
derived from alcohols and ethers. [Compare the articles entitled Alcohol, ^Ether and 
Chloroform in Part I.] 

Local Anesthetics and Anodynes (an, without, odunay, pain), — 
reduce the functions of the sensory nerves until they lose the power of 
receiving or conducting sensations. Some act by direct depression of 
the end-organs in the skin, etc., others by impairing the conductivity 
of the sensory nerves, while some act indirectly by reducing the local 
circulation. The Anodynes diminish, and the Anesthetics destroy, for a 
time, the sensibility of the skin and mucous membranes to which they are 
applied. The chief members of this class are named in the following 
list: — 

Local Anodynes. Local Anesthetics. 

Acetanilid. ' Extreme Cold, Ice. 

Aconite, Aconitine. Ether Spray. 

Belladonna, Atropine. Ouabain. 

Opium, Morphine. Cocaine. 

Carbolic Acid. Antipyrin. 

Chloroform. Erythrophlcein. 

Chloral. Hydrocyanic Acid. 

Veratrum, Veratrine. Carbolic Acid. 

Volatile Oils. Creosote. Guaiacol. 

Oil of Turpentine. Iodoform. 

Galvanism. Orthoform. 

Anhidrotics (an, without, heedrose, sweat), — are agents which check 
perspiration, and are the opposites of the Diaphoretics, which promote 
this secretion. They usually act either — 

1. By depressing the action of the sweat-glands. 

2. By depressing the excitability of the sweat-centres. 

3. By reducing the circulation in the skin. 



CLASSIFICATION OF MEDICINES. 33 

The most important agents of this class are those named in the follow- 
ing list, the figures indicating their mode of action as above arranged. 

Belladonna. 1 Acids, locally. 3 Chloralami 

Atropine. 1 Jaborandi. Quinine (?). 

Hyoscyamus. 1 Pilocarpine. Picrotoxin. 

Stramonium. 1 Nux Vomica. Dover's Powder. 

Muscarine. 2 Strychnine. Opium 2 (small doses). 

Agaricus Albus. 2 Ergot. 3 Zinc Salts. 3 

Salvia (Sage). Sulphuric Acid. Local Cold. 3 

Strychnine, Atropine, Dover's Powder, Jaborandi, Picrotoxin and Zinc Salts are all 
respiratory stimulants, and very efficient against the sweating of phthisis, though most of 
them are classed as diaphoretics. This is explained by the theory of accumulation of 
carbonic acid in the blood by depressed respiration caused by severe coughing, this 
stimulating the sweat-centres, and being opposed by agents which stimulate the respira- 
tory centre. 

Antagonists are agents which directly oppose each other in some or 
all of their physiological actions, and may be used against each other to 
counteract their effects upon the organism. Antagonistic action takes 
place in the blood and tissues, after the absorption of both the poison 
and the antagonist ; it is available against poisons administered hypoder- 
mically as well as by other channels, and so far as drugs are concerned it 
is applicable chiefly to vegetable poisons or to those which produce their 
toxic effects after absorption. In most cases of poisoning by vegetable 
principles absorption has proceeded so far before professional assistance 
is obtained that the time for antidotes has passed, and reliance can be 
placed only upon the physiological antagonists and such antagonistic 
measures as may support vitality until the poison can be eliminated by 
the excretory organs of the body. There may be an exception to this 
rule in the case of Morphine, which, after making the round of the cir- 
culation, constantly returns in part to the stomach until finally eliminated, 
so that repeated washing of that organ with a solution of potassium per- 
manganate, or the ingestion thereof from time to time, may have a con- 
tinuous antidotal action on such portion of the poison as may. have been 
absorbed. [Compare Antidotes.] 

Antagonistic Measures include all such procedures as may tend to 
antagonize any remote effects of poisons, as artificial respiration, faradi- 
zation of the respiratory muscles, constant motion or absolute repose, 
application of heat or cold, douching, etc. 

Thus, in the case of poisoning by Digitalis, the antagonists which will counteract the 
effects of such portion of the drug which has been absorbed are the following : Aconite 
or Morphine against the cardiac action, the former for the effects of large doses, the latter 
for those of the long- continued use of the drug. Saponin and Senegin are the most 
complete antagonists against Digitalis, their counteraction extending throughout nearly its 
entire range of action. Alcohol is also indicated, as a cardiac stimulant, and absolute 
Rest i?i the recumbent posture is an antagonistic measure of prime importance, by reason 
of the liability to sudden cessation of the lowered cardiac action on the assumption of . 
the erect posture by the patient. 

In Part I of this book, under the several titles of the poisonous drugs, their most 



r 



34 CLASSIFICATION OF MEDICINES. 

efficient Antidotes and Antagonists are mentioned ; but these are more fully described, 
and are arranged in a form suitable for reference, under the caption Poisoning in 
Part III. 

Physiological Antagonism means a balance of opposed actions on par- 
ticular organs or tissues, excited by medicinal agents and measures or by 
disease. It may extend throughout the whole or the greater part of the 
range of action of the opposing agents, or, as is usually the case, may be 
limited to a few points thereof. There is no instance in which the 
antagonism of two drugs is absolutely complete along their whole line of 
action. In a few cases it is nearly so; as with Morphine and Atropine 
(except as to narcotism), Digitalis and Saponin, and Atropine and Mus- 
carine, the latter being considered the most complete instance known. 
In most cases the antagonism extends only to certain definite spheres of 
action, and the antagonists therein may be synergists to each other in 
other spheres, as the narcosis produced by both Morphine and Atropine. 
It may be local, affecting a single organ or function, or it may extend to 
a group of organs, to several associated functions, or over the distribution 
of the nerves proceeding from a single nerve-trunk (as the vagus) or 
controlled by a single nerve-centre. Antagonism implies a balance of 
functional disturbance, not an alteration of structure. 

Drugs are rarely antagonistic to each other in the same degree, but, by 
reason of differences in their mode and time of action, the action of one 
preponderates over that of the other, so that the latter will not counteract 
the former to the extent of averting a fatal result, though in the reverse 
order their counteraction may be most satisfactory. For example, while 
Chloral is the antagonist to Strychnine, opposing as it does the spinal 
action of the latter drug, the reverse is true to a very limited extent ; 
and, while Atropine may prevent death from a lethal dose of Aconitine, 
Morphine or Bromal Hydrate, no one of these three will do so in atropine 
poisoning. 

Two mutually antagonistic principles may exist in the same plant, as 
the alkaloids Pilocarpine and Jaborine in pilocarpus, and the glucoside 
constituents of digitalis, one of which, Digitonin, antagonizes the actions 
of the other three, Digitalin, Digitoxin and Digitalein. 

Toxicological Antagonism is a very ancient idea in medicine. Mithridates of 
Pontus (b. C. 164-124) and other monarchs of the heathen world occupied themselves 
with the study of poisons and their antidotes and antagonists, established botanical 
gardens for the purpose of their investigation, and gave their names to what were sup- 
posed to be universal preventives against the results of poisoning. In the 1 6th century 
Prosper held that theriaca (opium) was an antagonist to all poisons. From l570to 1677 
many observations were made and published on the treatment of belladonna poisoning 
by opium, and in 18 10 the same matter was made the subject of an inaugural thesis by 
Lipp. The scientific investigation of drug action and antagonism was not possible until 
the discovery and isolation of the alkaloids, but followed immediately thereafter, and 
was begun in 1809 by Magendie upon the upas poison (nux vomica) and its newly dis- 
covered alkaloid, strychnine. In 1869 Schmiedeberg and Koppe made their researches 



CLASSIFICATION OF MEDICINES. 35 

on muscarine and atropine, and Liebrich discovered chloral and proved the antagonism 
of strychnine to its action, the converse of which was shown by Bennett in 1875. 
In 1870 Fraser published his investigations upon atropine and physostigma, and Preyer 
his on the antagonistic influence of atropine and hydrocyanic acid on respiration. In 
1875 a committee of the British Medical Association made an extended investigation and 
report on the antagonisms of several drugs, which was supplemented by the work of 
Vulpian on atropine and pilocarpine in the same year, that of Fothergill in 1877 on 
aconite, atropine and digitalis, and that of Huseman on the antagonisms of chloral. 
Much good work has also been done in England by Brunton and Ringer, and in the 
United States by Wood and Bartholow, on the same lines. The name of Brunton is 
unalterably associated with the antagonism between amyl nitrite and the spasmodic 
paroxysm of angina pectoris, a discovery in therapeutic antagonism which was made 
by him through the exercise of purely scientific reasoning, and which has since been 
applied to the similar paroxysm induced in poisoning by certain drugs, as cocaine. 
Bartholow has collected a list of 120 cases of poisoning by opium and belladonna, in 
which each poison was treated with the other as an antagonist, and in which only 15 
proved fatal, a mortality of 12^ per cent. 

The following table, modified from Brunton, gives the antagonistic poisons, also their 
mutual antagonistic and lethal doses in each case in which they have been determined. 
The doses are expressed in grains or fractions of a grain per pound weight of the animal. 



ANTAGONISTS. 



II. 



Aconitine and Atropine, 

" " Digitalin, 

" " Strychnine, 

Alcohol and Strychnine, 

Atropine and Aconitine, 

" " Chloral, . 



" " Hydrocyanic Acid, 

" " Jaborandi, . . . 

" " Muscarine, . . . 

" " Morphine, . . . 

" " Pilocarpine, 

" " Phytolaccine, . . 

" " Physostigmine, 

" " Quinine, .... 

Bromal Hydrate and Atropine, 
Chloral and Atropine, .... 

" " Picrotoxin, .... 

" " Physostigmine, . . 

" " Strychnine, .... 
Chloroform and Amyl Nitrite, . 
Digitalin and Aconitine, . , . 

" " Muscarine, . . . 

" " Saponin, .... 

Gelsemium and Opium, . . . 

" " Atropine, . . . 

Morphine and Caffeine, . . 

" " Chloroform, . . 

Muscarine and Atropine, . . 
Opium and Atropine, 

'* " Gelsemium, . . 

" " Veratrum Viride, 



ANTAGONIS- 
TIC DOSE. 



600 
1 

Too 



* 

* 



LETHAL 
DOSE. 



900 
900 



7 

7 
1 

7 
7 
7 
7 
7 
7 
7 

9 
7 

7 
7 

7 
7 



288 

1 
9rt0 

7 



36 CLASSIFICATION OF MEDICINES. 

Anthelmintics (anti, against, hehnins, a. worm), — are agents which 
destroy (vermicides) or expel (vermifuges) worms inhabiting the intes- 
tinal canal. The principal vermifuges are the purgatives Castor Oil, 
Jalap and Scammony, — and the vermicides are classed according to the 
worm they are each most efficient against, thus, — 

Thread Worms Round Worms Tape Worms 

(Oxyuris Vermicularis). (Ascaris Ltwibricoides). (Tenia, etc.). 

Alum. Santonica. Filix Mas. 

Sulphate of Iron. Santonin. Kamala. 

Lime Water. Spigelia. Kousso. 

Quassia. Chenopodium. Granatum. 

Eucalyptol. Azedarach. Pelletierine. 

Sodium Chloride. Senna ") with the Pepo. 

Tannin. Calomel j above. Turpentine. 

Veg. Astringents. Naphtalin. Chloroform. 

Naphtalin. Naphtalin. 

The substances enumerated in the first column are all used locally by enema. Adjuncts 
to these remedies are such agents as prevent the excessive secretion of intestinal mucus, 
which affords a nidus for the worms. Such are Bitter Tonics and preparations of Iron, 
also Ammonium Chloride and Sodium Chloride. 

Antidotes (anti, against, didomi, I give), — are agents which affect a 
poison either physically or chemically, or both, so as to remove it from 
the body or alter its character by forming with it an insoluble or inert 
compound before its absorption, with the object of preventing its toxic 
action upon the organism. Antidotes do their work in the alimentary 
canal or in the respiratory passages, and are applicable to vegetable as 
well as mineral poisons, but are not available against poisons adminis- 
tered hypodermically. They include sundry chemical substances, also 
measures of various kinds, and maybe divided into two classes: (1) 
Chemical or True Antidotes, which unite chemically with the poison, 
converting a soluble and absorbable substance into a compound which 
is more or less insoluble and non-absorbable, or harmless though 
soluble; (2) Mechanical Antidotes ox Antidotal Measures, which include 
such medicinal or mechanical processes as tend to remove a poison from 
the body, either before or after the use of an antidote ; and include emesis, 
the use of the stomach-pump, purgation, etc. The term Antidotal Treat- 
ment covers the employment of both antidotes and antidotal measures, 
and is often used in a still wider sense, namely, to mean all the treatment 
of a case of poisoning, including the use of Antagonists as well as that of 
Antidotes. [Compare Antagonists.] 

Thus, Tannic Acid is the antidote for poisoning by Digitalis, as it forms with the 
active toxic principles of the drug chemical compounds (tannates) which are almost insol- 
uble and therefore comparatively harmless. But as these tannates are not entirely inert, 
an antidotal measure, evacuation of the stomach, must also be employed, by the adminis- 
tration of Zinc Sulphate or any other emetic, or by the use of a stomach-pump. 



CLASSIFICATION OF MEDICINES. 



37 



Antiperiodics are remedies which affect certain periodical febrile 
diseases, lessening the severity of their paroxysms or preventing their 
return. They act probably by arresting the development in the blood of 
successive crops of pathogenic organisms, upon which the disorders are 
supposed to depend. The principal antiperiodics are — 

Cinchona Bark and its alkaloids, especially Quinine. Arsenic. 

Bebeeru Bark and its alkaloid Berberine. Eucalyptol. 

Salicin, Salicylic Acid, Salicylates. Iodine. 
Opium and its alkaloid, Narcotine. 

Quinine is the most powerful antiperiodic and Arsenic ranks next in order of effi- 
ciency. 

Antiphlogistics (anti, against, phlogeezo, I burn), — are measures and 
medicines which are supposed to have some specific power in reducing 
inflammation. The term is becoming obsolete, but frequent references 
are still seen to the influence of Mercury and Opium in inflammations of 
serous membranes, Anti??iony and Aconite in inflammations of the respi- 
ratory tract and organs, and to the power of Veratrum Viride over 
puerperal metritis. The chief antiphlogistics are — 



Aconite. Opium. 
Veratrum Viride. 
Tartar Emetic. 
Mercury. 
Gelsemium. 



Digitalis. 

Ergot. 

Ipecacuanha. 

Potassium Nitrate. 

Rest (recumbent position). 



Venesection. 
Local Depletion. 
Purgation. 
Counter-irritation. 
Cold (locally). 



Antipyretics {anti, against, fiuretos, fever), — are agents or measures 
which reduce the body-temperature when abnormally high. This may be 
done by two principal methods, and the agents doing either accomplish 
the result by five different actions, as follows, viz. — 



[a) Lessening the Production of Heat, by 



(b) Promoting the Loss of Heat, by 



1. Diminishing tissue-change. 

2. Reducing the circulation. 

f 3. Dilating the cutaneous vessels, and 
producing increased radiation. 

-j 4. Producing perspiration, and its evap- 
oration. 

[ 5. Abstracting heat from the body. 



The following list contains nearly all the antipyretics, the numbers 
following each referring to its proper method of action, as enumerated 
above : — 



Quinine. l 
Quinidine. 1 
Cinchonine. 1 
Cinchonidine. x 
Berberine. x 
Benzoic Acid. l 
Carbolic Acid. 1 » 3 
Picric Acid. x 
Salicin. 1 



Salicylic Acid. x 
Sodium Salicylate. 1 ' 4 
Quinine Salicylate. 1 
Methyl Salicylate. 1 

(Oil of Gaultheria. 
Trimethvlamin. 2 
Salol. 1 

Acetanilid. 1 - 4 
Antipyrin. 1 ' 4 



Phenacetin. 1 - 4 
Chinolin. 1 
Resorcin. 1 
Kairin. 1 - 4 
Kairolin. 1 , 4 
Hydroquinon. x 
Thallin. 1 ' 4 
Pyrocatechin. 1 
Pheno-resorcin. 



38 



CLASSIFICATION OF MEDICINES. 



Eucalyptol. 1 

Thymol. 1 

Other Essential Oils. * 

Alcohol. 1 ' 3 

Digitalis. 2 

Aconite. 2 

Camphor. 1 



Antimonials. 2,4 
Veratrine. 2 
Colchicum. 2 
Leeching. 2 
Cupping. 2 
Blistering. 2 
Poulticing:. 2 



Nitrous Ether. 3 - 4 
Dover's Powder. 4 
Cold Bath. s 
Cold Drinks. 5 
Ice to Surface. 5 
Cold Sponging. 5 
Wet Packing. 5 



Purgation and Venesection produce antipyretic results, but their mode of action is 
doubtful (Brunton). The Body-temperature is raised by Belladonna (or Atropine) and 
by Cocaine, but not to such a degree as to constitute fever or enable them to be classed 
as pyretics. Tuberculin, various albumoses, and certain animal poisons, as that of shell 
fish, will also produce a rise of temperature. 

Antiseptics [anti, against, sayptekos, putrefaction), — are agents 
which prevent or retard septic decomposition, by destroying the bacteria 
which produce it, or by arresting their development. The chief antisep- 
tics are named in the following list, the first column containing the most 
powerful ones, the middle column those which are moderately antiseptic, 
and the third column the weakest members of the group. 



Strong. 

Corrosive Sublimate. 
Formaldehyde. 
Oxygenated Water. 
Silver Nitrate. 
Gold Chloride. 
Zinc Chloride. 
Copper Sulphate. 
Iodine. Bromine. 
Chlorine. 

PotassiumPermanganate. 
Carbolic Acid. Creosote. 
Chloroform. Orthoform. 
Thymol. Menthol. 
Hydronaphtol. 
Alum. Tannin. 
Acetanilid. Antipyrin. 



Moderate. 

Boric Acid. 

Chloral Hydrate. 

Ferrous Sulphate. 

Zinc Sulphate. 

Arsenic. 

Quinine. 

Salicin. 

Sodium Salicylate. 

Salol. 

Mercuric Iodide. 

Eucalyptol. 

Sulphurous Acid. 

Sulpho-carbolates. 

Bismuth Subgallate, 

Resorcin. 

Coffee. 



Feeble. 

Benzoic Acid. 
Sodium Borate. 
Sodium Bicarbonate. 
Calcium Chloride. 
Sodium Chloride. 
Barium Chloride. 
Strontium Chloride. 
Ammonium Chloride. 
Ammonium Sulphate. 
Alcohol (pure). 
Sodium Hyposulphite. 
Potassium Chlorate. 
Potassium Arsenate. 
Potassium Iodide. 
Manganese Chloride. 
Glycerin. 



The first four named are the most powerful. Co7'rosive Sublimate is probably the most 
powerful of all, but it is very poisonous. The best are those which act sufficiently on the 
microbes without injuring the tissues. Chlorine, Bromine and Iodine are too irritant for 
general use. Salol is the best intestinal antiseptic, though Naphtol will destroy micro- 
organisms in the stomach and intestines. We do not know any drugs which, taken in- 
ternally or inhaled, will certainly destroy micro-organisms in the body, unless sufficiently 
concentrated to be fatal to the patient. 

Antispasmodics (anti, against, spasmos, a spasm), — are agents 
which prevent or allay spasm of voluntary or involuntary muscles in any 
portion of the organism. Some of the agents belonging to this class act 
by tonic stimulation of the higher nervous centres, the coordinating 
power, and the circulation, as Alcohol and Ether in small doses, Camphor, 
Musk, Valerian, etc. ; others by a depressant influence on the motor 
centres, as the Bromides, and still others by paralysis of the end-organs 
of the vaso-motor nerves, as Amyl Nitrite. A few depress all the vital 



CLASSIFICATION OF MEDICINES. 



39 



functions, as Aconite, Tobacco, Lobelia, Hellebore, and Prussic Acid ; 
and a number stimulate the muscular fibres of the intestines to expel 
gaseous accumulations, namely — Asafetida, Cajuput, Valerian, Musk, 
Aromatic Oils, etc. They are used in convulsive affections, especially 
asthma and other spasmodic diseases of the respiratory organs, hysteria, 
chorea, angina pectoris, epilepsy, etc. The principal antispasmodics are 
named in the following list : — 



Alcohol. Ether. 

Paraldehyde. 

Chloroform. 

Amyl Nitrite. 

Nitrites. 

Bromides. 

Potassium Iodide. 

Potassium Nitrate. 

Arsenic. 

Valerian. 

Conium. 



Aconite. 

Lobelia. 

Tobacco. 

Hellebore. 

Opium. 

Belladonna. 

Stramonium. 

Hyoscyamus. 

Hydrocyanic Acid. 

Physostigma. 

Curare. 



Ammoniac. 

Castor. 

Musk. 

Galbanum. 

Sumbul. 

Ipecacuanha. 

Senega. 

Silver Salts. 

Zinc Salts. 

Copper Salts. 

Asafetida. 



Antizymotics {anti, against, zumohsis, fermentation), — are agents 
which arrest the fermentative processes, which depend upon the action of 
unorganized ferments (enzymes), as diastase, ptyalin, pepsin, etc., or upon 
that of organized ferments, as the yeast-plant, bacteria, etc. The Anti- 
zymotics are usually subdivided into two groups, respectively entitled 
Antiseptics and Disinfectants, (which see). 

Fermentation is a general name for certain processes of decomposition, during which 
certain carbon compounds called Ferments act upon other carbon compounds, as on their 
food, — splitting these latter up, setting free their elementary constituents, and thereby 
leading to the formation of still other carbon compounds, by the rearrangement of the 
freed molecules. These processes are of two kinds, viz. : — 

(i) — Those in which water is taken up, (hydration), — chiefly carried on by enzymes. 

(2) — Those in which O is transferred from the H to the C association, as in lactic and 

alcoholic fermentation, and the putrefactive processes, — and which are chiefly carried 

on by the agency of organized ferments. 

The Ferments producing these fermentative changes are also carbon compounds, 

and are divisible into two groups, viz. : — 

Enzymes, or Organic Ferments, — have no definite structures, and are unorganized, 

i. e., not living, — as Diastase, Ptyalin, Pepsin, etc. 
Organized Ferments, — are minute, living organisms, as the moulds, yeast-plant, 
bacteria, and other members of the Protophytes, the lowermost class of plants, 
which, in the course of their life history, split up the carbon compounds in which 
they live, appropriating some part of their elements. 
Antizymotic Drugs are drugs which arrest or inhibit these fermentative processes, 
either by destroying or by rendering inactive the causative ferments. 



Aphrodisiacs (Aphroteeday, Venus), — are medicines which stimulate 
the sexual appetite and power. They act by reflex or direct action upon 
either the cerebral or the spinal genital centre. Tonics are indirectly 
aphrodisiac, as are all measures which promote the general bodily nutri- 
tion. The chief agents used as direct aphrodisiacs are named in the fol- 
lowing list. [Compare Anaphrodisiacs.] 



40 CLASSIFICATION OF MEDICINES. 



Nux Vomica. 


Cimicifuga. 


Ergot. 


Strychnine. 


Serpentaria. 


Iron. 


Cannabis. 


Sanguinaria. 


Alcohol. 


Cantharis. 


Opium (at first). 


Bitter Tonics 


Phosphorus. 


Camphor (at first). 


Flagellation. 


Aurum. 


Damiana (?). 


Meat Diet. 



Acids. 


Tannic A 


Alcohol. 


Gallic Ac 


Alum. 


Catechu. 


Chalk. 


Galls. 


Lime. 


Kino. 


Creosote. 


Oak -bark 


Carbolic Acid. 


Uva-Ursi. 



Strychnine acts by increasing general nutrition and exalting the reflex excitability of 
the genital centres. He7?ip probably only causes a mild delirium which may or may not 
take a sexual direction. Cantharides acts by direct irritation of the mucous lining of the 
urethra, and is dangerous in aphrodisiac doses. Alcohol in small doses excites the genital 
centre in the brain ; so also Opium and Camphor, the latter being decidedly anaphro- 
disiac after a time. The power of Damiana is doubtful. Urtication and Flagellation of 
the nates produce priapism by irritation of the genital centre in the cord through the sen- 
sory nerves of the part. Ergot is considered useful by contracting the dorsal vein of the 
penis, preventing its emptying too rapidly. 

Astringents (ad, to, stringo, I bind), — are agents which produce 

contraction of muscular fibre and condensation of other tissues, the first 

probably by direct irritation, the second by precipitating its albumin 

and gelatin. They also lessen secretion from mucous membranes. The 

principal astringents are — 

Bismuth Subnitrate, etc. 
Cadmium Sulphate. 
Copper Sulphate. 
Ferric Chloride. 
Lead Acetate. 
Silver Nitrate. 
Zinc Sulphate. 

Sulphuric Acid, Gallic Acid, and Lead Acetate are examples of Remote Astringents, 
acting on internal organs through the blood. Those which affect the part to which they 
are applied are Local Astringents, and include the others named above. 

Cardiac Sedatives lessen the force and the frequency of the heart's 
action. They are used to control palpitation and overaction of that 
organ, and to slow the pulse in febrile conditions in sthenic subjects, 
especially when local inflammation is the exciting cause of the fever. 
The chief cardiac sedatives are — 

Aconite. Pilocarpine. Senega, Saponin. 

Antimony. . Digitalis. Hydrocyanic Acid. 

Veratrum Viride. Ouabain. Potassium Salts. 

Muscarine. Emetine. Cold. 
Quinine, in full doses. 

Aconite, Veratrum, Muscarine, Pilocarpine, Saponin and Hydrocyanic Acid, are 
direct cardiac poisons, depressing the heart muscle and the cardiac motor ganglia ; Mus- 
carine and Pilocarpine also stimulate the inhibitory ganglia. Digitalis stimulates the 
vagus centre and the cardiac muscle, and acts as a sedative in many cases by slowing the 
cardiac rate and giving it a regular rhythm. Aconite is said by some authorities to relax 
inhibition, by others to stimulate the vagus centre. Antimony depresses the motor 
ganglia, Potassium depresses the cardiac muscle. 

Cardiac Stimulants rapidly increase the force and frequency of the 
pulse in depressed conditions of the cardiac apparatus. One of the most 
useful agents of this class is Alcohol in some form, its action being largely 
due to a reflex influence excited through the nerves of the mouth and 



CLASSIFICATION OF MEDICINES. 



stomach. It should therefore be given in but slightly diluted form, and 
in small quantities frequently. Ether is next in value and still more 
rapid in action, and the local application of Heat is one of the most 
powerful and available. Ammonia has an energetic action as a stimulant 
to the vaso-motor centre, as well as a reflex one upon the heart similar to 
that of Alcohol. The chief cardiac stimulants are — 



Alcohol. 
Ammonia. 
Atropine. 
Nitroglycerin . 
Orchitic Extract. 
Spermine. 



Hydrastinine. 

Cocaine. 

Ether. Chloroform. 

Heat (locally). 

Continuous Galvanic Current. 

Counter-irritation. 



Sparteine. 
Camphor. 
Aromatic Oils. 
Turpentine. 

Opium and Morphine, in 
small doses. 



Cardiac Tonics, when given in moderate doses, stimulate the cardiac 

muscle, slowing and strengthening its contractions. In large doses they 

are apt to produce irregular action of the heart, and some of them have 

more or less of a tendency to cause sudden death by syncope if pushed 

to any great extent. The most important of these agents are — 

Digitalis. Squill. Strophanthus. 

Convallaria. Erythrophlcein. Strychnine. 

Cimicifuga. Caffeine. Hellebore'in. 

Sparteine. Saponin. Adonidin. 

Digitalis acts partly by stimulation of the vagus end-organs in the heart, thus in- 
creasing cardiac inhibition, and partly by direct stimulation of the cardiac centre in the 
medulla, as well as by a direct influence on the heart muscle itself. It contracts the 
arterioles and raises the blood-pressure greatly. Convallaria, Erythrophlcein, Squill, 
and Cimicifuga act similarly but less powerfully, and are correspondingly safer. Stro- 
phanthus is still better, as it does not affect the vessels, and therefore does not raise the 
blood-pressure. 

Carminatives (carmino, I soothe), — promote the expulsion of gas 
from the stomach and intestines by increasing peristalsis, stimulating the 
circulation, and relaxing the cardiac and pyloric orifices of the stomach. 
They also act as diffusible stimulants, both of the bodily and mental facul- 
ties. The principal carminatives belong to the aromatic oils, alcohols or 
ethers, and are named in the following list : — 



Asafetida. 


Mace. 


Oil of Cloves. 


Camphor. 


Mustard. 


Oil of Coriander. 


Capsicum. 


Pepper. 


Oil of Eucalyptus. 


Cardamom. 


Serpentaria. 


Oil of Fennel. 


Chloroform. 


Spirits. 


Oil of Peppermint 


Ether. 


Oil of Anise. 


Oil of Spearmint. 


Fennel. 


Oil of Cajuput. 


Oil of Nutmeg. 


Ginger. 


Oil of Caraway. 


Oil of Pimento. 


Horse-radish. 


Oil of Cinnamon. 


Oil of Valerian. 



Cathartics or Purgatives {kathairo, purgo, I cleanse), — are agents 
which increase or hasten the intestinal evacuations. According to their 
respective degrees and direction of action they are subdivided into several 
groups, as follows : — 

Laxatives (laxo, I loose), or Aperients {aperio, I open), — include those 
which excite moderate peristalsis, and produce softened motions without 
irritation. Sulphur is the typical laxative. 



42 



CLASSIFICATION OF MEDICINES. 



k 



Simple Purgatives, — cause active peristalsis, and stimulate the secretions 
of the intestinal glands, producing one or more copious and semifluid 
motions with some irritation and griping. Senna is the type of this 
group, which also includes Aloes, Rhubarb, Castor Oil, etc. 

Drastic Purgatives (drao, I act), — act still more intensely, producing 
violept peristalsis and watery stools, with much griping pain, tenesmus, 
and borborygmi. They irritate the intestinal mucous membrane, cause 
exosmosis of serum from its vessels, and in large dose set up inflammation 
and symptoms of irritant poisoning. Jalap is a typical drastic. 

Saline Purgatives. — This group includes the neutral salts of metals of 
the alkalies or alkaline earths. They stimulate the- intestinal glands to 
increased secretion, and by their low diffusibility impede reabsorption, 
causing an accumulation of fluid in the intestinal tract, which, partly from 
the effect of gravity and partly by gentle stimulation of peristalsis excited 
by distention, reaches the rectum and produces a copious evacuation. 
Magnesium Sulphate and Sodium Sulphate are the typical salines. They 
should be given in plenty of water and during active movement (as in 
walking) in order to produce their best effects. 

Hydragogue Purgatives {Jiudore, water, ago, I bring away), — include 
the most active of the drastic and saline groups, especially those which 
remove a large quantity of water from the vessels. Elaterium is a typical 
hydragogue cathartic. 

Cholagogue purgatives (kohlay, bile, ago, I bring away), — are those 
agents which stimulate the discharge of bile and produce free purgation 
at the same time, the stools being green-colored (" bilious ") and liquid. 
Podophyllin is the type of this group. 

The principal Cathartics are the following-named : — 



Laxatives. 
Sulphur. 
Magnesia. 
Cassia. 
Manna. 
Figs. Prunes. 
Tamarinds. 
Honey. * 
Cascara Sagrada. 
Physostigma. 
Ergot. 
Belladonna. 
Stramonium. 
Hyoscyamus. 
Almond Oil. 
Olive Oil. 
Soap. 

Taraxacum. 
Glycerin. 
Oatmeal. 
Bran Biscuit. 
Brown Bread. 



Simple Purgatives. 
Senna. 
Aloes. 
Rhubarb. 
Castor Oil. 
Rhamnus Frangula. 
Ox-gall. 
Calomel. 
Small doses of drastics, 

salines or cholagogues. 

Saline Purgatives. 

Magnesium Sulphate. 
Magnesium Citrate. 
Potassium Sulphate. 
Potassium Tartrate. 
Potassium Bitartrate. 
Sodium Sulphate. 
Sodium Phosphate. 
Sodium Chloride. 
Pot. et Sodium Tartrate. 
Manganese Sulphate. 



Drastics. 
Jalap. Gamboge. 
Colocynth. 
Elaterium. 
Scammony. 
Croton Oil. 

Cathartic Acid, hypoder- 
mically. 

Hydragogues. 

Elaterium. 

Gamboge. 

Potassium Bitartrate. 

Croton Oil, 

Salines in large doses. 

Cholagogues. 
Podophyllin. 
Mercurials. 
Aloes. Rhubarb. 
Euonymin. 
Iridin. 



CLASSIFICATION OF MEDICINES. 



43 



Cerebral Depressants lower or suspend the functions of the higher 
cerebrum after a preliminary stage of excitement. Under this head may 
be included the Hypnotics, Narcotics, General Anesthetics, and several 
of the Antispasmodics, all acting on the cells of the convolutions ; at 
first stimulating the brain-functions, they produce after a time stupor, 
coma and insensibility. 

The most useful of this class are the Bromides, Zinc Salts and Caffeine, as they also 
diminish reflex excitability and thus secure rest of the nervous system. Some of them 
are decidedly dangerous, as they may paralyze the heart or the medulla and its centres 
of organic life before the consciousness is much disturbed ; such being Chloroform, 
Aconite, Opium, and the irritant poisons, also Carbolic Acid. 

Cerebral Excitants are remedies which increase the functional activ- 
ity of the brain, without producing any subsequent depression, or any 
suspension of the cerebral functions. They act partly by increasing the 
action of the heart and consequently the rapidity of the circulation, 
partly by a direct action upon the gray matter of the brain. The chief 
members of this group are — 



Acetic Acid (inhaled). 


Cannabis. 


Ether. 


Alcohol (at first). 


Coffee, Caffeine. 


Quinine. 


Ammonia (inhaled). 


Tea, Theine. 


Tobacco. 


Ammoniac. 


Guarana, Guaranine. 


Strychnine 


Asafetida. 


Coca, Cocaine. 


Valerian. 


Camphor. 







The Cerebellum is markedly disturbed by the few drugs which affect it specifically, 
their action upon its different lobes producing various disturbances of coordination and 
equilibrium. Alcohol in considerable dose causes a staggering gait, and a tendency to 
fall ; and different preparations thereof seem to affect different portions of the cerebel- 
lum. Intoxication by wine or beer is said to be accompanied by a tendency to fall side- 
ways, — that by whiskey, especially Irish whiskey, an inclination to fall on the face, — and 
that by cider, a backward tendency ; and these disturbances correspond exactly with 
those caused by injury to different lobes of the cerebellum (Brunton). Apomorphine in 
large doses seems to act upon the cerebellum or corpora quadrigemina, as the animal 
poisoned by it does not vomit, but moves round and round in a circle. 

Ciliary Excitants are substances which, when dissolved in the 
mouth, promote the expectoration of bronchial mucus by their reflex 
excitation of the tracheal and bronchial cilia. This group includes such 
agents as the Chlorides of Ammonium and Sodium, Potassium Chlorate 
and Gum Acacia. 

Deliriants excite the functions of the higher brain to such a degree 
as to disorder the mental faculties, producing intellectual confusion, loss 
of will-power, delirium and even convulsions. They are all narcotics 
(though all narcotics are not deliriants), and the most important may be 

listed as follows : — 



Belladonna. 


Alcohol. 


Cannabis Indica. 


Stramonium. 


Chloral. 


Lupulus (at first). 


Hyoscyamus. 


Ether. 


Opium (at first). 


Turpentine. 


Chloroform. 


Nitrous Oxide Gas 



44 CLASSIFICATION OF MEDICINES. 

Demulcents (demulceo, I soothe), — are substances usually of oleagi- 
nous or mucilaginous nature, which soothe and protect the parts to which 
they are applied. This term is generally used for substances employed 
for mucous membranes, and the term Emollients for similar agents used 
on the skin. The chief agents belonging to this class are : — 



Acacia. 


Starch. 


Honey. 


Olive oil. 


Cetraria. 


Glycerin. 


Marsh-mallow. 


Isinglass. 


Barley. 


Flaxseed. 


White of Egg. 


Tragacanth 


Liquorice. 


Gelatin. 


Almond. 


Bland Oils. 



Dental Anodynes are substances employed locally in toothache 
due to caries exposing a nerve filament. Such are Aconite, Opium and 
Cocaine salts, — also Carbolic Acid, Creosote, Chloral, and Potassium 
Chlorate. A solution, containing the three first named, applied on a 
pledget of cotton, will promptly relieve whenever the nerve is accessible. 
Chloral should never be employed for this purpose, as in solution suffi- 
ciently strong to be of any service it is very apt to cause sloughing of the 
gum, especially if injected thereinto by a hypodermic syringe, as is fre- 
quently done by ignorant dentists, who advertise the " extraction of 
teeth without pain." 

Dentrifices {dens, a tooth, frico, I rub), — are medicated powders or 
pastes applied with a stiff brush to cleanse the teeth and gums. Chalk is 
the basis generally used, for its mechanical action and its alkaline quality. 
Antiseptics, as Borax, Quinine, Carbolic Acid, etc., should also be em- 
ployed, so as to prevent the acid fermentation of food products between 
the teeth and the consequent decay of the dentine. Tincture of Myrrh is 
an excellent ingredient, being an aromatic local stimulant and disinfectant. 

Many drugs affect the teeth injuriously, such being the Mineral Acids, Persalts of 
Iron and Alum. The first two should be taken through a glass tube, and the mouth 
should be rinsed afterwards with a weak alkaline solution. 

Deodorants are agents which destroy foul odors. The Volatile De- 
odorants are chiefly oxidizing and deoxidizing substances, acting chemic- 
ally on the obnoxious gases ; while the Non-volatile ones are mainly 
absorbents, which condense and decompose the effluvia. The deodorants 
in general use are the following-named : — 

Formalin. Hydrogen Dioxide. Charcoal. 

Chlorine Gas. Potassium Permanganate. Earth. Lime. 

Sulphurous Acid Gas. Coffee, freshly roasted. Ferrous Sulphate. 

For removing the fetid exhalations emitted by the feces, the following powder is a 
very efficient and cheap deodorizing and disinfecting agent. Zinc Sulphate, lbs. ij, Sul- 
phuric Acid, gjss to .^ijss, Essence of Mirbane, 5jj, Indigo Blue, gr. ij. About a des- 
sertspoonful of this salt is placed in the bed-pan or chamber utensil before it is used. 
Contact with urine or a liquid stool causes its prompt solution, deodorization is instanta- 
neous, the liquid excreta are at once sterilized, and the fetor is changed to a rather agree- 
able odor. Oil of Eucalyptus has the property of spreading rapidly over water in a thin 
film, and if a few drops are sprinkled over the water in the pan of a water closet before 
using the latter, no fecal odor will arise therefrom. 



CLASSIFICATION OF MEDICINES. 



45 



Alcohol. 


Salicin. 


Glycerin. 


Salicylates 


Oils and Fats. 


Quinine. 



Destructive Metamorphosis of the tissues is promoted by a num- 
ber of agents, most of which are classed as Alteratives or as Astringents, 
the most important of which are the following-named : — 

Alkalies. Sulphides and Iodides. 

Vegetable Acids. Sarsaparilla. 

Metals and their salts. Stillingia. 

Colchicum. Xanthoxylum. 

Tannic and Gallic Acids, and substances containing them. 

Destructive Metamorphosis may be diminished by many substances, the 
following-named being the chief ones : — 

Resorcin. 
Chinoline. 
Cocaine. 

Diaphoretics and Sudorifics {deeaphorheeo, I carry through ; sudor, 
sweat, facio, I make), — are remedies which increase the action of the 
skin and promote the secretion of sweat. When they act energetically, 
so that the perspiration stands in beads upon the surface, they are known 
as Sudorifics. They may be subdivided into the following groups, viz. — 

(i) Simple Diaphoretics, which enter the circulation and are eliminated by the sudor- 
iferous glands, which they stimulate to increased action. 

(2) Nauseating Diaphoretics, which produce relaxation and the dilatation of the super- 
ficial capillaries. 

(3) Refrigerant Diaphoretics, which reduce the circulation, at the same time acting 
directly on the sweat-centres in the spinal cord and medulla. 

The principal diaphoretics are the following-named, the figures refer- 
ring to their respective supposed modes of action as indicated above ; — 



Aconite. 3 
Veratrum Viride. 3 
Tobacco. 2 - 3 
Lobelia. 2 . 3 
Alcohol. 2 . 3 
Ether. 2 - 3 
Nitrous Ether. 2 - 3 
Salicylates. 1 
Jaborandi. 1 ' 3 

Pilocarpine. 1 - 3 



Ipecacuanha. 2 
Opium 2 - 8 (large doses). 
Dover's Powder. 2 
Tartar Emetic. 2 
Sulphur. 1 
Camphor. 1 
Cocaine. 3 

Ammonium Acetate. 1 
Ammonium Citrate. 1 
Potassium Salts. 3 



Mezereon. x 
Sarsaparilla. 1 
Guaiacum. x 
Serpentaria. 1 
Sassafras. x 
Senega. x 
Vapor Bath. 2 
Turkish Bath. 2 
Wet Pack. 2 
Warm Drinks. 2 



Diluents (di/uo, I dilute), — are indifferent substances which, after 
their absorption, dilute the excretory fluids and enable the latter to hold 
more solid material in suspension. Water is the one true diluent, what- 
ever form it may be disguised in, as teas, weak fluid foods, acid drinks, etc. 

Discutients or Sorbefacients (discutio, I dissipate; sorbere, to 
suck), — are agents which promote absorption, and may be divided into 
two classes; (1) those which stimulate the lymphatics to the removal of 
morbid or inflammatory deposits, (2) those which promote the imbibition 
of nutritive or medicinal material into the system. [Compare Altera- 
tives.] These agents include the following-named : — 



46 CLASSIFICATION OF MEDICINES. 



Arsenic. 


Ichthyol. 


Vapor Bath. 


Mercury. 


Lanolin. 


Hot Water Bath 


Iodine. 


Oleic Acid. 


Poultices. 


Iodides. 


Cacao Butter. 


Counterirritation 


Cadmium. 


Massage. 


Galvanism. 



Lanolin and Oleic Acid have remarkable power of penetration through the skin and 
are used as excipients for drugs which are to be administered by cutaneous absorption. 
Cacao Butter possesses the same penetrative property, and is usually employed in making 
medicated suppositories. 

Disinfectants destroy the specific germs of communicable diseases, 
many of which belong to the microbe class, hence many antiseptics are 
also disinfectants. They act in several modes, some as oxidizants, others 
by combining with albumin, others, by chemical combination forming 
substitution-compounds, others by arresting molecular changes, and still 
others by altering the reaction of the media containing the germs. The 
principal disinfectants are — 

Corrosive Sublimate. Carbolic Acid. Chlorine. 

Formaldehyde. Creolin. Chlorinated Lime. 

Heat (230 to 250 F.). Lysol. Chlorinated Soda. 

Potassium Permanganate. Potassium Bichromate. Iodine. Bromine. 

Zinc Chloride. Ferrous Sulphate. Lime (fresh). 

Zinc Sulphate. Sulphurous Acid. Thymol. 

Llydrogen Dioxide. Nitrous Acid. Camphor. 

Condy's Fluid is an aqueous solution of Potassium Permanganate, 2 parts in 100, or 
gr. 176 in 3 20. Burnett' 's Fluid is a solution of Zinc Chloride, containing about 50 per 
cent, of the salt, and equivalent to the official Liquor Zinci Chloridi. Labarraque's 
Solution is the same as the official Liquor Sodas Chloratse. Sanitas is an aqueous solu- 
tion of oxidized Turpentine and contains Hydrogen Dioxide, also Thymol and Cam- 
phor. 

The popular idea of disinfecting the air of a room by burning sulphur, etc., is an 
absurdity, because foul air is easily removed by simple ventilation. In disinfecting a 
room in which there has been a case of contagious or infectious disease, the true aim is 
to kill the germs contained in the dust on ledges, in the crevices between the boards, or 
adhering to the walls, and a dry gas is powerless for this purpose, which is best accom- 
plished by using a Corrosive Sublimate Solution of the strength of I in iooo; or by Lime 
washing, provided that the lime be freshly burnt, and caustic ; or by spraying with Form- 
alin, or by dropping the latter on hot plates or sheets of hot metal. 

Diuretics (deoaraysis, urination), — are agents which promote the 
secretion of urine, either by raising the local or general blood-pressure 
and so increasing the renal circulation, by stimulating the secreting cells 
or nerves of the kidneys, or by flushing the kidneys with water. Diu- 
retics may be classified according to their physiological action or accord- 
ing to the different purposes for which they are employed. Refrigerant 
Diuretics, especially the salines, excite the renal epithelium, induce a 
hyperemic condition of the kidneys and increase the water of the urine. 
They possess a sedative action upon the heart and the general circulation, 
but used to excess they depress the heart and impoverish the blood. 
Potassium Chlorate is a decided renal irritant, and should never be used 
as a diuretic. Hydragogue Diuretics increase the water of the urine 



CLASSIFICATION OF MEDICINES. 



47 



largely, and in general act by raising arterial pressure, either — (a) 
throughout the body, or (<£) locally in the kidneys. This they accom- 
plish in various ways, direct and indirect, — increasing the action of the 
heart, counteracting the efferent vessels or dilating the afferent vessels, so 
as to raise the blood-pressure in the glomeruli, etc. The action of the 
Stimulant Diuretics is directly upon the renal tissue, by which they are 
largely eliminated from the body. In small or moderate doses they 
dilate the renal arterioles, increase the renal blood-supply, and so induce 
diuresis, but in large doses they irritate the renal epithelium, contract 
the renal arterioles, diminish the renal blood-supply, excite renal inflam- 
mation, render the urine albuminous and bloody, and may even induce 
suppression of the urine. All the members of this division should be 
used with caution. 

Individual members of the diuretic class act in various modes, some of 
them in more than one manner, and probably as follows, viz. — 

T. By increasing the action of the heart (Alcohol, Digitalis, etc.) or by contracting 
the intestinal and other vessels, thus raising the general blood-pressure. 

2. By dilating the afferent renal vessels, thereby increasing the renal blood-supply 
and raising the pressure in the glomeruli. 

3. By contracting the efferent vessels, raising the pressure in the glomeruli and lessen- 
ing absorption in the tubules, or both. 

4. By stimulating the secreting cells or nerves of the kidneys. 

5. By flushing the kidneys, as by the ingestion of Water in large quantity. 

The following list contains the most important agents of this group, 
which are usually subdivided into the three classes indicated by the sub- 
titles. The numbers refer to the probable modes of action of the drug 
in the above synopsis : — 



Refrigerant Diuretics. 
Potassium Acetate. 4 
Potassium Bitartrate. 4 
Potassium Citrate. 4 
Potassium Chlorate. 4 
Potassium Nitrate. 4 
Sodium Acetate. 4 
Sodium Chlorate. 4 
Sodium Chloride. 4 
Ammonium Acetate. 4 
Calcium Chloride. 4 
Lithium Carbonate. 4 
Lithium Citrate. 4 
Magnesium Citrate. 4 
Magnesium Sulphate. 4 
Water. 5 Milk. 5 
Carbonic Acid. 
Cold to surface. 1 



Hydragogue Diuretics. 


Stimulant Diuretics 


Digitalis. 1 » 2 


Alcohol. 2 


Strophanthus. 2 


Blatta orientalis. 4 


Convallaria. 1 


Cantharides. 4 


Cimicifuga. i > 2 
Adonis vernalis. 1 - 2 
Erythrophlceum. 1 
Squill. 1 - 2 
Broom. 3 Sparteine. 3 


Turpentine. 4 
Juniper. 4 
Savine. 4 
Copaiba. 4 
Cubeb. 4 


Calomel. 4 


Cannabis. 4 


Caffeine. 1 - 4 
Theobromine. 4 


Capsicum. 4 
Buchu. 4 


Apocynum. 1 - 2 

Nitrous Ether. 2 Nitrites. 2 


Asparagus. 4 
Guaiac. 4 


Strychnine. x 
Colchicum. 4 


Fennel. 4 
Urea. 4 


Tobacco. 3 


Uva Ursi. 4 


Sugar of Milk. 1 ' 4 


Zea. 4 



Diuretics are employed in medicine for certain definite purposes, as 
follows: — to remove fluid from the tissues and cavities of the body in 
cases of dropsy ; to promote the elimination of waste-products and other 



I 



48 CLASSIFICATION OF MEDICINES. 

poisons from the blood ; to maintain the action of the kidneys ; to dilute 
the urine, and to alter morbid conditions of that excretion. 

In Dropsies from Cardiac Disease, or other dropsies due to venous congestion, the 
most efficient diuretics are those which act on the general vascular system, as Digitalis, 
Strophanthus, Squill, etc. Calomel is often very efficient in this form of dropsy, also 
Theobromine Sodio-Salicylate (Diuretin). 

In Dropsy from Renal Disease, Diuretin, Broom-tops, Nitrous Ether, Oil of Juniper, 
Digitalis and Squill are the most reliable diuretics, in the order named. 

In Ascites from Hepatic Cirrhosis, Copaiba is the best diuretic when the kidneys are 
healthy. In this form and the previous ones a little Pil. Hydrargyri given occasionally 
will often aid the diuretic action of the other agents. 

To Eliminate Wasteprodncts from the Blood, Potassium Nitrate and Bitartrate, Tur- 
pentine, Juniper, Caffeine, and Water in large quantity. [Compare LlTHONTRiPTiCS.] 

To Dilute the Urine, Water is the best agent, its most efficient form being Distilled 
Water charged with Carbonic Acid gas. 

As Adjuvants to Diuretics, when pressure on the uriniferous tubules or venous conges- 
tion prevent their action, — paracentesis abdominis, purgation, cupping over the loins, 
and even venesection, are often necessary to start the diuretic action. 

The activity of the renal cells is directly depressed by the Renal De- 
pressants, which thereby lessen or suspend the secretion of urine. Mor- 
phine, Quinine and Ergot act in this manner through their influence on 
the circulation. Instead of acting as a diuretic Digitalis may stop the 
secretion of urine, by so stimulating the vaso-motor centre as to greatly 
contract the renal vessels, and arrest the renal circulation (Brunton). 
This it might do if a preparation were used which was deficient in Digi- 
toxin or Digitalei'n, the dilators of the renal arteries : (see under Digi- 
talis.) The same is true of Caffeine and Strychnine, hence it is well to 
combine these with other diuretics which dilate the renal vessels, as the 
Nitrites, (Nitrous Ether, etc.), and Alcohol. Digitalis contains in itself 
the power of doing both these actions, and hence it is the ideal diuretic. 

Emetics {emeo, I vomit), — are agents which produce vomiting. 
They may be subdivided into two groups, Local Emetics, or those 
which act by irritating the end-organs of the gastric, pharyngeal or eso- 
phageal nerves, and General or Systemic Emetics, which act through 
the medium of the circulation. The members of both these groups pro- 
duce emetic action by irritation of the vomiting centre in the medulla, 
the first by reflex, the second by direct stimulation. The principal 
emetics are the following named : — 

Local Emetics. General Emetics. 

Alum, Mustard, Salt. Ipecacuanha. Emetine. 

Ammonium Carbonate. Apomorphine. 

Zinc and Copper Sulphates. Tartar Emetic. 

Subsulphate of Mercury. Veratrine. 

Tepid Water, in quantity. Senega. 

Vegetable Bitters, as Quassia, Squill. 

in strong infusions. Ouaba'in. 



CLASSIFICATION OF MEDICINES. 



49 



Tartar Emetic, Ipecacuanha and probably Apomorphine, act locally as well as sys- 
temically, for if injected subcutaneously they are excreted by the stomach in part, thus 
irritating the gastric nerves as well as the vomiting centre. Pilocarptis is a local emetic, 
and Digitalis and its congeners, also Muscarine, are systemic emetics, but none of these 
agents are used medicinally for that purpose. Opium, Morphine and Codeine usually 
produce emesis as one of their after effects. 

Vomiting is an evacuant act which consists in compression of the stomach by the 
simultaneous spasmodic contraction of the diaphragm and abdominal muscles ; also in 
relaxation of its cardiac orifice by contraction of the radiating muscular fibres in the 
gastric wall. If both acts occur at the same time, the contents of the stomach are 
expelled and vomiting occurs ; if, however, the two acts do not take place simultaneously, 
the contents of the stomach are retained, and the abortive efforts are called retching. 
These acts are controlled and regulated by a nerve-centre in the medulla oblongata, 
which is closely connected with the respiratory centre, the muscular movements of 
vomiting being merely modified respiratory movements. This vomiting centre is ordina- 
rily excited in two ways, — (i) by the peripheral stimulation of afferent nerves going to 
it from other parts of the body, (2) by impulses sent down to it from the brain (Brunton). 



Nausea and vomiting are diminished by agents termed Anti-emetics, 
including gastric sedatives and general sedatives ; some of which act by 
means of a local sedative influence upon the end-organs of the gastric 
nerves, others by reducing the irritability of the vomiting centre in the 
medulla. The act of vomiting being occasioned by irritation of afferent 
nerves from many regions of the body or impulses from the brain excited 
by impressions on the nerves of special sense, the measures and agents by 
which it may be combated are very diversified. [Compare the article 
entitled Vomiting, in Part III.] The most important anti- emetics are 
named in the following lists: — 



Local Gastric 
Alcohol. 
Alum. 
Arsenic. 
Belladonna. 
Bismuth. 
Carbonic Acid. 
Cerium Oxalate. 
Chloroform. 
Carbolic Acid. 
Potassium Nitrate. 



Sedatives. 

Creosote. 

Ether. 

Ice. 

Opium. 

Hydrocyanic Acid. 

Silver Nitrate. 

Calomel ^ small 

Ipecac / doses. 

Hot Water. 

Cocaine. 



General Sedatives. 
Opium. 

Morphine. 

Codeine. 
Hydrocyanic Acid. 
Bromides. 
Chloral. 
Nitro-glycerin. 
Alcohol. 
Amyl Nitrite. 
Food. 



Ice, swallowed in small pieces, is probably the most efficient of the local sedatives. 
Carbolic Acid and Cocaine are also effective anti-emetics, given in small doses by the 
mouth at short intervals. Astringents are very useful where there is congestion of the 
gastric mucous membrane, as in the vomiting of alcoholism and phthisis, when Silver 
Nitrate and Alum are especially to be recommended. Opium and its principal alkaloid, 
Morphine, will produce nausea and vomiting in many persons, even when given in very 
small doses. 

Emmenagogues (emmayneah, the menses, ago, I move), — are reme- 
dies which restore the menstrual function, either directly by stimulation 
of the uterine muscular fibre, or indirectly by improving the blood and 
toning up the nervous system. Some of the direct emmenagogues are 
oxytocic in large doses. The principal members of this class are named' 
in the following list: — 



50 CLASSIFICATION OF MEDICINES. 

Direct Emmenagogues. 

Ergot. Apiol. Iron. 

Savine. Borax. Manganese. 

Tansy. Rue. Myrrh. Cinnamon. 

Digitalis. Guaiacum. Quinine. 

Cantharis. Polygonum Hydropip. Strychnine. 

Pulsatilla. Potass. Permanganate. Aloetic Purgatives. 

Asafetida. Cimicifuga. Cod-liver Oil. 

Alcohol. Oxalic Acid. Hot Hip-baths. 

Indigo. Hedeoma. Leeching the genitals. 

Hydrargyrum Biniodide. Origanum. Rubefacients to thighs. 

Caulophyllum. Viscum Flavescens. Tonic Remedies. 

Emollients (emollio, I soften), — are substances which soften and 
relax the tissues to which they are applied. They relieve tension, dilate 
vessels, diminish pressure on the nerves, and protect inflamed surfaces 
from the air and from friction. The principal articles which may be 
classed under this heading are the following : — 

Hot Fomentations. Linseed Oil. Petroleum. 

Poultices. Olive Oil. Soap Liniment. 

Glycerin. Spermaceti. Starch. 

Lard. Almond Oil. Cacao Butter. 

Errhines and Sternutatories {en, in, rhin, the nose; sternuto, I 
sneeze), — are agents which produce increased nasal secretion and sneez- 
ing, when locally applied to the mucous membrane of the nose. The 
first term is usually applied to substances which cause increase of the 
mucus without sneezing, the latter to those which invariably produce 
sneezing. The drugs should be applied in powder. The stimulus pro- 
duced by these agents is transmitted by the nasal branches of the fifth 
nerve to the respiratory centre, exciting the sudden and forcible expira- 
tory effort called sneezing; also to the vaso-motor centre, contracting 
the smaller vessels throughout the body and producing a general rise in 
the blood-pressure. The principal agents of this class are — 



Tobacco, as snuff. 


Euphorbium. 


Capsicum. 


Ipecacuanha. 


Sassy Bark. 


Hellebore. 


Sanguinaria. 


Saponine. 


Ammonia. 


Veratrum Album. 


Ginger. 


Cubebs. 



The last two named may be used as simple Errhines, as the vapor of dilute Ammonia- 
water or the smoke of burning Cubebs do not excite sneezing generally. 

Escharotics or Caustics (eskahrah, a slough or scab; kaioh, I 
burn), — are agents which destroy a tissue to which they are applied, and 
produce a slough. They may be divided into two classes, the actual, or 
those in which heat is the active agent, and the potential, by which a 
chemical process is called into play. Escharotics act usually in one of 
the following modes: — 



CLASSIFICATION OF MEDICINES. 



51 



1. By abstracting the water of the tissues. 

2. By combining with the albumin of the tissues. 

3. By corrosive deoxidation of the tissues. 

4. By conversion of the tissues into carbon or gaseous bodies. 

The principal escharotics are named in the following list, the numbers 
pointing out the mode of action as stated above : — 



Mineral Acids. 1 
Glacial Acetic Acid. 1 
Carbolic Acid. 1 
Chromic Acid. 3 
Arsenous Acid. 1 
Antimony Chloride. 1 
Lime. 1 



Caustic Potash. 1 
Caustic Soda. x 
Dried Alum. 2 
Silver Nitrate. 2 
Copper Sulphate. 
Zinc Sulphate. 2 
Zinc Chloride. 2 



Mercuric Chloride. 2 
Mercuric Oxide. 2 
Mercuric Nitrate. 2 
Bromine. 3 

{Cautery. 4 
Moxa. 4 
Boiling Water. 



Nitric Acid and Zinc Chloride are probably the safest and most generally useful of the 
potential caustics where any decided escharotic action is desired. Silver Nitrate is the 
best for superficial use, its action being limited to the part with which it comes in con- 
tact, and being stopped at once by the application of a solution of common salt. 
Chromic Acid is one of" the most efficient escharotics, but it must be carefully used. 

Expectorants (ex, out of, pectus, the breast), — are remedies which 
modify the secretion of the broncho-pulmonary mucous membrane, and 
promote its expulsion. They may be divided into the following groups : 

Nauseating Expectorants in large doses act mechanically by expelling 
the mucus in the act of vomiting, in small doses by increasing osmosis 
from the inflamed mucous membrane. The members of this subdivision 
generally increase secretion and tend to lower the blood-pressure. The 
chief ones are the following named : — 



Antimony, Tartar Emetic. 
Ipecacuanha, Emetine. 
Pilocarpus (Jaborandi). 



Apomorphine. 

Quebracho. 

Alkalies. 



Potassium Iodide. 
Lobelia. 
Lobeline. 



Stimulant Expectorants are largely eliminated by the bronchial mucous 
membrane, which they stimulate, altering the secretion and facilitating 
expectoration. These remedies generally diminish secretion and increase 
blood-pressure. This subdivision includes the following named : — 

Ammonium Chloride. 
Ammonium Carbonate. 
Benzoin and Benzoic Acid. 
Balsams of Peru and Tolu. 
Wood Tar, and Tar. 
Oleum Pini Sylvestris. 

Besides the above many other remedies may act as expectorants, some by relieving 
bronchial spasm, as Opium, Stramonium and Tobacco ; others by soothing the irritable 
respiratory centre, as Opium and Chloral ; and the ciliary excitants by reflex action 
through their impression on the nerves of the mouth. 



Acids. 


Nux Vomica. 


Squill. 


Strychnine. 


Garlic. 


Senega. 


Onion. 


Saponine. 


Turpentine. 


Liquorice. 


Sulphur. 


Saccharine Substances 



Galactagogues (gala, milk, ago, I bring away), — are agents which 
are supposed to increase the lacteal secretion. The value of most of 



52 CLASSIFICATION OF MEDICINES. 

them is very doubtful, probably the only efficient one being Pilocarpus 
(Jaborandi), but its influence is very transient and the excessive perspira- 
tion and salivation caused by it are objectionable. The leaves of Ricinus 
communis, the castor-oil plant, locally applied, have been highly recom- 
mended ; but general measures are more trustworthy, such as the correc- 
tion of anemia, attention to sore nipples, administration of tonics and good 
food. [Compare the article entitled Lactation in Part III.] Other agents 
reputed to have galactagogue properties are the following-named : — 

Anise. Gallega. Beer, Ale, Porter. 

Dill. Physostigma. Black Tea. 

Fennel. Strychnine. Sinapisms. 

Vanilla. Potassium Chlorate. Electricity. 

Galactophyga (gala, m\\k, pheugo, I shun), — are agents and measures 
which diminish or arrest the secretion of milk. Belladonna or its alka- 
loid Atropine is the most efficient, acting whether applied locally or ad- 
ministered internally. Antipyrin has similar power, so also has Camphor 
applied locally and Potassium Iodide, Colchicum with Magnesium Sul- 
phate, Tobacco, Sage, Quinine, Tannin, etc. Compression of the 
breasts, by bandaging or strapping with adhesive plaster, has positive 
antigalactic action. 

Hearing is affected by several drugs. Strychnine and Morphine 
increase the excitability of either the auditory nerve or the centre for 
hearing in the superior temporo-sphenoidal convolution, making that 
faculty much more acute. Quinine, Antipyrin and Salicylates produce 
hyperemia of the auditory apparatus, causing subjective noises, as hum- 
ming, buzzing, or ringing, which are very unpleasant. Hydrobromic 
Acid and the Bromides, also Ergot, will diminish the congestion and 
thus neutralize or prevent these noises to a great extent. 

Quinine in large doses is believed by some to have produced permanent injury of the 
sight and the hearing, but authentic cases of such action are extremely rare, if indeed 
they can be found at all. Temporary deafness is often caused by Quinine, but it usually 
disappears soon after the administration of the drug is stopped. 

Hepatic Depressants lower the functional activity of the liver, 
some reducing the secretion of bile, others lessening the production of 
glycogen, and others diminishing the production of urea. Lead Acetate 
is a direct hepatic depressant, especially in large doses, and is probably 
the only drug which lessens the biliary secretion without causing purga- 
tion. Many Purgatives diminish the secretion of bile by lowering the 
blood-pressure in the liver and by carrying off material from which bile 
may be formed. The list of hepatic depressants includes the following- 
named agents : — 



CLASSIFICATION OF MEDICINES. 



53 



Lessening- Bile. 


Diminishing Glycogen. 


Lessening Urea 


Lead Acetate. 


Opium. 




Opium. 


Atropine. 


Morphine 




Morphine. 


Calomel. 


Codeine. 




Codeine. 


Chloral. 


Arsenic. 




Alcohol. 


Castor Oil. 


Antimony. 




Colchicum. 


Gamboge 


Phosphorus. 




Quinine. 


Magnesium Sulphate. 








ontrary to the generally 


accepted opinion, 


Opium and 


Morphine do not 



biliary secretion (Murrell). 

Hepatic Stimulants and Cholagogues (kohlay, bile, ago, I bring 
away), — are two groups of agents acting upon the biliary secretion, the 
first-named increasing the functional activity of the liver-cells and the 
amount of bile formed, the second removing the bile from the duodenum 
and preventing its reabsorption into the portal circulation. Some hepatic 
stimulants are also cholagogues, others are not, while cholagogues proper 
generally act indirectly as hepatic stimulants by carrying off the bile and 
thereby urging the liver to secrete more. The discovery of the entero- 
hepatic circulation of bile has cleared up many of the discrepancies 
formerly existing with regard to the action of drugs upon this gland and 
its secretion, yet neither this subject nor hepatic chemistry have yet 
attained such results as would enable us to formulate positive doctrines 
thereon. Bile, Bile Salts and Sodium Salicylate are at present the only 
agents which have been experimentally proven to have the direct power 
of increasing the biliary secretion, though a number of drugs are believed 
to act in this manner upon clinical and other evidence. The following 
list includes the principal agents which are generally credited with the 
actions defined above : — 



Hepatic Stimulants. 



Bile, Bile Salts. 
Sodium Salicylate. 
Nitro-hydrochloric Acid. 
Corrosive Sublimate. 
Mineral Acids. 
Arsenic. 

Sulphurated Antimony. 
Benzoic Acid. 
Sodium Benzoate. 
Sodium Phosphate. 
Sodium Sulphate. 
Sodium Sulphocarbolate. 



Ipecacuanha. 

Colocynth. 

Colchicum. 

Podophyllin. 

Euonymin. 

Iridin. 

Aloes. 

Jalapin. 

Scammony. 

Rhubarb. 

Sanguinarine. 

Hydrastin. 



Cholagogues. 
Mercury with Chalk. 
Calomel. 
Pil. Hydrargyri. 
Sodium Phosphate. 
Sodium Sulphate. 
Potassium Sulphate. 
Aloes. 

Podophyllin. 
Colchicum. 
Colocynth. 
Rhubarb. 
Jalapin. 



To secure the best cholagogue effect it is advisable to combine an hepatic stimulant 
with an intestinal stimulant which shall produce increased secretion from the intestinal 
mucous membrane and excite peristalsis. Hydrochloric Acid which has been kept long 
and has become a light or golden-yellow color, is relatively inert as an hepatic stimu- 
lant, but the freshly combined, deep red acid is active and valuable (Wood). 

The glycogenic function of the liver, and the production of urea are 
stimulated by the following-named drugs : — 



I 



54 CLASSIFICATION OF MEDICINES. 

Increasing Glycogen. Increasing Urea. 

Amyl Nitrite. Arsenic. Iron. 

Sodium Bicarbonate. Antimony. Phosphorus. 

Nitro-hydrochloric Acid. Ammonium Chloride. 

Hypnotics {heupnos, sleep), — are remedies which produce sleep. In 
this wide sense the term includes the narcotics and the general anesthetics, 
but it is usually restricted to those agents which, in the doses necessary to 
cause sleep, do not disturb the normal relationship of the mental faculties 
to the external world (Brunton). Another definition of hypnotics is — 
that they produce sleep without suspending the consciousness of pain, 
narcotics doing both. Hypnotics may be subdivided into the following 
classes : — 

(a) Pure Hypnotics, — which directly induce a sleep closely resembling 
the normal, without causing narcotic or other dangerous cerebral symp- 
toms. The Bromides are the type of this subdivision, but the list is con- 
stantly growing smaller as experience reveals toxic powers in the action 
of its members. 

(JP) Narco-hypnotics, — which induce sleep by direct depression of the 
cerebral functions and in larger doses are narcotic, suspending the con- 
sciousness of pain and producing coma. Opium is the type of this class. 

{/) Indirect Hypnotics, — which induce sleep by removing or suppressing 
any cause (not mental) which interferes therewith. Such are the non- 
narcotic analgesics,* acting against pain ; the respiratory stimulants,f 
relieving dyspnea; the pulmonary sedatives, J relieving cough; the 
motor depressants, § restraining excessive motor activity; also the vascu- 
lar and cardiac tonics,^" antagonizing cerebral hyperemia and regulating 
the cardiac action. 

The principal members of each of the above subdivisions are named in 
the following lists : — 

Pure Hypnotics. Narco-hyptiotics. Indirect Hypnotics. 

Potassium Bromide. Chloral Hydrate. * Antipyrin. 

Sodium Bromide. Opium, Morphine, Narceine. * Acetanilid. 

Paraldehyde. Hyoscine. Duboisine. * Phenacetin. 

Sulphonal. Cannabis Indica. | Strychnine. 

Trional. Pellotine. % Hydrocyanic Acid. 

Tetronal. Passiflora Incarnata. \ Conium. 

Urethane. Piscidia Erythrina. | Gelsemium. 

Chloralamid. Amylene Hydrate. \ Ergot. 

Alcohol. \ Digitalis. 

Chloral Hydrate is undoubtedly the most efficient of all hypnotics. Paraldehyde is 
one of the most reliable and safe, but its sleep is transient, lasting only a few hours. 
Sulphonal and Trional are very efficient in some cases, but often fail entirely. Urethane 
is feeble and uncertain, and the same may be said of Hamulus and some other agents 
which are not mentioned above. Piscidia is also somewhat uncertain in action, though 
its hypnotic and anodyne powers have proved very decided in many cases. 

Dr. Wilcox rejects the dangerous, unreliable and objectionable hypnotics, and retains 
four as amply sufficient for all ordinary cases of insomnia. These he classifies as fol- 
lows : — 



CLASSIFICATION OF MEDICINES. 



55 



As to Potency ; Paraldehyde, Chloralamide, Pellotine, Trional. 
As to Rapidity : Pellotine, Paraldehyde, Chloralamide, Trional. 
As to Freedom from causing Habituation : Pellotine (slight), Trional, Chloralamide, 

Paraldehyde (considerable). 
As to Safety : Chloralamide, Pellotine, Paraldehyde, Trional. 



Intestinal Astringents contract the walls of the intestinal vessels, 
diminishing the exudation therefrom, and lessening the fluidity of the 
fecal discharges. The more powerful members of this group have also a 
constringing action on the intestinal mucous membrane. The principal 
agents of this class are named in the following lists : — 



Astringents. 
Phosphoric Acid. 
Nitric Acid. 
Sulphuric Acid. 
Acetic Acid. 
Lead Acetate. 
Silver Nitrate. 



Diluted. 



Constringents. 
Tannic Acid. 
Vegetable Astringents. 
Alum. 
Zinc Oxide. 
Copper Sulphate. 
Persalts of Iron. 



Irritants are substances which, when applied to the skin, produce a 
greater or less degree of vascular excitement. When used to produce a 
reflex influence on a part remote from their site, they are termed counter- 
irritants. They may be subdivided into the following groups : — 

(a) Rubefacients, are those which produce temporary redness and con- 
gestion of the skin, unless left too long in contact with trie surface, when 
they may cause exudation between the cuticle and the true skin (vesicants), 
or may destroy the tissue and form a slough (escharotics). They may 
also induce muscular atrophy. 

(<£) Vesicants, Epispastics or Blisters, are those which cause decided 
inflammation of the skin and the outpouring of serum between the epi- 
dermis and the derma. Cantharides is the agent generally used for 
blistering purposes. 

(V) Pustulants, affecting isolated parts of the skin, namely — the orifices 
of the sweat-glands, giving rise to pustules. 

The following list includes the principal agents and measures belong- 
ing to these three groups: — 



Rubefacients. 


Rubefacients. 


Vesicants. 


Mustard. 


Oil of Cajuput. 


Cantharides. 


Capsicum. 


Oil of Turpentine. 


Euphorbium. 


Camphor. 


Volatile Oils. 


Mezereon. 


Ammonia. 


Pitch. 


Iodine. 


Mezereon. 


Friction. 


Rhus Toxicodendron. 


Arnica. 


Hot Water. 


Ammonia (the confined vapor) 


Alcohol. 




Glacial Acetic Acid. 


Ether. 


Pustulants. 


Volatile Oil of Mustard. 


Chloroform. 


Croton Oil. 


Heat. i»°iling Water. 

( Corngan s Hammer. 


Iodine. 


Tartar Emetic. 


Menthol. 


Ipecacuanha. 
Silver Nitrate. 





56 



CLASSIFICATION OF MEDICINES. 



Lithontriptics and Antilithics {leethos, a stone, treebo, I wear 
down), — are agents which are supposed to promote the solution of con- 
cretions in the excretory passages (lithontriptics) or to prevent their for- 
mation (antilithics). These terms are generally restricted to remedies 
affecting the urinary calculi, but those directed against the biliary form 
are included in this arrangement for the sake of consistent classification. 
The chief agents coming under these titles are the following-named : — 



Biliary Calculi. 
Ether and Turpentine. 
(Durande's Solvent.) 
Sodium Bicarbonate. 
Sodium Salicylate. 
Sodium Phosphate. 
Castile Soap. 
Alkaline Waters, especially Vichy. 



Uric Acid Calculi. 
Distilled Water. 
Potassium Salts. 
Lithium Salts. 
Magnesium Citroborate. 
Piperazin. 
Lysidin. 
Lycetol. 



Calcium Oxalate Calculi. 
Dilute Nitro-hydrochloric Acid. 
Carbonated Water. 
Lactic Acid (for digestion). 



Phosphatic Calculi. 
Ammonium Benzoate. 
Benzoic Acid. 
Dilute Nitric Acid. 



There is probably little or no solvent value to the agents recommended for biliary cal- 
culi. In the case of uric acid calculi the administration of Potassium or Lithium Salts 
is based on their power of combining with the acid in the calculus, thus forming urate of 
potassium or of lithium, which salts are more soluble than uric acid itself. Piperazin is 
still more efficient in this respect, forming a piperazin urate which is seven times more 
soluble than lithium urate. Lysidin is still more powerful. 

Motor Depressants lower the functional activity of the spinal cord 
and other parts of the motor apparatus and in large doses paralyze them. 
Drugs which depress the cerebral motor convolutions, the motor centres 
in the medulla, the motor nerve-trunks and nerve-endings, or the muscular 
contractility itself, produce impairment of the motor power, and in large 
doses may cause complete paralysis of the part or parts involved. Some 
act indirectly by reducing the spinal circulation, as Aconite, Digitalis and 
large doses of Quinine, others by a direct paralyzant action on the centres. 
The principal members of this class are named in the following list : — 



Curare. 
Physostigma. 
Conium. 
Gelsemium. 
Opium, Morphine, 

Apomorphine. 
Belladonna, Atropine. 
Stramonium. 
Hyoscyamus. 
Muscarine. 
Pulsatilla. 
Grindelia. 
Phytolacca. 
Pilocarpus. 
Quebracho. 



Aconite. 

Veratrum. 

Tobacco. 

Lobelia. 

Digitalis. 

Arnica. 

Ailanthus. 

Saponin. 

Sparteine. 

Ergot (at last). 

Quinine (large doses). 

Camphor. 

Alcohol (large doses). 

Ether (large doses). 

Chloroform (large). 



Chloral. 

Bromides. 

Potassium Salts. 

Many metallic Salts. 

Amyl Nitrite. 

Nitroglycerin. 

Hydrocyanic Acid. 

Potassium Cyanide. 

Methyl-strychnine. 

Many Methyl compounds. 

Ammonium Cyanide. 

Ammonium Iodide. 

Many compound Ammonias. 

Galvanism. 

Cold. 



CLASSIFICATION OF MEDICINES. 



57 



The motor centres in the medulla are powerfully depressed by Opium, Morphine, Aco- 
nite, Conium, Chloral, Physostigma, and large doses of Alcohol, Ether and Chloroform. 
These last three are also paralyzers of the motor convolutions in the brain, arresting all 
voluntary movements when administered in sufficient quantity. The anterior cornua of 
the cord are greatly depressed by Physostigma, Carbolic Acid, and other agents, and the 
motor nerves by Conium, Methyl-strychnine, etc., both actions resulting in paralysis of 
the limbs. Curare, even in small doses, paralyzes the end-organs of the motor nerves, 
and Belladonna, the compound Ammonias, Methyl compounds, etc., exercise a similar but 
less powerful influence. Galvanism is also an effective local depressant of motor activity. 

Motor-Excitants are agents which increase the functional activity 
of the spinal cord and the motor apparatus, producing disturbances of 
motility, heightened reflex excitability, and tetanic convulsions when 
given in large doses, their ultimate effect being motor paralysis from 
over-stimulation. 



The most important members of this class are Nux Vomica and Ignatia, with their 
alkaloids Strychnine and Brucine, also Thebaine, the tetanizing alkaloid of Opium. The 
group also includes Morphine and Atropine, which, though at first sedative, when given 
in large doses produce convulsions. The respiratory centre in the medulla is stimulated 
by Strychnine, Atropine, Ammonia, and small doses of Alcohol, Ether and Chloroform. 
The motor convolutions in the brain are stimulated by Alcohol in moderate doses, also 
for a brief period by Ether and Chloroform. The end-organs of the motor nerves are 
stimulated by the local use of- Electricity, Strychnine and friction ; and are irritated by 
the internal administration of Aconitine, Nicotine, Camphor, Pilocarpine and Pyridine. 
Other members of this class are named in the following list : — 



Nux Vomica. 

Ignatia. 

Strychnine. 

Brucine. 

Thebaine. 

Morphine (large dose). 

Atropine (large dose). 



Alcohol (small dose). Ergot. 

Ether (small dose). Ustilago. 
Chloroform (small dose). Gossypium. 

Ammonia. Picrotoxin. 

Absinthe. Aconitine. 

Buxine. Nicotine. 

Calabarine. Camphor. 



Digitalis. 

Convallaria. N 

Cimicifuga. 

Pilocarpine. 

Pyridine. 

Rhus Toxicodendron. 

Electricity. 



Mydriatics (fneudos, moisture), — are agents which produce dilatation 
of the pupil of the eye (mydriasis). Some act locally, others when given 
internally, but the principal ones (Atropine and its congeners) act both 
locally and internally, producing at the same time paralysis of the ciliary 
muscle, resulting in temporary loss of accommodation, the eye remaining 
focussed for distant objects, and the intra-ocular tension being increased. 
The principal mydriatics are the following-named : — 



Atropine. 

Belladonnine (internally only). 

Hyoscyamine. 

Daturine. 

Duboisine. 



Homatropine. 

Gelsemine (locally only). 

Muscarine. 

Cocaine. 

Anesthetics (at last). 



The dilating action of Atropine and its congeners is due to stimulation of the end- 
organs of the sympathetic nerve, increasing the power of the radiating muscular fibres of 
the iris, and also to paralysis of the end-organs of the motor oculi (3d cranial) nerve, 
lessening the power of the circular fibres or sphincter iridis. When administered inter- 
nally the drug is carried by the circulation to the eye, acting thereon locally as if instilled 
directly upon the conjunctiva. Cocaine acts by stimulating the terminations of the sym- 
pathetic. Anesthetics produce mydriasis late in their action, which is central. Atropine, 
Duboisine and Homatropine are the mydriatics chiefly used by ophthalmologists. 



I 



58 CLASSIFICATION OF MEDICINES. 

Myotics {meuo, I close), — are agents which produce contraction of 
the pupil. The alkaloid Physostigmine (Eserine) is the chief local myotic, 
and the only one used in ophthalmic practice. It acts by stimulating the 
circular muscular fibres of the iris, at the same time contracting the 
ciliary muscle so that the eye is accommodated for near objects only, 
also diminishing intra-ocular tension ; in all of which it exactly antago- 
nizes the action of Atropine. 

Muscarine, Pilocarpine and Nicotine are also local myotics, acting upon the end- 
organs of the oculo-motor nerve. Anesthetics in the early stage of their action cause 
contraction of the pupil by lessening reflex action ; later, when they begin to paralyze 
respiration, the accumulation of venous blood irritates the centres and produces dilatation, 
which during anesthesia is a sign of failing respiratory power. The myotic action of 
Opium is of central origin, probably paralysis of local reflex excitability. The chief 
myotics are — 

Physostigma, Eserine. Muscarine. Lobeline (internally). 

Opium, Morphine. Gelsemine (internally). Nicotine (locally). 

Pilocarpus, Pilocarpine. Carbolic Acid (internally) . Anesthetics (at first). 

Narcotics (narkay, stupor), are agents which lessen the relationship 
of the individual to the external world. At first more or less excitant to 
the higher brain and stimulant to the mind and to all the bodily func- 
tions, the next stage of their action is one of profound sleep characterized 
by increasing stupor, and this, if the dose has been sufficient, is followed 
by coma and insensibility (narcotism), and finally death occurs from 
paralysis of the medullary centres which govern respiration and the other 
functions of organic life. Narcotics and stimulants are closely related, 
Alcohol and Opium affording good illustrations, in the different stages of 
their action, of stimulation followed by narcosis. Narcotics, in proper 
medicinal doses, give us the power of lowering morbidly acute percep- 
tion, of relieving pain and allaying irritation, nervous agitation and 
spasm, of inducing sleep, and of regulating the vital functions by rest — 
all of which are means of great therapeutical value. The chief narcotics 
are : — 

Opium, Morphine. Alcohol. Carbolic Acid. 

Belladonna, Atropine. Ether. Hydrocyanic Acid. 

Hyoscyamus. Chloroform. Oil of Turpentine. 

Stramonium. Chloral Hydrate. Other Essential Oils. 

Cannabis Indica. Bromal Hydrate. Carbonic Acid Gas. 

Opiiwi is the typical member of the group. Humulus (hops) and Lactucarium 
(lettuce) are generally included among the narcotics, but their action is so feeble that 
they are seldom used for such purpose. 

Oxytocics or Ecbolics (okseus, quick, tokos, childbirth ; ekbolay, 
abortion), — are agents which stimulate the muscular fibres of the gravid 
uterus to contraction, and may therefore produce abortion. In small 
doses the same remedies are emmenagogue as a rule. Their mode of 
action has not been clearly made known, but it is generally believed to 



CLASSIFICATION OF MEDICINES. 59 

be due in some cases to direct stimulation of the uterine centre in the 
cord, in others to congestion of the uterus producing reflex stimulation. 
The principal oxytocics are those named in the following list : — 

Ergot. Hydrastis. Pilocarpine. 

Ustilago. Borax. Viscum Flavescens. 

Savine. Cotton-root Bark. Strong Purgatives. 

Potassium Permanganate. Oil of Rue. 

Any drastic purgative, or gastro-intestinal irritant, may produce abortion by reflex 
action. The Volatile Oils act in this manner, also Colocynth' and many other agents used 
by women to produce abortion, as Tansy, Pennyroyal, etc., all of which are dangerous 
to life in doses sufficient to excite the action of the gravid uterus. 

According to Boissard there are no abortifacient drugs in the strict sense of the term, 
though some drugs given in toxic doses may cause abortion and the death of the woman. 
Such drugs are therefore useless in any except the most reckless hands. The oxytocic 
and ecbolic drugs belong to another class, having the power of strengthening the intensity 
of the uterine contractions after they have been aroused (oxytocics), or of arousing and 
aiding uterine contractility (ecbolics). The action of the former is certain, that of the 
latter is very doubtful. 

Pancreatic Stimulation may be obtained by the administration of 
Ether, or by galvanism of the gland itself. The secretion is depressed 
by Atropine, also by any agent inducing nausea and vomiting. 

Parasiticides (parrahseetos, a parasite, ccedo, I kill), — are agents 
which destroy the animal and vegetable parasites found upon the human 
body. They are generally applied in the form of lotions, ointments or 
oleates, and include the following-named substances : — 

Sulphur. Mercury. Carbolic Acid. 

Sulphides. Ammoniated Mercury. Petroleum. 

Sulphurous Acid. Mercuric Chloride. Storax. 

Sulphur Iodide. Mercuric Nitrate. Staphisagria. 

Iodine. Mercuric Oxide. Balsam of Peru. 

Protectives are agents of a mechanical nature employed to cover and 
protect an injured part from the air, water, friction, etc. Collodion and 
Gutta-percha are those in general use, but certain plasters, as the adhesive, 
the lead or the soap plaster, may be employed for this purpose, also 
cotton. 

Pulmonary Sedatives diminish cough and dyspnea by lessening the 
irritability of the respiratory centre or that of the nerves of respiration. 
Some act by directly depressing the respiratory centre ; others by remov- 
ing some irritant from the passages, or by lessening local congestion, as 
the expectorant group ; and others by lowering the excitability of the 
vagus end-organs in the lungs and that of other afferent filaments through- 
out the respiratory tract. The principal pulmonary sedatives are named, 
in the following list : — • 



60 CLASSIFICATION OF MEDICINES. 

Opium. Hydrocyanic Acid. Turpentine. 

Morphine. Codeine. Potassium Cyanide. Ethyl Iodide. 

Belladonna. Amyl Nitrite. Conium. 

Stramonium. Quebracho. Tobacco. 

Hyoscyamus. Cannabis. Lobelia. 

Opium has the most powerful influence as a sedative to the respiratory centre, and 
mucilaginous or saccharine substances soothe the local irritation, hence the latter are so 
frequently used as vehicles for the former in cough mixtures. Hydrocyanic Acid has a 
similar sedative action, hence the use of Prunus Virginiana and other substances contain- 
ing it against cough. Belladonna stimulates the respiratory centre, but at the same time 
lessens the excitability of the vagus terminations in the lungs, and completely arrests 
secretion from the bronchi. Stramonium acts similarly. 

Refrigerants (refrigero, I cool), — are remedies which allay thirst and 
impart a sensation of coolness. They include the Vegetable Acids, the 
Mineral Acids (greatly diluted), Ice, Water if cold, effervescing drinks, 
fruit juices, and many diaphoretics. 

Respiratory Depressants lower the activity of the respiratory 
centre, rendering the respirations slow and shallow. The chief agents of 
this class are : — 



Cold. 


Gelsemium. 


Alcohol. 


Caffeine. 


Opium. 


Aconite. 


Ether. 


Colchicine. 


Physostigma. 


Veratrine. 


Chloroform. 


Nicotine. 


Muscarine. 


Hydrocyanic Acid. 


Chloral. 


Quinine. 


Lobeline. 


Conium. 


Saponin. 


Camphor. 
Carbolic Acid 



The eleven last named first excite the centre for a brief period and then depress it. 

Respiratory Stimulants exalt the function of the respiratory centre, 
quickening and deepening the breathing. Such agents are — 

Strychnine. Opium (small doses). Quebracho. 

Brucine. Thebaine. Zinc and Copper Salts. 

Atropine. Apomorphine. Tobacco (briefly). 

Duboisine. Ammonia. Alcohol (briefly). 

Emetine. . Hydrocyanic Acid. Ether (briefly). 

Chloralamid. Digitalis. Cold Douche. 

Strychnine also stimulates the vagus tract. Electricity, applied to the nerve-trunks or 
to the inspiratory muscles, is a direct respiratory stimulant. Veratrine, Eserine and 
Muscarine stimulate the vagus terminations, quickening the respiration, but afterwards 
slow it by depressing the respiratory centre. Aconite stimulates the end-organs of the 
vagus when given in small doses. 

The Respiratory Centre is situated in the medulla oblongata, close to the termination 
of the calamus scriptorius. It probably consists of thoracic and diaphragmatic Inspira- 
tory Centres, the act of expiration being considered normally a passive one, due to the 
natural contraction of the walls of the air-vesicles, and the return of the diaphragm and 
thoracic walls to the position from which they were moved by the inspiratory effort. An 
Expiratory Centre must also exist for the initiation of forced expiration, as in the pro- 
duction of voice, cough, sneezing, etc. The chief Inspiratory A T erves are the pulmonary 
branches of the vagus. The Expiratory Nerves are the nasal branches of the fifth, the 
superior and inferior laryngeal, and the cutaneous nerves'of the chest and abdomen. 



CLASSIFICATION OF MEDICINES. 6 1 

Restoratives are agents which promote constructive metamorphosis, 
including the Foods, Hematics and Tonics, as well as many agents called 
Stimulants in other classifications. 

Foods, are substances which, when introduced into the body, supply 
material to renew some structure or to maintain some vital process; 
being distinguished from medicines in that the latter modify some vital 
action but supply no material to sustain such. 

The food of man is derived from all three of the kingdoms of nature, the animal, 
vegetable, and mineral, and includes many substances treated of in the Materia Medica, 
as Oils and Fats, Sugar, Starch, Gum, Alcohol, Beverages like Coffee and Tea, Water, 
Phosphate of Lime, Sodium Chloride, etc. 

Hematics (hainia, the blood), are medicines which augment the quan- 
tity of hematin in the blood, and thus restore the quality of that tissue 
by enriching its red corpuscles. They consist chiefly of Iron and Man- 
ganese and their compounds. 

Tonics (Jonos, tension), are agents which improve the tone of the 
tissues on which they have specific action, restoring energy and strength 
to debilitated subjects by a scarcely perceptible stimulation of all the 
vital functions, their effects being apparent in an increased vigor of the 
entire system. The chief tonics are enumerated in the foregoing lists 
under the heads of the organs or tissues particularly affected by them. 
[Compare the articles entitled Stimulants, Respiratory Stimulants, 
Cardiac Tonics, Vascular Tonics, Gastric Tonics, etc.] 

The most typical medicinal agents which impart general tone and strength are Strych- 
nine, Quinine, Iron and Vegetable Bitters. Those specially acting upon the stomach, 
are Arsenic, Bismuth, Cinchona, Hydrastis and Nux Vomica, — on the spinal cord and 
general circulation, Strychnine, — on the heart, Digitalis, Squill, Convallaria and Cimi- 
cifuga, — on the nervous system, Phosphorus, Quinine and the Valerianates, — on muscular 
tissue, Tannin, — on the blood, Iron, Manganese, Cod-liver Oil, and other fats. 

Sedatives (sedo, I allay), — are agents which exert a soothing influ- 
ence on the system by lessening functional activity, depressing motility 
and diminishing pain. 

General Sedatives include the narcotics and anesthetics. Local Sedatives include 
Aconite, Opium, Ice, etc. Pulmonary Sedatives, as Hydrocyanic Acid, Veratrine and 
the nauseants and emetics. Spinal Sedatives, as Physostigma, Gelsemium, Potassium 
Bromide. Stomachic Sedatives include Arsenic, Bismuth, Silver Nitrate, Sodium Bicar- 
bonate. Vascular Sedatives, as Digitalis, Tobacco, Aconite, Veratrum, and the emetics. 
Nervous Sedatives, among which are Potassium Bromide, Tobacco, Lobelia, and the 
group of spinal depressants. 

Sialogogues (seealon, saliva, ago, I carry off), — are agents which 
increase the secretion and flow of saliva and buccal mucus, either by 
reflex action from the local irritation produced when anything is taken 
into the mouth, or by stimulating the glands during their elimination. 
The principal sialogogues are divided into two groups, the first or topical 



62 CLASSIFICATION OF MEDICINES. 

sialogogues acting by reflex stimulation ; the second, general' sialogogues, 
acting through their systemic influence on the glands or their secretory 
nerves; and include the following-named substances : 

Topical Sialogogues. General Sialogogues. 

Acids and Alkalies. Pilocarpus (Jaborandi). 

Ether, Chloroform, etc. Muscarine. 

Mustard. Ginger. Physostigma. 

Pyrethrum. Mezereon. Mercurials. 

Tobacco. Cubebs. Iodine compounds. 

Capsicum. Rhubarb. Antimonials. 

Horse-radish. Tobacco. Ipecacuanha. 

x\gents which diminish salivary secretion are termed Antisialics. The 
principal member of this group is Atropine, which paralyzes the terminals 
of the nerves of secretion. Physostigma counteracts this paralysis, but 
in large doses acts also as an antisialic by lessening the blood supply to 
the glands. Opium diminishes the reflex excitability of the reflex centre 
and also lessens the secretion directly. Others acting locally are — 

Borax. Soda. Lithia 

Potassium Chlorate. Lime. Magnesia. 

Insipid or nauseous articles of food or medicine. 

Smell is one of the senses which is increased by Strychnine. It is 
decreased by all cerebral depressants and by those agents which produce 
changes in the nasal mucous membrane, as Potassium Iodide. 

The cerebral centre for this faculty is situated at the tip of the temporo-sphenoidal 
lobe, and the terminal branches of the olfactory nerve are distributed upon the mucous 
lining of the upper portion of the nasal fossae. Strychnine probably stimulates the 
former, and all drugs acting upon the latter region have more or less effect upon the 
power of distinguishing smells. 

Stimulant {stimulus, a goad), — is a term which is used in various 
senses when applied to medicinal agents. Alcoholic preparations, which 
are true narcotics, are commonly termed "stimulants," and the same 
expression is employed to designate any agent which excites even briefly 
the organic action of any part of the system. All excessive stimulation 
reacts into depression, and most of the agents which stimulate the nerve 
centres at first will soon depress and finally paralyze them. In many 
cases the action is one of progressive stimulation primarily and progress- 
ive paralysis afterwards, affecting the centres in the inverse order of their 
development, the highest or latest developed centres being affected first, 
the lowest or oldest ones last. These laws are well exemplified in the 
action of Alcohol upon the nervous system. [Compare the article 
entitled Alcohol in Part I.] 

Diffusible Stimulants are those which have a prompt but transient effect on the general 
system, such as Alcohol, Ammonia, Camphor, etc. Spinal Stimulants exalt the functions 
of the cord, as Strychnine, Picrotoxin, Ergot, Atropine, Phosphorus. Cardiac Stimti- 



CLASSIFICATION OF MEDICINES. 63 

lants increase the action of the heart, as Alcohol, Atropine and Morphine in small 
doses, Strychnine, etc., also Squill, Convallaria, Cimicifuga and Digitalis, which slow 
but strengthen the cardiac action. Respiratory Stimulants directly stimulate the respira- 
tory centre, as Ammonia, Strychnine, Apomorphine, Belladonna, etc. Vaso-motor Stimu- 
lants, as Alcohol, Chloroform, Ether (all three in very small quantities), Ammonia, 
Strychnine, Digitalis and Squill, acting on the vaso-motor centre ; and the Nitrites, Bella- 
donna, Electricity, Volatile Oils, etc., acting as local dilators of the vascular system. 
Cerebral Stimulants, as Alcohol, Opium, Belladonna, Caffeine, Cocaine, Theine, Canna- 
bis, Chloroform, Ether, Tobacco, etc. Renal Stimulants, as the diuretic group. Stom- 
achic Stimulants, as the Aromatics, Volatile Oils, Vegetable Bitters, Mineral Acids, Nux 
Vomica, Mustard, Capsicum, etc. Hepatic Stimulants, as Nitro-muriatic and Nitric acids, 
and the cholagogue purgatives Podophyllum, Jalap, Leptandra, Euonymin, Iridin, etc. 
Intestinal Stimulants, as Mercurials, Elaterium, Colocynth, Jalap, Scammony, Podophyl- 
lum, etc., which affect the glandular apparatus, — and Belladonna, Physostigma, Nux 
Vomica, Rhubarb, Senna, Aloes, Frangula, Cascara, etc. , which chiefly affect the mus- 
cular fibres and the intestinal nerves. Czrfaneous Stimulants, as the diaphoretic group, 
and the rubefacients Mustard, Capsicum, Turpentine, Ammonia, etc. 

Local Stimulants increase common sensibility to the extent of producing pain, chiefly 
by direct action upon the end-organs of the sensory nerves in the skin, though some act 
probably by stimulating the local circulation, as in inflammation. The principal members 
of this subdivision are — 

Faradism. Chloroform. Volatile Oils. 

Heat. Carbolic Acid. Acrid Essential Oils. 

Cold. Creosote. Metallic Salts. 

Alcohol. Mineral Acids. Veratrine (at first). 

Ether. Ammonia. Cantharis (at first). 

Stomachics or Gastric Tonics are agents which increase the 
appetite and promote gastric digestion. They include a number of sub- 
stances, dietetic and medicinal, some acting by stimulating the produc- 
tion of gastric juice, others by stimulating the local circulation, and 
several by exciting the activity of the nervo-muscular apparatus of the 
stomach. The first indication is met by the use of dilute alkaline solu- 
tions before meals, — the second by administering any of the pungent 
carminatives, as the Aromatic Oils, Pepper, Mustard, etc., or by Alcohol 
and Ether in small doses, or by the Aromatic Bitters, as Gentian, Orange, 
etc., or the simple bitters, as Calumba ; — while the third desideratum is 
secured by the use of such agents as Nux Vomica, Hydrastis, Arsenic, 
the dilute Mineral Acids and the Volatile Oils. 

Adjuvants to digestion are the digestion-ferments, Pepsin, Ingluvin, Papain, and also 
dilute HC1 acid ; all of which may be used to supplement the gastric juice when deficient 
in quantity or quality. The juice of the Pineapple contains a very active digestive prin- 
ciple, and may be employed as an aid to digestion with excellent results. Pepsin acts in 
acid media, and is only applicable to gastric indigestion ; Pancreatin acts in alkaline 
media, is destroyed by acids, and is only applicable to intestinal indigestion ; while 
Papain exercises its proteolytic power in either acid, alkaline or neutral solutions, and is 
equally applicable to either gastric or intestinal indigestion. 

Styptics and Hemostatics {stuphoh, I contract, haimah, blood, 
stahsis, a standing), — are agents which arrest bleeding ; Styptics being 
those which are applied locally, and Hemostatics those which are admin- 
istered internally. Some of the former act mechanically, by promoting - 
the formation of a clot in the mouths of the bleeding vessels; others 



64 CLASSIFICATION OF MEDICINES. 

cause the vessels themselves to contract, thereby checking the flow of 
blood. The principal members of this class are the following-named : — 

Styptics. Hemostatics. 

Acids. Matico. Ergot. Digitalis. 

Alum. Spider's- web. Gallic Acid. Matico. 

Antipyrin. Tannic Acid. Lead Acetate. 

Collodion. Lead Acetate. Dilute Sulphuric Acid. 

Ferric Chloride. Zinc Sulphate. Ipecacuanha. 

Ferric Sulphate. Vegetable Astringents. Hamamelis. 

Silver Nitrate. Cold (locally). Oil of Turpentine. 

Cauterization. Heat (locally). 

Taste is not much affected by drugs except as each drug makes its own 
peculiar impression on the nerves of taste, and may overcome that of 
another agent. Smell has much to do with taste in many instances, the 
expedient, of holding the nose while swallowing Castor Oil being familiar 
to every one. 

The " after-taste " of drugs is often different to their original taste; thus Bitters are 
said to leave a sweet after-taste, and the same is claimed ior Quinine if given in acid 
solution so as to be entirely dissolved, and if washed out of the mouth with water im- 
mediately after swallowing. Substances which are excreted from the system in the saliva 
(as Iodides) leave a very persistent after-taste. 

Urinary Acidifiers include Benzoic and Salicylic Acids and several 
of their salts, Vegetable Acids in excess, also excess of proteids, sugar and 
starch in the food, and certain wines and spirits. The Mineral Acids 
have little or no influence on the acidity of the urine, being excreted as 
neutral sulphates, chlorides, phosphates, etc. 

Benzoic Acid and its salts are among the very few agents by which morbid alkalinity of 
the urine can certainly be neutralized. Salol is much quicker in its action on the urine 
than is Ammonium Benzoate ; as ordinarily in a day or so, under its administration, the 
urine in chronic cystitis loses its alkalinity and foul odor, and becomes clear (Dr. Mansel 
Sympson). 

Urinary Alkalinizers include the alkalies, particularly Potassium and 
Lithium Salts, but excepting Ammonia which is broken up in the organ- 
ism. Sodium salts, being partly excreted by the bile and the bronchial 
mucus, and partly locked up in the system as the neutral chloride, while 
sodium urate is insoluble, are not so efficient in this regard as are other 
alkalies. Fruits, milk and fish also act in the same manner by means of 
the salts which they convey into the economy, and a strictly vegetable 
diet plays an important part towards the same end. 

Urinary Sedatives and Astringents, when administered internally, 
act in a sedative manner upon the whole extent of the urinary tract 
through the medium of the urine, which, being charged with them, 
brings them into contact with the genito-urinary mucous membrane. 
Some of them may be applied locally as far as the urethral and vesical 



CLASSIFICATION OF MEDICINES. 65 

mucous surfaces, the portion above the latter being inaccessible to direct 
local medication. 

Instances of the application of these agents are the use of Potassium and Lithium 
Salts to diminish the acidity of the secretion, — Cubebs, Copaiba, and Sandal-wood Oil as 
antiseptics and astringents, — and urethral injections of Alum, Acetates of Zinc and Lead, 
Boracic Acid, Chloral and Zinc Chlorides, etc., for a simple purpose. Copaiba is one of 
the most efficient agents for rendering the urine antiseptic, and should be more employed 
in cystitis and urethritis than it is. Oil of Eticalyptus is nearly as efficient, and Stigmata 
Maidis (Corn Silk), in tincture, is well thought of for its general alterative influence on 
the urinary tract. 

Uterine Depressants lower the activity of the nervo-muscular appa- 
ratus which controls the uterine contractions. The most important of 
these agents are — 

Opium. Chloral. Tobacco. 

Bromides. Chloroform. Sulphate of Copper. 

Cannabis. Tartar Emetic. Emetics. 

Viburnum Prunifolium. Piscidia Erythrina. 

Uterine Stimulants — See Oxytocics, ante. 

Uterine Tonics and Alteratives, are medicines which are consid- 
ered to have such specific influence over the uterus. Authorities differ 
very much regarding the action and use of these agents, but those named 
in the following list are generally believed to have considerable value in 
uterine therapeutics, viz. — 

Uterine Tonics. Uterine Alteratives. 

Potassium Bromide. Iodine. 

Potassium Chlorate. Iodoform. 

Pulsatilla. Iodized Phenol. 

Helonias Dioica. Glycerin. 

Cimicifuga. Hydrastis. 

Savine. Silver Nitrate. 

Astringents (locally). Galvanism. 

Those in the first list, except Astringents, are used internally ; those in the second 
column are employed as topical applications to the uterine cavity or cervix. 

Vascular Contractors increase the contractile power of the vessels, 
lessening the circulation therein and raising the blood-pressure ; hence 
they are used to check hemorrhage and cut short inflammations. The 
principal agents included in this group are — 



Cold. 


Antipyrin. 


Opium (small doses) 


Ergot. 


Adrenal Extract. 


Cocaine (locally). 


Barium Salts. 


Belladonna. 


Sulphuric Acid. 


Lead Salts. 


Digitalis. 


Hamamelis. 


Silver Salts. 


Squill. 


Iron. 


Zinc Salts. 


Strophanthus. 


Strychnine. 



These agents act upon the local vaso-motor mechanism in the walls of the vessels, 
Hamamelis affecting the venous system especially. Cold is one of the most powerful 
agents of this class, and is also a cardiac sedative. Adrenal Extract produces an enor-* 
mous rise of the blood-pressure, due to its extraordinary contractile power over the 
muscular fibres in the walls of the arterioles. 

5 



66 CLASSIFICATION OF MEDICINES. 

Vascular Dilators produce dilatation of the peripheral vessels, and 
increase the rapidity of the circulation, thus equalizing the blood-pressure 
and relieving internal congestions. The most useful are Alcohol and 
Ether, as they stimulate the action of the heart simultaneously with the 
vascular relaxation. The chief members of this group are — 

Alcohol. Belladonna. Chloral. 

Ether. Stramonium. Chloroform. 

Nitrous Ether. Hyoscyamus. Ammonium Acetate. 

Nitroglycerin. Opium (at first). Tartar Emetic. 

Amyl Nitrite. Dover's Powder. Camphor. 

Thyroid Extract. Ipecacuanha. Heat, by poultices, etc. 

The dilating action of Amyl Nitrite and other Nitrites is due either to weakening of 
the muscular walls of the arterioles or to paralysis of the vaso-motor ganglia in them. 
Alcohol, Ether and Opiw?i probably depress the vaso-motor centre. Aconite does not 
affect the vaso-motor centre or the vaso-motor nerves, hence the lessened arterial tension 
induced by it is due to its depressant action on the heart alone (Ringer). 

The Vascular Dilators are often called Vascular Stimulants or stimulants of the cir- 
culation ; but there is this difficulty of speaking of stimulants or sedatives of the circula- 
tion, that if both the heart and the vessels are stimulated at the same time, the action of 
the one tends to counteract that of the other. On the other hand, a drug which weakens 
the heart may increase the circulation by dilating the vessels, thus acting as a vascular 
stimulant (Brunton). 

Vesical Sedatives are substances which lessen irritability of the 
bladder, relieving pain and decreasing the desire to micturate. Opium, 
Belladonna, Hyoscyamus, Stigmata Maidis, Cannabis, etc., lessen the 
irritability of the nerves, Calciu?7i Carbonate relieves that due to the 
presence of calculi ; mucilaginous drinks ; such as Barley-water or Linseed 
tea, also astringents like Buchu, Uva Ursi, Pareira, etc., diminish the 
irritation due to chronic cystitis, and antiseptics, as Copaiba, and Cubebs, 
act in like manner, being carried by the urine to the bladder. 

Vesical Tonics increase the contractile power of the muscular fibres 
in the wall of the bladder. By strengthening the detrusor they prevent 
retention of urine and by stimulating the sphincter they prevent inconti- 
nence. The most important members of this group are Cantharides, 
Belladonna, Strychnine and Potassium Bromide by internal administra- 
tion, Silver Nitrate locally, and the use of a urethral bougie. 

Cantharides stimulates the sphincter vesicas by rendering the urine irritant thereto ; 
Strychnine, by increasing the irritability of the nerve-centre which governs it. Potassiujn 
Bro?7iide lessens reflex susceptibility from the bladder, so that the detrusor is less fre- 
quently called into action. Belladonna probably decreases the sensibility of the bladder 
to changes of pressure within it. Silver Nitrate, locally applied to the neck, acts in the 
same manner as the passing of a urethral bougie, namely — by altering the direction of 
reflex action (Brunton). 

Visions are caused by several drugs, the action of which is probably 
exerted on the sight-centres in the cerebrum (angular gyrus and occipital 
lobes), rather than on the eye itself. The delirium and hallucinations 
produced by Alcohol are familiar examples, — the objects raised thereby 



ADMINISTRATION OF MEDICINES. 6j 

being usually animals, as snakes, toads, dogs, etc. Sodium Salicylate in 
some persons produces very disagreeable visions. The Bromides, if taken 
in continued large doses may, during the typhoid condition which fol- 
lows, cause visions of such intense character that they are often impressed 
permanently on a brain which, at the time, was utterly unconscious of all 
its real surroundings. Digitalis may produce subjective sensations of the 
continued presence of light, and Cannabis Indica, among the many curi- 
ous effects produced by its ingestion in large doses, frequently gives origin 
to similar disturbances of the visual function, of an indefinite and varied 
but usually pleasant character. 



ADMINISTRATION OF MEDICINES. 



Medicines may be introduced into the circulation by various routes, 
including the mouth, the stomach, the rectum, the respiratory tract, the 
veins and arteries, the subcutaneous cellular tissue, and the integument. 

The Mouth is the usual receptacle for medicines intended for the 
stomach, but may itself be employed for the introduction of minute quan- 
tities of powerful agents. A drop of the tincture of Aconite placed on 
the tongue is quickly absorbed, and soon manifests that fact by its symp- 
toms. Many of the small tablets used for hypodermic administration, if 
placed under the tongue, are readily conveyed into the system, and used 
in this way form a very convenient means of medication with alkaloids 
and other active principles. 

The Stomach is the most convenient organ for the absorption of 
medicines and the one most frequently employed. After being swallowed, 
the remedies find their way into the current of the circulation through the 
walls of the gastro-intestinal blood-vessels and the lacteals. When the 
stomach is empty and its mucous membrane healthy crystalloidal sub- 
stances in solution pass through the walls of its vessels with great rapidity. 
Colloidal Substances (fats, albumin, gum, gelatin, etc.) require to be 
digested and emulsified before they can be absorbed. lodifie and Iodides 
should be given on an empty stomach, so that they may diffuse rapidly 
into the blood; if administered during digestion, the acid gastric juice 
and the starch of the food will alter their chemical constitution and. 
weaken their action. Acids should be given, as a rule, on an empty 
stomach, especially when they are intended to check the secretion of the 



68 ADMINISTRATION OF MEDICINES. 

acids of the gastric juice. Alkalies, of which Sodium Bicarbonate may 
be taken as the type, are given after meals to neutralize excessive acidity, 
and before meals to stimulate the acid gastric secretions. Silver Oxide 
and Silver Nitrate should be administered after the digestive process is 
ended ; if given during digestion, chemical reactions destroy or impair 
their special attributes and defeat the object for which they were pre- 
scribed. Metallic Salts (especially corrosive sublimate), also Tannin and 
pure Alcohol, impair the digestive power of the active principle of the 
gastric juice, and should be given by the stomach only during its period 
of inactivity. Malt Extracts, Cod-liver Oil, Phosphates, etc., should be 
administered with or directly after food, so that they may enter the blood 
with the products of digestion. Bismuth should be given before meals, 
as it is usually employed for its local sedative action on the gastric mucous 
membrane. Potassium Permanganate should be given after meals ; on an 
empty stomach it would irritate the mucous membrane and might possi- 
bly produce ulceration thereof. Arsenic and other irritant and dangerous 
drugs (such as copper, zinc and iron salts), should be given directly after 
food, except where local conditions require their administration in very 
small doses on an empty stomach. Morphine should only be given by 
hypodermic injection when the patient is lying down, unless he is previ- 
ously habituated to its use. Pilocarpine, administered to produce sweat- 
ing, should be given when the patient is in bed in a warm room. Ammo- 
nium Acetate acts as a diaphoretic when the recipient is warm in bed, but 
as a diuretic when the patient is in a cold atmosphere. Sulphonal should 
be given two or three hours before its hypnotic action is desired, as it is 
very slowly absorbed. 

Under some circumstances it becomes necessary to introduce medicines directly into 
the stomach, as in cases of the patient's inability to swallow, through narcotic poisoning 
or other causes. The stomach-pump or the stomach-tube may then be employed to 
convey both food and medicine to that organ. In obstruction of the esophagus, as from 
stricture or malignant disease thereof, it may become necessary to make an opening 
through the abdominal wall and the wall of the stomach itself. Nasal feeding, by the 
use of a small catheter with a hard rubber funnel inserted into its end, is a very efficient 
method of conveying liquids into the stomach. The eye end of the catheter is oiled and 
passed gently along the floor of the nose and down the pharynx ; the fluid being then 
poured into the funnel. This method is particularly serviceable in cases of acute tonsil- 
litis or other painful affections of the mouth or palate, also after excision of the tongue, 
when swallowing is to be avoided as much as possible. In many cases, especially insane 
ones, the patient will so constrict the muscles of the throat as to force the catheter into 
the mouth ; but if it is withdrawn until nearly out of the pharynx, the presence of the 
fluid as it drops down will excite swallowing, and the patient may be fed as well as if 
the tube were in the esophagus. 

The Rectum will absorb many substances applied in the form of 
enemata or suppositories. Those most suited to this route are the salts 
of the alkaloids in solution, especially those of Morphine, Atropine and 
Strychnine, the latter being absorbed more rapidly by the rectum than by 



ADMINISTRATION OF MEDICINES. 69 

the stomach. Acid solutions, if not too frequently repeated, are also well 
administered by this channel. Nutritive enemata must be small, not ex- 
ceeding three or four fluid ounces, or they will not be retained. They 
become necessary in many cases, especially in cases of gastric ulcer, in 
order to afford rest to the stomach. It is often found advantageous to have 
the food predigested before being administered by the rectum, for which 
purpose Pancreatin is used. [Compare the articles entitled Injectiones 
and Suppositoria in Part II and Enemata in Part III.] 

The Respiratory Tract admits of the rapid absorption of medicinal 
substances through its extensive blood-supply. The inhalation of vapors 
or atomized fluids, the insufflation of powders into the nares, fauces, 
larynx, etc., and the use of a medicated nasal douche, are methods 
whereby this channel may be utilized. [Compare the article entitled 
Inhalationes, in Part II.] 

The Veins are only used as a route of medication in emergencies, 
when the other channels are not available, and where immediate action 
is necessary to the preservation of life, the operation being a highly dan- 
gerous one. The injection intravenously of Saline Solutions in the col- 
lapse of cholera, diabetic coma, etc., Blood or Milk as a last resort in 
excessive hemorrhage, epilepsy, uremia, the collapse of cholera, etc., and 
a solution of Ammonia for the bites of venomous reptiles, Hydrocyanic- 
acid poisoning, opium-narcosis, chloroform-asphyxia, etc., are the in- 
stances admitted in practice. 

Arterial Transfusion has also been performed successfully in a number of cases, and 
is considered safer than venous transfusion when a large quantity of fluid has to be in- 
troduced into the circulation. A special apparatus is employed for these purposes, known 
as Aveling's transfusion syringe, but the ordinary Dieulafoy's aspirator slightly modified 
may be used with safety and convenience. The danger of the operation lies in the lia- 
bility of the introduction of air into the circulation, an occurrence which may cause 
instant death in the human subject. 

The Hypodermic Method is the introduction of medicines into the 
organism by injecting them into the subcutaneous areolar tissue, from 
which they are quickly absorbed by the lymphatic and capillary vessels. 
The great advantage of this method is the absolute certainty as to the 
quantity of drug actively affecting the organism, a very essential question 
when using small quantities, as when powerful alkaloids are employed. 
Another advantage is the avoidance of reaction between the drug and 
the contents of the stomach, which may destroy the activity of the 
former, or seriously change its character. The medicine must be in solu- 
tion, and the latter should be of neutral reaction and f7'eshly prepared ; 
the usual menstruum being distilled water, though filtered spring water 
will answer just as well, and much better than distilled water which has 
been standing several days and frequently exposed to the air. The solu- 
tion is to be injected beneath the skin, not into it, by a hypodermic 



JO ADMINISTRATION OF MEDICINES. 

syringe, care being taken to avoid puncturing a vein. The most suitable 
localities for the injection are the external aspect of the arms and thighs, 
the abdomen, the back, and the calves of the legs. On the external 
aspect of the thigh, just in front of the great trochanter, there is an area 
of some two inches square, over which the insertion of a fine hypodermic 
needle is not felt, so barren is the skin of sensitive nerve filaments in that 
region. A few years ago the sight of a hypodermic syringe in a physi- 
cian's hand suggested an injection of morphine to the patient and to the 
patient's friends, and many a physician has acquired the reputation of 
giving morphine on every possible occasion because he administered 
drugs by the hypodermic method. It is therefore well to inform the 
patient that another drug is being so administered when such is the fact. 
In this age of toxin and antitoxin treatment the hypodermic syringe has 
become a necessity, as many of these agents are inert when given by the 
stomach. Whenever such preparations are employed their injection must 
be administered under strict aseptic conditions, applied to the syringe 
and needle as well as to the site of the operation, and the contents of the 
syringe should be discharged very slowly into the tissues beneath the sh'n, 
giving time for the fluid to diffuse itself without rupturing the connective 
tissue. 

The classic practice of pinching up a fold of the integument before inserting the hypo- 
dermic needle is entirely wrong both in theory and in practice. It is never done by per- 
sons who habitually use this instrument on themselves, and they are admittedly the most 
expert of all operators in this line. It increases the liability to local soreness, and often 
produces bruises and ecchymoses which might be avoided by following the method de- 
scribed below. 

After nearly filling the syringe with the solution to be used, the needle, if separate, 
should be screwed on tightly ; and with the instrument held in a vertical position, point 
uppermost, the excess of solution over the amount required should be ejected, thus ex- 
pelling air-bubbles and filling the needle itself. A site having been selected, where there 
is no danger of penetrating a vein or artery, the needle should be quickly inserted at a 
right angle with the surface, and carried on for fully one-half its length into the subcuta- 
neous tissue, except when a solution of Cocaine is to be injected for the production of local 
cutaneous anesthesia, in which case it is injected into the skin itself. The syringe should 
be held steadily, not moved around, so as to avoid injuring the tissue. The piston should 
be pressed down slowly, and when the injection has been delivered the needle should be 
quickly withdrawn, and no attention paid to the few drops of solution which may follow 
it. The very finest needles should alone be used, except in cases where the patient is 
struggling and liable to break the needle off by his movements. The point of the needle 
should be perfect and its surface highly polished. It is far better to use a new needle 
every day than to risk one's reputation for skill on a blunt-pointed and rough-surfaced 
instrument. The writer buys Green's short and finest needles by the dozen and uses a 
new one on every patient. He has injected a strychnine solution in this manner on some 
300 patients during the last three years, three or four times daily in the same upper arm 
for a month in each case, without having produced any more serious result than a hyper- 
emic zone around some punctures in a very few instances. If the solutions are freshly 
prepared with clean water, the needles sharp, clean and bright, and the injections deliv- 
ered beneath the skin and not into it, there is no danger of producing abscesses or even 
indurations with the agents ordinarily employed in this manner. After using the syringe 
force out all liquid, and wipe the needle-point dry between the fingers, before returning it 
to the case ; the sebaceous matter on the fingers will keep it free from rust. Avoid punc- 
turing a vein; if you do so, watch the patient and prepare an injection containing gr. ^ 



ADMINISTRATION OF MEDICINES. 



71 



of Atropine Sulphate, to administer if dangerous symptoms arise. Never, except under 
special circumstances, administer the Salts of Morphine or Atropine hypodermically to 
children less than 15 years of age. 

Acetanilid, in minute proportion, added to aqueous solutions for hypodermic use, is 
said to preserve them from decomposition more efficiently than any other agent hitherto 
employed for that purpose, but Carbolic Acid, a drop or two to the fluid ounce, is gen- 
erally effective in this respect. 

Compressed Tablets for hypodermic use are prepared by the prominent manufac- 
turers, and are furnished in glass tubes containing from 20 to 25 tablets each. The writer 
prefers those made by Wyeth, of Philadelphia, for many reasons. They are very small, 
are entirely free from any foreign material, are sufficiently soluble, and are put up in 
short tubes which can be carried in cases to fit the vest pocket. The tablets may be 
readily dissolved in a teaspoon at the bedside, or in the syringe itself if the instrument 
has a screw-hole large enough to admit the tablet before screwing on the needle. A 
regular line of Hypodermic Tablets includes the agents named in the following list, 
though many others are prepared by the manufacturing chemists. 



List of Hypoder7)iic Tablets. 



Aconitine (crystals), gr. T fa 

Apomorphine Hydrochlorate, gr. -^ s . 

Atropine Sulphate, gr. ^, T fa fa 

Caffeine, gr. 1. 

Cocaine Hydrochlorate, gr. i, ^. 

Coni'ine Hydrobromate, gr. -i. 

Colchicine, gr. -£$. 

Corrosive Sub. and Urea, gr. J^- 

Digitalin (soluble), gr. y^g. 

Duboisine Hydrochlorate, gr. y-g-g-. 

Ergotin, gr. \. 

Gelsemine Hydrochlorate, gr. -^. 

Hyoscine Hydrobromate, gr, T ^, -^ 

Hyoscyamine, gr. T ^ 5 fa 



8> J' 3> 2' 



Morphine Sulphate, gr. 
Morphine & Atropine, No. 

Morphine Sulph., gr. £. 

Atropine Sulph., gr. 5 foj. 
Morphine & Atropine, No. 2. 

Morphine Sulph., gr. ^. 

Atropine Sulph., gr. x^. 
Nitroglycerin, gr. ¥ ^, T ^, fa 
Physostigmine Sulphate, gr. T ^. 
Picrotoxin, gr. -.L. 
Pilocarpine Hydrochlorate, gr. ^. 
Sodium Arsenate, gr. fa 
Sparteine Sulphate, gr. -Jg. 
Strychnine Nitrate, gr. T l^, fa fa 
Strychnine Sulphate, gr. T ^, fa fa fa 



[For Formulae for Hypodermic Solutions, see Appendix.] 

Parenchymatous Injection is the delivery of a medicine deeply into the tissues, 
either to affect a muscle itself or to locally influence some important nerve-trunk. The 
principal agents used in this manner are Strychnine for palsied muscles, Chloroform for 
sciatic and other neuralgias, Salts of Cocaine for local anesthesia, and Carbolic Acid for 
deep-seated inflammations. 



The Integument is an active absorbent of crystalloidal substances 
when its epidermis or cuticle is removed, and many substances may be 
made to pass through the latter and produce their characteristic effects on 
the system. By this route there are four methods of introducing medica- 
ments into the circulation — the Endermic, Enepidermic and Epidermic 
Methods and Inoculation. 

The Endermic Method obviates the difficulty of absorption through the 
cuticle by removing the latter with a blister, and then powdering the 
medicament over the surface of the denuded derma. Before the intro- 
duction of the hypodermic method this procedure was quite common, but 
it is rarely employed now, as it is both painful and unpopular. 

An ordinary Cantharides-plaster, followed by a poultice to raise the blister, may be 
employed ; but a quicker method is to place upon the skin a piece of lint soaked in 
Stronger Water of Ammonia, covering it with a watch-glass or a piece of oiled silk to 



J2 DOSAGE OF MEDICINES. 

prevent evaporation. The blister raises rapidly and should be removed with scissors, 
and the medicine in powder is then placed on the raw surface. Morphine, Atropine, 
Quinine and Strychnine are the agents generally used in this manner. 

The Enepidermic Method consists in placing the medicine in simple 
contact with the epidermis, no friction being used to hasten its penetra- 
tion. Chloroform and oleic acid solutions of the alkaloids pass by osmo- 
sis in this manner with comparative ease, but aqueous solutions act very 
slowly, and alcoholic ones with great difficulty if at all. Drugs are readily 
absorbed from the surface of hot, moist poultices, a fact to be remem- 
bered in directing such applications for children, as narcotic poisoning 
may follow the liberal use of opium in this manner. A good belladonna 
plaster will cause dilatation of the pupils and may produce the character- 
istic rash all over the body. 

The Epidermic Method or Inunction consists in the use of friction to 
promote the passage of the medicament between the cells of the epider- 
mis. Mercurial ointment, cod-liver oil, and other fats, oleates, etc., are 
rubbed into the skin of the armpits, the popliteal space, and other parts 
of the body, for their local and systemic effects. Oil inunctions are an 
excellent method of introducing fatty substances into children and per- 
sons who cannot take oils by the stomach. The inunction of castor oil 
will produce a purgative effect. 

Inoculation is the introduction of medicinal agents through the scraped 
or punctured skin by an operation similar to that employed for vaccina- 
tion. 



DOSAGE OF MEDICINES. 



The Doses given throughout this book are for adults ; for children the 
following rule (Young's) will be found the most convenient. Add 12 to 
the age and divide by the age, to get the denominator of a fraction, the 
numerator of which is 1. Thus, for a child two years old, -2-^2.— ^ 
and the dose is one-seventh of that for an adult. Of powerful narcotics 
scarcely more than one-half of this proportion should be used. Of mild 
cathartics, two or even three times the proportion may be employed. 

Children bear Opiates badly : — but on the other hand they stand comparatively large 
doses of several other drugs ; such being Arsenic, Belladonna, Ipecacuanha, Calomel 
and other preparations of Mercury, also Squill, Rhubarb and several other purgatives. 
Pilocarpine has very little effect on children, though it readily induces perspiration and 
salivation in adults. 

For Hypodermic Injection, the dose should be two-thirds or three-fourths of that 
used by the mouth ; by rectum five-fourths of the same. Strychnine acts more actively 
when given per rectum than by the stomach. 



DOSAGE OF MEDICINES. 73 

Conditions which modify the action of medicines, and therefore affect 
their dosage, are — age, body-weight, temperament and idiosyncrasy, drug- 
habits, intervals between doses, time of administration, condition of the 
stomach, temperature of the body, cumulative drug-action, mode and 
form of drug-administration, disease, climate, race, etc. 

The Dosage of Medicines is the weakest part of the therapeutic 
armament, the flaw in our weapons which may be the cause of their fail- 
ure at any moment, perhaps the most critical one for a life. If the accu- 
mulated rubbish of ages, which has been called therapeutic knowledge, is 
ever to be given scientific shape, or placed in process of becoming a sci- 
ence, the question of dosage must form one of the principal corner-stones 
in the foundation. Drugs have widely differing actions on the human 
organism in health and in disease, according as they are administered in 
different doses, in different menstrua, and during different conditions of 
the subject's health. This difference, when between extremes of dosage, 
is often so wide as to separate actions directly contrary to each other, the 
action of the very large dose opposing that of the very small one : — a 
truth hidden by one set of dogmatists under their former doctrine (now 
rule) of "similars," and avoided by the great mass of the medical pro- 
fession, through dread of the bogy-name "irregular." 

In the British Pharmacopoeia a minimum and maximum dose is stated for all the 
more important medicines, the quantities being intended to represent average doses in 
ordinary cases for adults. In the preface to that work it is however distinctly stated that 
these doses " are not authoritatively enjoined," and that " the practitioner must rely on 
his own judgment and act on his own responsibility in graduating the doses of any thera- 
peutic agents which he may wish to administer to his patients." As a matter of fact, 
most British practitioners ignore the doses given in their pharmacopoeia, or at best con- 
sider them as mere indications. The German Pharmacopoeia has appended to it a 
table giving the maximum single dose and the maximum daily dose for a number of 
drugs and preparations, but they are of little value in practice except to catch an unwary 
physician in a legal proceeding for mal-practice. 

In the following pages an effort has been made, whenever possible, to 
indicate the different doses of active agents for different purposes, and 
the proper intervals for repetition in certain cases, as determined by the 
accumulated experience of clinicians, which is the only safe guide in this 
respect at present. The average doses of the official preparations should 
be memorized by the student, and the following rules will be found use- 
ful for that purpose. 



Average Adult Doses of Official Preparations. 

Acids (dilute), n\,x ; — except Dilute Hydrocyanic Acid, the average dose of which 
isTiyij. 

Alkalies, — Liquor Potassae, TT^x, well diluted ; Carbonates, gr. xv ; Sodium Borate 
(Borax), gr. xx ; Bicarbonates, gr. xxx. 

Alkaloids and their Salts, form three groups, (i) those of the Solanacece, etc., the 
average dose of which is gr. y i ^ ; (2) those from A T ux Vomica, gr. ^ ; (3) those from 



74 DOSAGE OF MEDICINES. 

Opium, gr. % ; — except Codeine, gr. j, Narcotine (which is not a narcotic), gr. iij, 
Quinine and the other Cinchona alkaloids, gr. x. 

Aquae (Waters), ^;j ; — except Aqua Ammoniae, TT^x, Aqua Chlori, TT^xv, and Aqua 
Creosoti, gij. 

Extracts, gr. v ; — except Ext. Physostigmatis, gr. T L, Ext. Aconiti, gr. }(, Ext. 
Belladonnae, gr. yfc, Ext. Colchici Radicis, gr. j, Ext. Colocynthidis, gr. j,Ext. Cannabis 
Indicae, gr. ^, Ext. Opii, gr. ]/ 2 , Ext. Stramonii, gr. ^ , and Ext. Aloes, gr. iij. 

Fluid Extracts, rr\x ; — except the fluid extracts of Aconite, TT\j, Belladonna, rr^ij, 
Colchicum-root, m^v, Colchicum-seed, TTyj, Digitalis, TT\j, Nux Vomica, mjj, Sanguina- 
ria, Uljj, Squill, rryj, Stramonium, Ttljj, and Veratrum Viride, TT^ij. 

Infusions and Decoctions, ^j ; — except Infusion of Digitalis, gij. 

Mixtures, 3J ; — except the Mistura Glycyrrhizae Composita (for children), 3J, and 
Mistura Ferri Composita, 3 iij. 

Oils, Fixed, Jss; — except Oleum Phosphoratum, Ttyij, and Oleum Tiglii (Croton 
Oil), ™j. 

Oils, Volatile, Tr^ij ; — except Oleum Amygdalae Amarae, "IT^ss, and the Oils of Co- 
paiba, Erigeron, Cubeb, Eucalyptus, Juniper, Sandal-wood and Amber, of each TT^x. 

Pills, gr. v; — except those of Phosphorus, Ferrum Iodide, Opium, Blue Mass, and 
Compound Antimony, which are given in smaller doses. 

Powders, form two classes (i) those given ingrains, including Pulvis Antimonialis, 
gr. v ; Pulvis Morphinae Comp. . gr. x ; Pulvis Ipecac, et Opii, gr. x ; Pulvis Opii,gr. j ; 
Pulvis Cretae Comp., gr. xx ; and Pulvis Jalapae Comp., gr. xxx ; (2) those given in 
doses of a drachm or more, including Pulvis Glycyrrhizae Comp., Pulvis Rhei Comp., 
and Pulvis Effervescens Comp. 

Resins, gr. v; — except Resin of Podophyllum, the average dose of which is gr. ss, 
and Resin of Copaiba, gr. ij. 

Spirits, £ss or more, according to the amount of alcohol desired to be taken; — 
except Spirit of Camphor, tt\x, and Spirit of Nitroglycerin (Spt. Glonoini), Tnjij. 

Syrups, gj ; — except Syrup of the Iodide of Iron, Tn^x, and Compound Syrup of 
Squill, n\x. 

Tinctures, £ss ; — except the tinctures of Aconite, Try, Belladonna, ix\x, Cantharides, 
TT\v, Capsicum, TT^v, Colchicum-seed, TT^xx, Digitalis, Y([x, Chloride of Iron, TTbx, Gel- 
semium, TT^x, Iodine, TKbv, Ipecac and Opium, TT\,x, Lobelia, TT^x, Nux Vomica, KX\x, 
Opium, TTljcv, Physostigma, Vf\x, Stramonium, TT^x, Strophantus, V(\v ; also the tinctures 
given in larger doses, namely that of Hyoscyamus, ^ij, and Camphorated Opium, gij. 
It is well to remember that children bear the above dose of tincture of Belladonna 
without difficulty, and that tincture of Aconite should always be given in doses of a drop 
or less. 

Wines, 7 > ) ;— except those of Antimony, Colchicum, and Opium, the average dose of 
each of which is TTbx. 

Vinegars, are only two in number, — that of Opium, n\x, and that of Squill, tt^xxx. 



PART I 



MATERIA MEDICA AND THERAPEUTICS. 



ABRUS, Jequirity (Unofficial), — is the seed of Abrus precatorius, 
the Wild Liquorice, a plant of the nat. ord. Leguminosae, indigenous in 
India, but growing wild in most tropical countries. The seeds are small, 
hard, of a bright scarlet color, and contain some fixed oil, A brie Acid, 
C 12 H 2 4N 3 0, and two proteid poisons, a paraglobulin and an albumose, the 
latter of which is named Abrin. The root, leaves and branches contain 
sugar and a principle which closely resembles glycyrrhizin. 

Preparation. 

Infusum Abri, Infusion of Jequirity (Unofficial), — prepared by macerating three 
powdered seeds in ^ ss of cold water for twelve hours, adding 3 ss of boiling water, and 
filtering when cold. It should be used while fresh, as after two or three days it is worth- 
less, and is found in a short time swarming with bacteria. Another formula contains 
gr. ix to the ^ , with gr. iv of Boric Acid to prevent decomposition. 



Physiological Action and Therapeutics. 

Jequirity seeds, when moistened with water, become highly poisonous. 
If applied to the conjunctiva, a severe inflammation is set up, with edema 
and false membrane, ulceration of the cornea, and extension to the lids, 
face, neck, and submaxillary glands. Inserted into a wound in cattle, 
they cause death in a few hours. Sidney Martin has shown that the pro- 
teid poisons contained in Jequirity seeds are almost identical in their 
physiological and toxic properties with the similar principles found in 
snake venom, although less powerful. 

Jequirity is used for the purpose of producing a purulent or croupous 
conjunctivitis, by which to destroy old granulations (trachoma) and 
pannus. A mild infusion is applied to the eye two or three times a day 
for two days, and followed by weak solutions of Alum or Borax. This 
should be repeated after three weeks if necessary. An emulsion of the 
seeds in water is a useful application to unhealthy ulcers and lupus. 

75 



y6 ABSINTHIUM ACETANILIDUM. 

ABSINTHIUM, Wormwood,— the leaves and tops of Artemisia Absinthium, a 
perennial garden herb of the nat. ord. Compositae, indigenous in Europe, but cultivated 
in the United States. It contains a volatile oil and a bitter principle, Absinthin. Dose, 
gr. xx-xl, in infusion. There are no official preparations, but of the formerly official 
Vinum Aromaticum, Absinthium constituted one per cent. 

Absinthe, the French liqueur, is an alcoholic solution of the oil, containing also ex- 
• tracts of Anise, Marjoram and Angelica. Its continued use produces various nervous 
symptoms, morning nausea and vomiting, also a tendency to epileptiform convulsions. 

The bitter constituent of Absinthium is stimulant to the digestive organs, but the oil is 
a narcotic poison. It increases the cardiac action, and produces tremor, stupor, epilepti- 
form convulsions, involuntary evacuations, and stertorous breathing. It is but little used 
in medicine, only as a stomachic tonic in dyspepsia. 

ACACIA, Gum Arabic, — is a gummy exudation from Acacia Sene- 
gal, a small tree of the nat. ord. Leguminosae, indigenous in Africa. It 
occurs in spheroidal tears of various sizes, breaking with a glassy, some- 
what iridescent fracture ; insoluble in alcohol, but soluble in water, form- 
ing a thick and mucilaginous liquid. It consists of Arabin or Arabic 
Acid, C 12 H 22 O n , combined with calcium, potassium and magnesium. 

Mucilago Acaciae, Mucilage of Acacia, — has of Acacia 35, Water to 100 parts. It 
should not be prescribed with tinctures or spirits except in very small quantity. Dose, 
indefinite. 

Syrupus Acaciae, Syrup of Acacia, — has of the Mucilage 25, Syrup 75. Should be 
freshly made. Dose, indefinite. 

Acacia enters into the composition of Mistura Amygdalae, Mistura Glycyrrhizae Com- 
posita, Pulvis Cretae Compositus, Trochisci Cretae, Trochisci Cubebae, and Trochisci 
Glycyrrhizae et Opii. 

Gum Arabic has no activity except the negative one of a demulcent, 

and is chiefly used in coughs, sore throats, catarrhal inflammation of the 

stomach and intestines, and irritant poisoning. It is much employed in 

pharmacy to suspend insoluble powders in mixtures, for which purpose 

^ the mucilage is generally used. 

ACETANILIDUM, Acetanilid, Antifebrin, — is a derivative of 
Anilin, from which it is obtained by the action thereon of glacial acetic 
acid, substituting the organic radicle Acetyle for an atom of hydrogen. 
Chemically, it has the name of Phenyl-acetamide, and the formula C 6 H 5 - 
NHC 2 H 3 0. 

The name Ajttifebrin is copyrighted by its original promoters for trade purposes, and 
therefore should be dropped from professional usage. 

Acetanilid is a white crystalline powder of neutral reaction, and odor- 
less, but of slightly burning taste. It is freely soluble in alcohol, wine, 
etc., but very sparingly (1 in 200) in cold water, more readily in hot 
water. In solution it turns orange-red (Antipyrin, grass-green) upon the 
addition of a few drops of sodium nitrite solution and a few drops of 
concentrated sulphuric acid. 



ACETANILIDUM. JJ 

The Dose ranges from gr. ij to gr. x, repeated twice, and not exceeding gr. xxx in the 
24 hours. As much as sjj has been swallowed without ill effects supervening. It may 
be administered in the very convenient form of compressed tablets ; — also in powders, or 
in dilute alcoholic solution. gj may be dissolved in ^ivss of brandy, to which, if we 
add g vj each of simple syrup and water, we get a six-ounce mixture, of which a table- 
spoonful (^ss) contains 5 grains of Acetanilid, a fair adult dose. As an antipyretic, 
gr. iij may be administered every ^ to y z hour, until 12 or 15 grains have been given, 
which will usually be a sufficient quantity, especially if given at the acme of the febrile 
movement. 

Unofficial Derivatives and Allied Compounds. 

Acetanilid Compound (Aulde), — is, a mixture containing Acetanilid 70, Caffeine 10, 
and Sodium Bicarbonate 20 per cent., and is put up in the form of compressed tablet 
triturates, each containing y z grain of the mixture. It is intended to replace the numer- 
ous proprietary preparations sold under fancy names and having acetanilid and caffeine 
as the active constituents. Dose, from 10 to 30 tablets. 

Agathin, Salicyl-aldehyde-a-methyl-phenyl-hydrazo7ie, — is a synthetic compound, 
which has been used extensively in Europe as an anti-neuralgic and anti-rheumatic rem- 
edy. Dose, gr. v-x, two or three times a day, but from 3 ss to 3 jss must be given before 
any effect is produced. 

Ammonol, Ammoniated Phenylacetamide , — a proprietary antipyretic and analgesic, 
claimed to possess unusual stimulating and expectorant properties due to the loosely com- 
bined Ammonia in its composition. Beringer concludes that it is merely an admixture of 
Acetanilid 2 parts, Sodium Bicarbonate I and Ammonium Carbonate I, with a minute 
quantity of the dye Metanil-yellow. A similar mixture is used at the Philadelphia Hos- 
pital under the name Ammoniated Acetanilid, which consists of Acetanilid, 2 X / Z grains, 
Sodium Bicarbonate, 1^ grains. Ammonium Carbonate, I grain ; this for a minimum dose. 
Dose, of Ammonol or Ammonol Salicylate, gr. v-xx. 

Analgen, 07'tho-oxy-ethyl-ana-mono-acetyl-amido-chinolin, — a Chinolin derivative ; 
was reformed by inserting benzoyl instead of the acetyl radicle, and re-christened Quin- 
ALGEN. (See below.) 

Analgesine, — a proprietary preparation, consisting of Acetanilid 60, Ammonium 
Chloride 20, Citrated Caffeine 10, Sodium Bicarbonate 10. Dose, gr. v-xv. 

Antikamnia, — is a proprietary preparation widely advertised as an antipyretic and 
analgesic. Analyses of several samples have been made by different chemists, all of 
which agree in finding the chief ingredients to be Acetanilid and Sodium Bicarbonate in 
varying proportions. By some observers Caffeine was detected, also Tartaric Acid, etc. 
The preparation is formulated by the latest analysis as a mixture of Acetanilid 70, Sodium 
Bicarbonate 20, and Caffeine 10 per cent. Dose, gr. v-xv, in powder or tablets. 

Antikol, — contains Acetanilid 75, Sodium Bicarbonate 17^, Tartaric Acid 7^ per 
cent. (Squibb). Dose, gr. v-xv. Another " Antikol" is advertised by its manufacturer 
to consist of Acetanilid, Quinine Bisulphate, Sodium Bicarbonate, and Caffeine Citrate, 
the latter in the proportion of 10 per cent. Antilupin is a similar preparation. 

Antinervin, Salbromalide [Salicylbromalide) , — is a mixture of Acetanilid 2, with I 
part each of Salicylic Acid and Ammonium Bromide (Ritsert). Dose, gr. v-xv. 

Antipyrinum, Antipyrin [Phenazone), — is described under its own title. 

Caffacemon and Caffenol, — are mixtures of Acetanilid and Caffeine, and are given 
in doses of gr. v-xv. 

Exalgin, Methyl- acetanilid, — is a crystalline compound allied to Acetanilid, occurring 
in acicular needles, readily soluble in dilute alcohol, less so in warm water, and with 
difficulty in cold water. Dose, gr. j-v, in wine, or other dilute alcoholic mixture. Alco- 
hol ^ss, and Water 3jj form a permanent solution with gr. xvj of Exalgin. Its name, 
derived from ef, otit of, a'kyoq, pain, denotes its principal therapeutic action. 

Exodyne is a mixture of Acetanilid 90, Sodium Salicylate 5, and Sodium Bicarbon- 
ate 5. The name (from ef, out of, odvvr], pai?t) sufficiently states its claims to medicinal 
virtue. Dose, gr. iij-x. 



7& ACETANILIDUM. 

Febrinol, Methyl-para-acet-phenetidin, — so called by its proprietors, is a mixture of 
Acetanilid and other inert substances, advertised at one-half the price of similar coal-tar 
preparations. 

Malakin, Salicyl-para-phenetidin, — is a combination of Phenacetin and Salicylic 
Acid, and is described under Salicinum, in this book. 

Migranin, — is a double Citrate of Antipyrin and Caffeine, and is described under 
Antipyrinum, in this book. 

Neurodin, Acetyl-para-oxyphenyl-tirethane, — an analgesic, antineuralgic and anti- 
rheumatic remedy. Its antipyretic action is too sudden for it to be used as a general anti- 
pyretic. Its action is uncertain and much inferior to that of phenacetin or antipyrin 
(Lippi). Dose, gr. v-xxv, but ^jss has been taken in 24 hours without ill effects. 

Phenacetin, Methacetin and Phenocoll, — are closely allied to Acetanilid, both 
chemically and medicinally, and are described under the title Phenacetinum, et seq. 

Phenatol, — contains Acetanilid, Sodium Carbonate, Bicarbonate, Chloride and Sul- 
phate, also Caffeine. Dose, gr. v-x. 

Phenolid, — is a mixture of Acetanilid 58, and Sodium Salicylate 43, and competes 
with the above as a panacea. Dose, gr. v-xv. 

Pyretine, — contains Acetanilid, Caffeine, Sodium Bicarbonate and Chalk, in varying 
proportions. Dose, gr. v-x. 

Quinalgen, Oi'tho-ethoxy-ana-mono-benzoyl-a??iido-quinolin, — is a derivative of Quin- 
olin (Chinolin), and is a reformation and renaming of the preparation named Analgen 
(see p. 77). It is described under Chinolinum. Dose, gr. vij-xv, up to gr. xlv daily. 

Salfene and Kaputin are Acetanilid mixtures, the latter being simply powdered 
Acetanilid colored with some indifferent substance. 

Thermodin, Acetyl-para-ethoxy-phenyl-methane, — is closely allied to Neurodin (see 
above), which it resembles in all respects except its smaller dose, gr. v-x. 



Physiological Action. 

Acetanilid is strongly analgesic, somewhat hypnoticand antispasmodic, 
a moderately efficient antipyretic, also a decided antiseptic and local 
anesthetic. It lessens the reflex action of the spinal cord, and inhibits 
the sensibility of the sensory nerves. It raises arterial tension somewhat, 
and slows the heart in a corresponding degree, quiet sleep often following. 

Compared with the action of Antipyrin, the effect of Acetanilid on 
the body-temperature is manifested more slowly (1 hour against j£ hour), 
but lasts a longer time (6 against 2 hours). It is markedly diuretic, and 
somewhat diaphoretic ; is a cerebral, muscular and vaso-motor stimulant, 
and leaves no ill after-effects ; — while Antipyrin is powerfully diaphoretic, 
a cerebral sedative, and produces great depression. Furthermore, Ace- 
tanilid frequently produces nearly the same degree of reduction of body- 
temperature as Antipyrin, with the ingestion of only one-fourth the dose; 
and, like the latter agent, it has little or no effect on the normal tempera- 
ture, but its continued use begets tolerance of its action. Its antipyretic 
action, is, however, less reliable than that of Antipyrin, and corresponds 
in degree and in duration to the size of the dose. There is neither vomit- 
ing nor diarrhea afterwards, but there is a tendency in some cases to col- 
lapse with chills and cyanosis, especially the latter, during the period of 



ACETANILIDUM. 79 

depressed temperature. The cyanosis often caused by this drug without 
other toxic symptoms is probably due to the liberation of free anilin in 
the blood. 

A toxic dose destroys the ozonizing function of the blood, decoloriz- 
ing its corpuscles and forming methyl-hemoglobin. The heart, liver and 
kidneys of animals poisoned thereby are found in a state of acute fatty 
degeneration. Its continued use in large doses is highly injurious to the 
blood, especially in diseases (as typhoid fever) which are themselves de- 
structive to the blood-elements. 

Therapeutics. 

Besides being a fairly efficient antipyretic, Acetanilid has marked anal- 
gesic and antispasmodic powers ; and these, together with its great ad- 
vantages of a small dose, comparative efficiency and safety, and the 
absence of the severe rigors and cardiac depression which mark the chino- 
lin derivatives, combine to make it an agent of wider therapeutical 
range than most of its analogues. It is especially useful in phthisis and 
typhoid fever for its action on pyrexia, thereby relieving wakefulness, 
lessening delirium, and upholding a failing heart ; but if long used in 
large doses in the latter disease it may increase the liability to serious 
sequelae, especially periostitis of the ribs, gangrene of tissues, etc. For 
the pains of locomotor ataxia, and in those of rheumatic origin, as sciatica 
and lumbago, it is a most efficient remedy. In acute rheumatism, influ- 
enza, and scarlet fever it is highly praised ; and in acute bronchitis doses 
of four grains every two hours have often arrested the attacks within 
twenty-four hours. In epilepsy it has been tried, with the view of mod- 
erating reflex excitability. Added in minute proportion to aqueous solu- 
tions for hypodermic use, it is said to preserve them from decomposition 
more efficiently than any other agent hitherto employed for that purpose. 
It acts very well with children, when used in proper doses; but in all 
cases overdosing must be avoided, both as to quantity and repetition. 

Acetanilid is now extensively employed in surgical practice as a dry 
dressing for wounds, burns, scalds, and other injuries involving breach 
of the tissues. Dusted in fine powder over the surface of a wound it 
promotes healing, prevents suppuration, relieves pain, and is odorless, 
unirritant and non-toxic, though a few cases of very young children are 
reported in which its topical application to wounds caused cyanosis and 
symptoms of collapse. It has also been used with much benefit as an 
application to mucous patches and rectal ulcers. 

Antinervin attracted much attention during the epidemic of influenza in Scotland, 
as an analgesic and antipyretic. It relieved the pains in the back and head, reduced the 
fever and produced copious perspiration, without being followed by unfavorable sequelae. 
It has proven to be of great benefit in acute rheumatism, and may be used with advan- 



r 



8<D ACIDUM ACETICUM. 

tage in all abnormal excitement of the nervous system, either against neuralgia or as a 
general nerve sedative. The best way to prescribe it is as an extemporaneous mixture, 
containing the proper proportions of its ingredients, viz. — Acetanilid 50, Salicylic Acid 
25, and Ammonium Bromide 25 per cent., mixed secundum artem, and administered in 
doses of gr. v-xv every two hours until relief is obtained. 

Exalgin resembles Acetanilid and Antipyrin in its antipyretic and analgesic powers. 
Compared with the latter it is less efficiently antipyretic, but more powerful as an anal- 
gesic and antiseptic. In overdose it is highly dangerous, having produced symptoms 
resembling those of angina pectoris, also toxic effects resembling those of carbolic acid, 
with delirium, dyspnea, cyanosis, and renal disturbances. It has been used with most 
excellent results in neuralgias ; also in chorea. In the latter affection daily doses of 3 
grains were sufficient. 

ACIDUM ACETICUM, Acetic Acid,— is a liquid composed of 
36 per cent, of absolute Acetic Acid, HC 2 H 3 2 , and 64 per cent, of water. 
It is a clear, colorless liquid, of a distinctly vinegar odor, a purely acid 
taste, and a strongly acid reaction ; miscible in all proportions with water 
and alcohol, and wholly volatilized by heat. It is prepared from wood 
by destructive distillation and purification. Acetic Acid is also official 
in two other degrees of concentration, viz. — 

Acidum Aceticum Glaciale, Glacial Acetic Acid, HC 2 H 3 2 , — is nearly or quite 
absolute Acetic Acid, solid below 59 F. , above that temperature a colorless liquid. Is 
strongly escharotic and only used locally. 

Acidum Aceticum Dilutum, Diluted Acetic Acid, — consists of Acetic Acid 10, Dis- 
tilled Water 50 parts, contains 6 per cent, of absolute Acetic Acid, and has a sp. gr. of 
1.008. Dose, 3J-ij. 

Acetum, Vinegar (Unofficial), — is an impure diluted Acetic Acid, produced by the 
acetous fermentation of any liquid susceptible of the vinous fermentation. 

Diluted Acetic Acid is used in the preparation of the two official Aceta (Vinegars). 

Physiological Action and Therapeutics. 

Acetic Acid, like the other vegetable acids, in concentrated form is 
escharotic and produces gastro-enteritis if swallowed. In dilute form it 
acts as a refrigerant, diminishing thirst and allaying restlessness. It forms 
salts in the stomach, thus enters the blood, and is there oxidized, produc- 
ing carbonic acid and thereby increasing the acidity of the urine. It is 
also diuretic. Long used, it causes emaciation and poverty of the blood, 
producing a general scorbutic condition. It is hemostatic and anthel- 
mintic, and the vapor inhaled causes reflex contraction of the vessels and 
raises the blood-pressure. Lately, investigations into its germicidal 
powers have given it high rank among germ-destroyers, a solution con- 
taining 7 per cent, of this acid proving as efficient as mercuric chloride. 

The glacial acid is used as a caustic in many skin affections, as warts, 
condylomata, etc., and to destroy the parasite in ringworm and pityriasis. 
It has been employed locally in carcinoma, with the view of dissolving 
the supposed cancer-cells. The dilute acid is used locally in superficial 
inflammations of the skin, and may be sponged over the body to check § 



ACIDUM BORICUM. 8 I 

perspiration and reduce the surface temperature in fevers. It is often 
administered internally to reduce obesity, which it does by impairing 
digestion. Locally, it may be employed to arrest slight hemorrhages, 
as epistaxis; and it is occasionally used by enema for the destruction of 
ascarides. Acetic acid is highly praised by Squibb as a solvent for the 
active principles of drugs, which it extracts completely, so that it may be 
substituted for alcohol in the preparation of both fluid and solid extracts. 



ACIDUM BORICUM, Boric Acid, Boracic Acid, H 3 B0 3 ,— is a 
weak acid occurring in transparent, colorless, six-sided plates, of unctu- 
ous touch, odorless, of a cooling and slightly bitter taste, soluble in 25 of 
water, in 15 of alcohol and in 10 of glycerin. Its aqueous solubility is 
increased by the addition of hydrochloric acid or borax. It is produced 
from Borax by the action of sulphuric acid ; also by the purification of 
the native acid. Dose, gr. v-xv. There are two official Borates, viz. — 

Sodii Boras, Sodium Borate {Borax), Na^O- -f- loH 2 0, — colorless, transparent 
prisms, of cooling and sweetish, afterwards alkaline taste, and alkaline reaction, soluble 
in 16 of water at 59 F., and in 0.5 of boiling water; insoluble in alcohol. Occurs 
native in ancient lake beds in the Death Valley region, California, and various other 
parts of the world. Dose, gr. v-xxx. 

Glyceryl Borate, Boroglycerin, — official in the following preparation, — 

Glyceritum Boroglycerini, Glycerite of Boroglycerin [Glycerite of Glyceryl Borate, 
Sohition of Boroglyceride), — prepared by heating together Boric Acid 301 and Glycerin 
460, until reduced to 500 grammes, then adding an equal weight of Glycerin. 

Unofficial Preparations. 

Boracic Ointment, — has of Boracic Acid I, White Wax I, Paraffin 2, Almond Oil 
2, thoroughly mixed together. 

Boracic Lotion, — is a saturated solution of the acid in water. 

Boracic Lint, — prepared by steeping lint in a boiling saturated solution and drying. 
It contains nearly one-half its weight of the acid. 

Borine, — is a proprietary antiseptic preparation, advertised to be "composed of the 
active constituents of Benzoin, Wintergreen, Meadowsweet, Golden Rod, Witch Hazel, 
combined with the stearoptenes of Wild Thyme, Eucalyptus, Peppermint, and Boracic 
Acid." What the stearopten of Boracic Acid is the advertisers do not say. It is in- 
tended chiefly for external use, diluted, 1 part to I -4 of water; but may be used inter- 
nally in doses of 3J-ij. 

Boroglyceridum, Borogloceride, — is a solid chemical compound, prepared by heating 
together Boric Acid and Glycerin. It is soluble in water, but is generally used in solu- 
tion with glycerin, as the above official glycerite. It combines readily with Chrysarobin, 
Carbolic Acid, Atropine and Morphine, and is used as a local application in eye diseases 
and skin affections. 

Borolyptol, — is a proprietary preparation intended for use as an antiseptic, both in- 
ternally and locally. It is said to be composed of Aceto-boro-glyceride 5 per cent. , 
Formaldehyde 2 per cent., together with the active antiseptic constituents of Pinus pu- 
milio, Eucalyptus, Myrrh, Storax and Benzoin. Dose, gj-ij, as an intestinal antiseptic. 

Euthymol and Euphormol are similar preparations, advertised as containing Boric 
Acid, Thymol, Menthol, Oil of Eucalyptus, etc. 
6 



I 



82 ACIDUM BORICUM. 

Listerine, — is a proprietary preparation, advertised to be " the essential antiseptic 
constituent of Thyme, Eucalyptus, Baptisia, Gaultheria and Mentha Arvensis, in com- 
bination. Each fluid-drachm also contains two grains of refined and purified Benzo- 
boracic Acid," — whatever that may be. It is chiefly intended for external use, but may 
be given internally, in doses of gj three or more times a day (as indicated), either full 
strength, or diluted with water, or in combination with other drugs. 

Magnesii Bora-citras, Magneshim Borocitrate, — prepared extemporaneously thus : 
& . Magnesii Carbonatis gj, Acidi Citrici ^ij, Sodii Biborat. gij, Aquae Bullientis 
^ viij. A tablespoonful three or four times daily as a solvent: of uric acid calculi. 

Potassii Tartra-boras, Potassium Tartraborate, — is a better solvent of uric acid 
calculi than the Magnesium salt, and is soluble in 2 parts of cold water. Prepared by 
heating together Boracic Acid I, Potassii Bitartras 4, Water 10 parts. Dose, gr. xx, 
largely diluted with water, three or four times a day. 

Sodium Tetraborate is a new preparation (or salt ?) obtained by heating together 
equal parts of Boric Acid, Borax and Water. The resulting compound is neutral, and is 
supposed to be an entirely new salt. It was introduced to furnish a more soluble form 
of Boric Acid, and may be used wherever the latter is indicated, but it has the disad- 
vantage of forming hard crusts upon dressings, which irritate abraded surfaces. 

It has long been known that the addition of Borax to Boric Acid in aqueous solution 
greatly increases the solubility of the acid, — and the above may explain the observed fact. 



Physiological Action and Therapeutics. 

Boric Acid is an efficient antiseptic, disinfectant and deodorant, arrest- 
ing fermentation and putrefaction, and very destructive to all low organ- 
isms. A solution of 1 in 133 arrests the activity of bacteria. It is feebly 
acid and but slightly irritant, and is used in the form of a dusting powder 
as a surgical dressing for its antiseptic and unirritating qualities. Its 
lotion and ointment have been successfully employed in ulcers, eczema, 
burns and scalds, pruritis ani, fetid perspiration, wounds, tinea tonsurans, 
and tinea circinata. 

Sodium Borate is a powerful antiseptic and disinfectant, as it destroys 
low vegetable organisms. It removes the epidermis when locally applied, 
has power to increase uterine contraction, and aids the solution of benzoic 
and boric acids. It is employed as a wash to remove the epidermis from 
the skin, and as a sedative lotion in acne, freckles, chloasma, leucorrhea, 
aphthae, etc., also to allay itching in urticaria, psoriasis, impetigo, and in 
pruritus pudendi, scroti et ani. It has been used internally in amenor- 
rhea, dysmenorrhea, puerperal fever, and puerperal convulsions, for its 
supposed specific action on the uterus; and has been found beneficial in 
epilepsy, though far inferior to potassium bromide in efficacy and far 
more dangerous in toxic effects. It is apparently of most service in cases 
where the bromides fail and in those in which the epilepsy is associated 
with gross organic disease. 

When administered in large doses Borax produces certain toxic symp- 
toms to which the term Borism is applied. These include intestinal dis- 
turbance, nausea, vomiting and anorexia, also dryness of the skin, with 
redness and even inflammation of the mucous membranes. There is 



ACIDUM CARBOLICUM. 83 

.great general weakness, the hair is dry and falls out, and there is an erup- 
tion on the skin, which may assume the forms of seborrheic eczema, red- 
dish patches which desquamate like psoriasis, or papules attended with 
much itching. In severe cases albumin may appear in the urine, and 
edema of the face and extremities may occur, so that whenever this drug 
is given in full doses, a careful watch should be kept upon the state of the 
urine (Fere). 

Boro-glyceride in aqueous solution (1 to 40), or as the official Glycerite, is also a 
powerful antiseptic, and is used as a lotion in purulent ophthalmia and in the treatment 
of wounds, also as a local application to diphtheritic membranes. It is an efficient pre- 
servative of milk and food against putrefactive changes, and is entirely harmless. 

An elegant cosmetic cream may be made by dissolving Boric Acid in Glycerin, and 
then incorporating it with White Wax and Almond Oil. 

ACIDUM CARBOLICUM, Carbolic Acid, Phenol, Phenic 

Acid, Phenyl Alcohol, C 6 H 5 OH, — occurs in Castoreum, in the urine of 
man and of herbivorous animals, and in the products of the dry distilla- 
tion of various organic substances, such as resin, bones, wood and coal. 
It is obtained by the fractional distillation of coal-tar, and subsequently 
purified ; occurring in colorless, interlaced, needle-shaped crystals, of 
characteristic, aromatic odor, deliquescent on exposure to damp air, and 
acquiring a reddish tint with age and light. When copiously diluted 
with water it has a sweetish taste, and a slightly burning after-taste. It 
is soluble in about 15 of water, very soluble in alcohol, ether, chloroform, 
benzol, glycerin, oils and carbon bisulphide ; almost insoluble in benzin. 
It is melted by gentle heating, and is liquefied by the addition of about 
8 per cent, of water. Dose, gr. %-\), well diluted. 

Acidum Carbolicum Crudum, Crude Carbolic Acid, — is obtained 
as above stated, but by a lower degree of heat ; and contains various 
other constituents of coal-tar besides Phenol, chiefly Cresol (Cresylic 
Acid) and Xylic Acid, in varying proportions. Is used as a disinfectant. 

Peculiarities about Carbolic Acid are that the addition of about 8 per cent, of water 
liquefies it, while a further addition of water produces a turbid mixture, until about 15 
parts of water to I of the acid is reached, when a stable and clear solution is formed. 
One volume of the liquefied acid, containing 8 per cent, of water, forms with one volume 
of Glycerin a clear mixture, which is not rendered turbid by the addition of 3 volumes 
of water (absence of Creosote and Cresol). 

Hitherto described as neutral to litmus paper, it is now officially given a faintly acid 
reaction. Its claims to be considered an acid are, however, very feeble, as, though it 
combines with salifiable bases, it is incapable of neutralizing the alkalies, and its combi- 
nations are decomposed by the feeblest acids (carbonic, etc.), sometimes, it is asserted, 
even by water. Chemically, it is considered to be the Hydroxyl (HO) derivative of Ben- 
zene (C 6 H 6 ), which would ally it to the alcohols; but as it does not yield the same pro- 
ducts on oxidation (yielding finally oxalic instead of acetic acid), it is taken as the type of 
a class called phenols, which are simple HO derivatives of the aromatic hydrocarbons. 
[For the chemical theory of the Benzene derivatives see the sub-title Substitutes FOR 
Quinine, under the title Cinchona.] 

Carbolic acid is converted by concentrated sulphuric acid into Sulpho-carbolic Acid, 
C 6 H 5 HS0 4 ; by nitric acid into several substitution-products, the most important of which 



84 ACIDUM CARBOLICUM. 

is Picric Acid. The reddish tint which it acquires with age and light, does not impair 
its properties ; but is not accounted for satisfactorily, though supposed to be due to the 
presence of Atirin and Rosolic Acid, impurities which form a red compound by the 
absorption of C0 2 and oxygen. 

Carbolic Acid coagulates albumin and collodion, Creosote does not. 

Official Preparations. 

Unguentum Acidi Carbolici, Ointment of Carbolic Acid, — strength 5 per cent. 
Carbolic Acid 5, Unguentum 95. For external use. 

Glyceritum Acidi Carbolici, Glycerite of Carbolic Acid, — has of Carbolic Acid i,in 
Glycerin 4. Dose, ff\v-x in water. It should be diluted with an equal quantity of 
water for external use. 

Sodii Sulpho-carbolas, Sodium Sulpho-carbolate, NaS0 3 C 6 H 4 (OH)-|-2H 2 0, — is pre- 
pared by dissolving Carbolic Acid in an equal part of strong Sulphuric Acid, thus form- 
ing sulpho-carbolic acid, which is neutralized with barium carbonate, and then treated 
with water and sodium carbonate, forming a solution of Sodium Sulpho-carbolate, which 
is evaporated to crystallization. It occurs in transparent, rhombic prisms, soluble in 5 of 
water, less freely in alcohol and in glycerin. Dose, gr. x-xxx. 

Sulpho-carbolates of Ammonium, Magnesium, Potassium and Sodium crystallize in 
tufts of acicular crystals, more or less white ; Sulpho-carbolate of Copper, in transparent, 
light blue, interlacing prisms; of Iron, in small brown, micaceous crystals ; of Zinc, in 
transparent, rectangular, colorless plates. That of Sodium is the only one official. 

Unofficial Preparations. 

Aqua Acidi Carbolici, Carbolic Acid Water, — has of the Glycerite of Carbolic Acid 
gx, to Aquae Oj. Dose, gj-iv. 

Carbolic Acid Solutions, — for antiseptic surgery, are — 

5 per cent, in Water, (TT\,xxv to the §), as a spray or wash. Is decidedly 

irritant. 
2.y z per cent, in Water, (n^xij to the ^ ) , for sponges, hands, or as a lotion. 
5 percent, or less in Olive Oil, as a special dressing. 

Carbolic Acid Gauze, — is Gauze medicated with Carbolic Acid I, Resin 5, Paraffin 
7, and may be used as a surgical dressing. 

Carbolic Acid Plaster, — an unofficial plaster composed of Carbolic Acid 25, Shellac 
75, coated with Gutta-percha dissolved in Carbon Disulphide. 

Phenol Sodique, — is composed of Carbolic Acid, gr. 188, Caustic Soda, gr. 31, 
Distilled Water, giv. 

Phenol-camphor, — has of Carbolic Acid and Camphor, equals parts. A colorless, 
refractive liquid ; soluble in alcohol, ether, chloroform and oils ; insoluble in water or 
glycerin. Used as a local anesthetic, chiefly for toothache ; also in the proportion of Car- 
bolic Acid I, Camphor 3, as an application to false membrane in diphtheria, and as sub- 
cutaneous and intrapulmonary injections in phthisis. Campho-phenique is a similar prep- 
aration. (See under Camphora.) 

Phenol Iodatum, Iodized Phenol, — a mixture of Iodine and crystallized Carbolic 
Acid. (See under Iodum.) 

Pheno-resorcin, — is a mixture of Carbolic Acid 67 with Resorcin 33 and Water 10, 
forming a liquid which mixes readily with water. It is supposed to combine the virtues 
of both its ingredients. 

Phenosalyl, — is a clear, syrupy liquid, consisting of a mixture of Carbolic, Salicylic 
and Benzoic Acids, melted together and dissolved in Lactic Acid. It is very soluble in 
water, has a pleasant and non-persistent odor, and is used in a I per cent, solution as an 
antiseptic application. 

Aseptol, — is the trade name of a 33.3 per cent, solution of Sozolic or Ortho-phenol- 
salphonic Acid, which is formed when Carbolic Acid is dissolved in concentrated Sul- 
phuric Acid. Aseptol occurs as a syrupy liquid which crystallizes in small deliquescent 
needles, decomposes when distilled and is very soluble in water, also in alcohol and in 
glycerin. It has a faint odor of carbolic acid, and is asserted to be antiseptic but neither 
poisonous nor irritant, and hence of especial value in abdominal and ophthalmological 



ACIDUM CARB0L1CUM. 85 

surgery. In spite of these allegations it is probably toxic, and at any rate has been shown, 
by a careful series of comparative experiments, to have not more than one-third the anti- 
septic power of carbolic acid. It has been recommended for internal use as a substitute 
for Salicylic Acid, on account of its greater solubility. It has been employed in concen- 
trated solution for the treatment of pharyngitis and diphtheritic laryngitis. Externally it 
is used so diluted as to contain from 3 to 10 per cent, of the active principle. 

Aseptolin, — is a solution containing about 2^ per cent, of absolute Carbolic Acid 
and 0.02 percent, of a new pilocarpine salt named Pilocarpine-phenyl-hydr oxide. It is 
intended for hypodermic use only, in one daily dose of 50 to 250 minims for adults, 
injected into the abdominal parietes or into the muscles of the back. 



Allied Products and Derivatives. 

Creosotum, Creosote, — is a similar product, obtained from wood-tar. It consists of 
a mixture of phenols, chiefly Guaiacol (C 7 H 8 2 ), and Creosol (C 8 H 10 O 2 ) ; and by the 
action of nitric acid is converted into oxalic acid principally, while Carbolic Acid is con- 
verted into picric acid by that reagent. Creosote does not coagulate albumin or collodion, 
Carbolic Acid does. It is described under its own title. 

Resorcinum, Resorcin, C 6 H 6 2 , — is also a phenol, obtained from certain resins by the 
action of fusing alkalies, and is described under its own title. 

Creolin (Unofficial), — was the first form in which the cresols were presented in a 
liquid condition for use in medicine. It is a coal-tar product, occurring as a dark brown, 
alkaline, semi-fluid substance, of the consistence of honey. It forms a white cloud when 
added to water, with which, however, it is miscible, as an emulsion, up to about 10 or 12 
percent, strength. The Solutions in general use vary from ^ to 2 per cent.; the Oint- 
ments to 5 per cent., and Creolin Gauze is prepared of 10 per cent, strength of the drug. 
Dose, TTLiij-v, in capsules. 

Lysol (Unofficial), — one of the latest disinfectants and antiseptics, is a saponified 
product of coal-tar. It is essentially a solution of tar-oils (cresols) in neutral soap, and 
occurs as a clear, brown, oily liquid, miscible readily with water, and forming clear solu- 
tions with glycerin, alcohol, chloroform and various other fluids. It is employed as a 
local application only, generally in a I per cent, solution. 

Trikresol (Unofficial), — is a mixture of the three isomeric cresols, respectively named 
the ortho-, meta- and para-methyl phenols, and also contains the hydroxyl group, which 
seems to be a characteristic constituent of antiseptics and germicides. It occurs as a 
white liquid, of creosote-like odor, sp. gr. 1,042 to 1,049, an d is soluble in water to the 
extent of 2. 55 per cent. Its solutions are clear and do not impart any sensation of numb- 
ness to the fingers. It is a powerful germicide in solutions of I per cent, strength, which 
are said to be as efficient as a 5 P e r cent, solution of carbolic acid. Trikresol Water 
(1 part to 1000) is used as a menstruum for the ordinary collyria employed in ophthal- 
mological practice. 

Saprol, Disinfection Oil (Unofficial), — is a dark brown, oily mixture, highly inflam- 
mable, and composed of the crude cresols in a great excess of the liquid hydrocarbons 
obtained from the refining of petroleum. It floats on water and yet gives up its soluble 
constituents as disinfectants to the offending fluid, leaving the remainder as an oily film 
on the surface to hinder the escape of disagreeable odors, and the spread of infecting 
spores. It is a cheap disinfectant, and can be employed on a large scale in barracks, 
prisons, schools, etc., if no light or fire is brought into proximity with it. Sewage treated 
with it still retains its value as a manure ; and so small a quantity as one per cent, of it 
will effectually sterilize urine and fecal matter impregnated with micro-organisms, as the 
bacilli of cholera and typhoid fever (Laser). 

Solutol and Solveol (Unofficial), — are disinfectants of the same class as the preceding, 
both being soluble forms of the insoluble Cresol (Cresylic Acid). Solutol is an alkaline 
solution of Sodium Cresylate in an excess of Cresol, and is not suited for surgical use, by 
reason of its caustic alkalinity ; but is of marked utility in the preservation of the- 
cadaver, and for general and copious use in disinfecting water-closets, sinks, infected 
bed-clothing, sputa, and deleterious discharges of all kinds. 

Solveol differs from Solutol in containing sodium cresotate instead of sodium cresy- 



86 ACIDUM CARBOLICUM. 

late, is devoid of the causticity so characteristic of the latter substance, and is also free 
from the greasiness of creolin and lysol. It is a dark-colored, nearly odorless liquid, 
of neutral reaction, soluble in water in all proportions. It is especially applicable to 
surgical uses, a y£ percent, solution being employed for dressings, being more active (it 
is claimed) antiseptically, than a 2 per cent, solution of carbolic acid. 

Physiological Action. 

Carbolic Acid is antizymotic and antiseptic, a good disinfectant, some- 
what antipyretic, also a local anesthetic, and a depressant of the cardiac, 
respiratory, cerebral and spinal functions. In strong aqueous solutions 
it is destructive to low forms of life, rapidly destroying all organized fer- 
ments, both animal and vegetable. On unorganized ferments (enzymes), 
such as pepsin and ptyalin, it does not act so readily, but in large doses 
it likewise destroys their activity, and it is an efficient parasiticide against 
certain vegetable parasites which infest the skin. The foregoing is true 
of the liquefied acid and its aqueous and glycerin solutions, but not of 
its solutions in oils, which have no antizymotic properties. 

Applied to the skin in weak or moderately strong solutions, it produces 
local anesthesia with a sensation of numbness, which lasts for several 
hours. Applied in concentrated form, it is irritant and superficially 
escharotic, with burning pain of brief duration, and produces at the point 
of application a white spot, changing to red if the acid is soon removed. 
It does not vesicate, but if the application be prolonged, a white eschar 
or slough results, from coagulation of the albumin of the tissue, and this 
is bordered by a red zone of inflammation. Even a 3 per cent, aqueous 
solution, kept on a part for several days, has produced dry gangrene of 
the tissues (Czerny). 

Taken internally, the concentrated acid has the same effect on the 
mucous membranes as on the skin, producing white, superficial eschars, 
after burning pain of short duration, in the mouth, gullet and stomach. 
To the latter viscus it is a powerful irritant, and causes a violent gastritis. 
In medicinal doses, when acted upon by the gastric secretions, it is con- 
verted into a sulpho-carbolate, and is so diluted by the contents of the 
stomach that it loses its antizymotic power, and hence is of no value as 
an internal antiseptic remedy. In the blood it probably circulates as an 
alkaline carbolate, in medicinal doses having no effect upon the circu- 
lation or respiration. Its antipyretic power is incapable of being utilized, 
requiring a dosage which would be dangerous. 

A toxic dose paralyzes the vaso-motor centre in the medulla before 
markedly affecting the heart. The blood-pressure and body-temperature 
fall ; the respiration, at first accelerated by stimulation of the vagi, is 
quickly depressed and ultimately paralyzed ; cardiac inhibition is stimu- 
lated, the heart being first slowed and then depressed. The anterior 
cornua of the spinal cord are first stimulated, producing convulsions ; and 



ACIDUM CARBOLICUM. 87 

subsequently depressed, causing suspension of reflexes, impaired motility 
and sensibility, and finally paralysis of both motion and sensation. The 
cerebrum is profoundly depressed, producing stupor deepening into coma, 
with minutely contracted pupils. Death occurs, in most cases, by par- 
alysis of respiration ; in a few, by paralysis of the heart. 

Carbolic Acid is readily absorbed and rapidly diffused ; many fatal 
cases having resulted from its external use in undiluted form. A single 
vaginal injection of a moderately weak solution has produced very severe 
constitutional results. It is partly oxidized in the blood, and partly 
eliminated by the lungs and kidneys. It imparts to the urine a peculiar 
smoky or olive-green color, which is not due to blood, and may be seen 
after moderate doses, or even as a result of its absorption from dressings. 
When ingested in a large dose, the acid itself may appear in the urine ; 
but the smoky color is due to the presence of its intermediate oxidation 
products, viz., pyrocatechin (only in alkaline urine), and hydrochinon, 
also salts of sulpho-carbolic acid and glycuronic acid. In poisoning 
thereby the sulphates are absent from the urine. 

A case of poisoning by Carbolic Acid shows white, corrugated eschars 
in the mouth and fauces, if the drug has been swallowed in concentrated 
form. These eschars are also found on the mucous lining of the esopha- 
gus and stomach, at the autopsy. The patient has complained of an 
intense, burning sensation along the same tract, immediately after the 
ingestion of the poison, and soon passes into a state of collapse; the 
skin being cold and clammy, the pupils contracted, respiration becomes 
more and more feeble and shallow ; the urine, if not entirely suppressed, 
is of a dark-green color ; reflexes are then abolished, stupor and coma 
supervene, and finally the breathing ceases. The blood, after death, is 
dark in color, and coagulates imperfectly ; and fatty degeneration of the 
liver and kidneys may be found. When poisoning occurs by absorption, 
an early symptom is the peculiar, smoky color of the urine. There may 
be pain in the lumbar region, indicating renal irritation, and slight rest- 
lessness or cerebral disturbance ; after which comes the impairment of 
respiration and stupor. 

A toxic dose of Carbolic Acid, taken internally, is one of the most 
rapidly acting poisons known, sometimes equalling Prussic Acid in this 
respect. The symptoms develop almost immediately, and death may 
occur in a very few minutes ; but usually the patient lives from one to ten 
hours ; rarely over two days. In some cases, a great amendment has 
occurred, with restoration of consciousness, but after some hours sudden 
and fatal collapse has supervened. The minimum fatal dose is not deter- 
mined, but 3ss has frequently caused death; and doses as small as n^vj 
have given rise to dangerous symptoms. Cases of suicidal and accidental 



88 ACIDUM CARBOLICUM. 

poisoning by this drug are very frequent, by reason of the facility with 
which it may be obtained for use as a disinfectant. 

Professor Mann has shown that during the ten years previous to 1895 there were 917 
deaths from Carbolic Acid, a yearly average of nearly 100 ; while in the year 1894 alone 
the number of deaths from this cause reached the appalling total of 202. 

Treatment of Poisoning by Carbolic Acid. 

If the case is seen shortly after ingestion, Apomorphine maybe administered hypoder- 
mically, as a rapidly acting emetic ; but, in any case, the stomach should be washed out 
freely. The chemical antidote is any soluble sulphate to form the harmless sulpho-car- 
bolates ; as Magnesium Sulphate £], or Sodium Sulphate ^ ss, dissolved in ]/ 2 pint of 
water. Even if several hours have elapsed since the ingestion of the poison, the sulphates 
should be used, as their antidotal action proceeds in the blood current. In one case 
where ^ ss of the 95 per cent, acid had been taken, nearly ^ iij of Magnesium Sulphate 
(Epsom salts) were used, resulting in complete recovery from an apparently hopeless con- 
dition. Stimulants, as ether or brandy hypodermically, should also be used freely; also 
hot water bottles and hot blankets if signs of collapse appear. Vegetable demulcents 
may be given (but no oils or glycerin), to protect the mucous surfaces. Liquor Calcis 
Saccharatus, or Syrupus Calcis, is also antidotal to the poison in the stomach, but is much 
less efficient than the sulphates. Atropine, hypodermically, is a very complete physio- 
logical antagonist to the systemic symptoms, maintaining the heart and respiration until 
elimination occurs (Post). Cider Vinegar may prove antidotal, as it removes the effects 
of the local application of the strong acid. Soap, in strong, watery mixture (suds), is 
said to have acted as a perfect antidote ; but its action would be confined to the poison in 
the stomach. Oils should not be used, as they increase the absorption of the poison. 

Therapeutics. 

Carbolic Acid owes much of its prominence to its having been the 
principal agent at first used in the antiseptic method of treating wounds ; 
but its employment in that connection has become much restricted, and 
many of the most prominent surgeons have abandoned it altogether in 
favor of other germicides. Recent investigations have proved beyond 
doubt that this agent has a reputation as a germicide far above that which 
it deserves; that in the ordinary solutions it is almost useless as a germi- 
cide though actively antiseptic ; and that very many hours of exposure 
to very strong solutions are required to kill pathogenic germs. In the 
estimation of many, however, it still retains high favor as a surgical anti- 
septic lotion ; and it is in general use as a disinfectant for surgical instru- 
ments, hospital apparatus, soiled linen, etc. The carbolic spray, formerly 
so commonly used during operations, has been entirely discarded. For 
disinfectant purposes about drains, privies, on floors, walls, etc., the crude 
acid is to be preferred, not only on account of its less cost, but also for 
the reason that its principal impurity, Cresol (Cresylic Acid), has very 
high power as a disinfectant. 

As a local application, Carbolic Acid has extensive and varied uses. 
Unna calls it the opium of the skin, as it relieves pruritus of almost any 
form, if applied in 5 per cent, aqueous solution over the itching surface ; 
and a lotion, composed of gr. xx to ^ss each of water and glycerin, 



ACIDUM CARBOLICUM. 89 

makes a very efficient application for the itching of jaundice. The gly- 
cerite, diluted, effectively destroys the fungus of tinea tonsurans or tinea 
versicolor, and may be applied as a stimulant to indolent ulcers, or to the 
patches of aphthous stomatitis. A one per cent, solution in water and 
glycerin (n^v to gj) makes an excellent anesthetic and cleansing gargle 
for the painful sore throat of diphtheria, tonsillitis, etc. Cotton soaked 
in the strong acid will stop the pain of a decayed tooth, but care must 
be taken, by covering it with dry cotton, to prevent its access to the 
gums, or sloughing thereof may result. For burns, one of the best 
dressings is carbolized sweet oil (gj to §vj) to relieve the pain. For local 
anesthesia in minor surgical operations, such as that for ingrowing toe- 
nail or opening a felon, the part may be soaked for ten minutes in a 30 
per cent, solution, or the pure acid may be brushed over the line of 
incision. 

As a parenchymatous injection, which should be not over gss of a 2 
per cent, solution, Carbolic Acid has been employed with much success 
in combating deep-seated inflammations. The skin being first anesthet- 
ized by the local application of the acid, a hypodermic needle is intro- 
duced obliquely, to the centre of the inflamed tissue, and should not be 
connected with the syringe if any blood escapes through it, lest the in- 
jection be introduced into a vein. This method has been successfully 
used in glandular swellings, 5 to 10 minims of the solution for each gland 
being sufficient in phlegmocs of every grade and character, erysipelas, 
poisoned wounds, inflamed bursae, hydrocele, acute and subacute rheu- 
matism, chronic synovitis, buboes, relapsing tonsillitis, and in some 
severe cases of tetanus. Under the trade-name Aseptolin (see a?tte, page 
85) Dr. Edson has recently put forth a solution, containing 2^ per cent. 
of carbolic acid and a minute quantity of a pilocarpine salt, for hypo- 
dermic use in curable cases of tuberculosis, malaria, and other diseases 
due to germ infection. There is nothing original in this treatment, it 
being a repetition of the phenic acid injection of Declat combined 
with the pilocarpine treatment of phthisis announced about four years 
ago as the "discovery" of Dr. Waldstein. It has gone through the 
usual puffing methods of trade promotion, and the few independent 
reports upon its use show no evidence of any special merit for it in these 
diseases. 

Internally, Carbolic Acid is not much employed. It has been given 
to relieve flatulence and dyspepsia, and is often an efficient remedy against 
vomiting. It has proven of considerable temporary benefit in diabetes 
of hepatic origin ; and has been used against intermittents, typhoid 
fever and various zymotic diseases ; but is probably of no efficacy in 
constitutional affections. A. mixture containing carbolic acid and spirit 
of chloroform has been lately used as an internal remedy for typhoid 



( 



> 



90 ACIDUM CARBOLICUM. 

fever by Dr. Quill, of the Indian army, without the loss of a single case, 
and in a country where enteric fever has a very high rate of mortality. 

In phthisis and other chronic pulmonary diseases, Carbolic Acid has 
been much employed as a spray by inhalation, and certainly does do 
good therein by relieving cough and irritation of the throat. In these 
affections, Creosote is preferred to it both for internal and local use. An 
acute conjunctivitis is greatly relieved »by holding the open eye in the 
spray of a steam atomizer, the cup of which contains a 5 per cent, solu- 
tion of carbolic acid. This measure may also be used for acute coryza 
with beneficial results ; or a mixture of Carbolic Acid and Tincture of 
Iodine may be dropped on to a sponge in a wide-mouthed bottle and 
volatilized for inhalation by being wrapped in a cloth wrung out of hot 
water, or even by being held in the hand. 

The Sulpho-carbolates of Sodium, Potassium, etc., have been em- 
ployed internally with advantage in the septic diseases, as the exanthe- 
mata, diphtheria, puerperal fever, etc., with the object of obtaining the 
antiseptic action of carbolic acid without the dangers attending its use in 
efficient doses. They may be used locally with good results in aphthse, 
tonsillitis, otorrhea, gonorrhea, and for inflamed mucous membranes 
generally. 

Creolin was highly vaunted, by Professor von Esmarch and other authorities, as the 
ideal antiseptic for external use, being possessed of great germicidal power, and a most 
efficient deodorant and disinfectant, while its absorption caused no toxic results whatever. 
Experience has justified these claims in the main, but the drug has, however, given rise 
to serious symptoms, when used to excess. As a vaginal wash, in puerperal cases, the 2 
per cent, solution is reported as fully equal to sublimate solutions, while better as a de- 
odorant, and free from danger by absorption. The weaker solutions have given satisfac- 
tion as local applications in the treatment of otorrhea, nasal ulcers, rhinitis (I to 1000), 
blepharitis, keratitis, etc. ; and in female cystitis a I per cent, solution as a vesical wash, 
gradually increased to 2 per cent., is highly praised by Parvin. The Ointments and 
Gauze are used for wounds and other solutions of continuity, in the same manner as car- 
bolized preparations, and with better satisfaction, Creolin being less volatile than Carbolic 
Acid, and of a more agreeable, though powerful, odor. Internally it has been employed 
in gastric fermentation, dysentery, and typhoid fever. 

Lysol is said to be superior to carbolic acid, creolin and the other analogous coal-tar 
products as a germicide, but it has no advantage over the antiseptics of established repu- 
tation ; and is only really efficient in solutions of such strength as to be irritating or 
caustic. Although not destined to play any great part in surgery, it may be useful in the 
prophylaxis and arrest of epidemics ; and is likely to be particularly serviceable in the 
disinfection of premises, privies, ships and stables, being readily soluble, reasonably 
active, and very cheap (Squibb). Dr. Pee, who has had very favorable results from 
Lysol, recommends a I per cent, solution in obstetrics and gynecology, and says that a 
solution of one part in 200 destroys streptococci in fifteen minutes. 

Trikresol possesses very high germicidal power, and is said to be practically non- 
toxic and less irritating to wounds than either carbolic or sublimate solutions. A I in 
1000 solution dropped into the eye did not produce the slightest irritation, and the I to 500 
solution dropped into my own eyes produced no burning sensation whatever (De 
Schweinitz). These solutions may therefore be advantageously employed as menstrua 
for the stock collyria, especially for those of cocaine, physostigmine and atropine, which 
are most liable to contamination. Trikresol is particularly fatal to pyogenic cocci, a I 
per cent, solution invariably killing them in half a minute in watery solutions, and in a 
minute and a half in rich albuminous fluids (Griiber). 






ACIDUM CARBONICUM. 91 

Phenosalyl is said to possess antiseptic power which is considerably superior to that 
of carbolic acid, a I per cent, solution immediately killing the staphylococcus pyogenes 
aureus, the most resistent microbe known. In order to attain the same result with car- 
bolic acid it is necessary to expose the staphylococcus to the action of a 2^ per cent. 
solution for at least one minute. Phenosalyl does not irritate the skin, has no corrosive 
action on instruments, is very soluble in water, is non-toxic, and leaves a pleasant and 
non-persistent odor which does not cling about the hands or the clothes. Its solutions 
have no corrosive action on the skin, and the mucous surfaces treated with it remain 
smooth and slippery and do not become dried up, as is the case after washing with car- 
bolic acid or corrosive sublimate solutions (Frankel). 



ACIDUM CARBONICUM, Carbonic Acid, Carbon Dioxide, 
C0 2 (Unofficial). The body which is commonly called Carbonic Acid, 
but should be called Carbon Dioxide, is a colorless and odorless gas, of 
sp. gr. 1.526, slightly sharp taste, soluble in its own volume of pure water 
at the ordinary temperature and pressure, much more soluble under in- 
creased pressure and lowered temperature of the water, also more soluble 
in water containing phosphates. In water it promotes the solution of 
phosphates and carbonates. Its aqueous solution gives an acid reaction, 
and is " sparkling " from rapid escape of the gas, especially when agitated. 
It is prepared by treating any carbonate (usually calcium carbonate in 
the form of marble-dust) with dilute hydrochloric acid ; the resulting gas 
is passed into water under pressure, and the solution is thus obtained. 

Carbon Dioxide occurs in the atmosphere in the proportion of 2 to 6 parts in 10,000, 
also in all water in varying quantity. Certain sparkling waters contain it in the propor- 
tion of more than one-half their volume, Johannis having more than 90 per cent. It 
occurs also in all the liquids of the body, especially in the blood, originating in the oxida- 
tion processes which are constantly taking place in the tissues, and readily passing by 
osmosis through animal membranes. It is continuously produced by the action of the 
yeast-plant, and by all other fermentation processes, and accumulates in brewers' vats, 
old wells, some caves, grottoes and deep valleys, also in mines, forming the well-known 
" choke-damp " of miners. It is constantly evolved during respiration and in the burning 
of gas, fires, etc. When the air of a room contains o. I per cent, of this gas it is unfit for 
continued respiration. 

True Carbonic Acid, C0 3 H y , or Hydrogen Carbonate, is an organic acid which is not 
known in the separate state, but only in aqueous solution. It is supposed to exist in a 
solution of carbon dioxide in water. 

Preparation. 

Aqua Carbonata, Carbonated Water, Soda-water (Unofficial), — is water highly 
charged with carbonic acid gas, the excess of gas being dissolved in the water by 
pressure, and escaping in bubbles when the pressure is taken off. It was official in the 
U. S. P., 1870, under the title Aqua Acidi Carbonici, the formula requiring that the water 
be charged with five times its volume of gas, for which a pressure of five atmospheres is 
required. 

Carbonated Mineral Waters. 

Selters, Nassau, Germany, 30 cubic inches "] 

Apollinaris, Nuenahr, Prussia, . 47 " of CO >2 

Old Sweet Spring, West Virginia, II " j to the pint. 

Sweet Chalybeate Spring, Virginia, 13 " J 

There are 10 official Carbonates and 2 official Bicarbonates, which are severally de- 
scribed under their basylous titles. 



92 acidum carbonicum. 

Physiological Action. 

Carbon Dioxide is highly antiseptic and preservative. D'Arsonval 
employs it, under 30 atmospheres pressure, for the sterilizing of orchitic 
extract. Beef will remain perfectly fresh and its taste unchanged for 
eight days if hung in a chamber filled with the gas. Externally, applied 
to the skin, mucous membranes or wounded tissues, the undiluted gas 
produces slight hyperemia, with prickling and a sense of heat, followed 
by a certain degree of local anesthesia. Internally, given by the stomach 
in aqueous solution, it is refreshing and quenches thirst, slightly stimu- 
lates the heart's action, quickens respiration and causes a brief sense of 
exhilaration. It increases somewhat the gastro-intestinal secretions and 
excites peristalsis, but diminishes the sensibility of the mucous lining of 
the alimentary canal. Inspired, the gas is highly toxic, a proportion of 
10 per cent, thereof in the air being irrespirable and fatal. Even 0.1 
per cent, produces unpleasant symptoms, as headache, sleeplessness and 
depression; 0.3 per cent, causing a throbbing headache, fulness and 
tightness across the temples and giddiness ; and a larger quantity 
profoundly affects the nervous system, inducing fainting, muscular 
weakness, somnolence or insensibility, and coma or convulsions. The 
inhalation of the undiluted gas at first excites irritation and sometimes 
spasmodic closure of the glottis with consequent asphyxia, but in any case 
it soon arrests the respiration. It hinders the exhalation of the carbon 
dioxide normally existing in the blood, and is itself absorbed in small 
quantity, inducing dyspnea, cyanosis, slow and labored pulse, and ulti- 
mately arrest of the heart's action. In toxic quantity it abolishes at 
once the functions of nerve and muscle by stopping the process of oxi- 
dation in the tissues. 

The symptoms of Carbon Dioxide poisoning maybe divided into three 
stages, which are the stages of Asphyxia. They are : (1) that of dyspnea, 
in which the blood pressure rises from excitation of the centres in the 
medulla by the venous blood, the vessels of the surface become dilated, 
and insensibility comes on; (2) that of convulsions, in which the respira- 
tory movements become more violent and spread to all the muscles of 
the body ; (3) that of paralysis, in which the convulsions cease, the 
blood pressure falls, the respiration gradually fails, and finally the heart 
stops. The autopsy shows great venous congestion everywhere, the right 
side of the heart distended with blood, the brain much congested, with 
exudation and even extravasation therein, and the blood exceedingly 
dark in color. 

Treatment of Carbon Dioxide Poisoning. 

The antagonists are Oxygen and stimulants of the peripheral circulation. The prime 
object of treatment is to get the blood oxygenated as quickly as possible. The patient 



ACIDUM CHROMICUM. 93 

should be brought at once into the open air, and if the respiratory movements have 
ceased, cold water should be dashed on the face and chest, in order to awaken them by 
reflex action. If no effect is thereby produced, recourse must be had to artificial respir- 
ation, which should be maintained for at least an hour. [Compare the article entitled 
Asphyxia and Apnea in Part III.] If the heart does not begin to beat shortly after 
artificial respiration has been begun, the jugular vein should be opened, with care to 
prevent the entrance of air, in order to relieve the distention of the right ventricle and 
prevent the consequent paralysis of the heart. This vein is selected because there are 
no valves of any importance between it and the heart. A series of sharp, quick blows 
upon the chest in the cardiac region will sometimes start the heart into action after it has 
stopped. 

Therapeutics. 

Carbon Dioxide has been locally employed as a stimulant in ulcers 
and as an anesthetic in cancers, either by directing a stream of the gas 
upon the part or by the application of a yeast poultice. It has been 
applied to the eyes, ears, nose, vagina and rectum, in catarrhal inflam- 
mations of these parts, also to the bladder, for irritability of that viscus, 
and its application is beneficial when there is no acute inflammation 
present. It is injected into the vagina with good results in dysmenorrhea 
and in many other painful affections of the pelvic viscera, whether neu- 
ralgic in character or arising from organic disease. Diluted with 90 to 
95 per cent, of air, its inhalation is serviceable in chronic laryngitis and 
pharyngitis, also in asthma, chronic bronchitis and chronic cough. 

Carbonated water, or Soda-water as it is popularly named, is a grateful 
beverage in warm weather, especially when flavored with certain syrups 
and fruit juices. It is a useful drink in febrile affections, as it relieves 
thirst, allays nausea and gastric irritability, and is both diaphoretic and 
diuretic in slight degree. It is an efficient remedy for vomiting, and in 
the form of iced champagne is one of the numerous agents which have 
proven efficacious in the vomiting of pregnancy. It forms an excellent 
vehicle for the administration of saline carthartics, the various carbonates 
and piperazin. The free use of carbonated mineral waters is of service 
in gout, especially when they contain the salts of lithium in solution. 
At many European spas the course of treatment is largely based on the 
use of carbon dioxide, administered in the forms of baths and inhalations 
as well as by the ingestion of the waters containing it. Bathing in the 
natural carbonated waters is sometimes beneficial in catarrh, gout, rheu- 
matism, anemic amenorrhea and leucorrhea, the gas acting as a gentle 
stimulant of the cutaneous circulation and promoting slight diaphoresis. 
[Compare the article entitled Aqua.] 

ACIDUM CHROMICUM, Chromic Acid, Chromic Trioxide, 
Chromic Anhydride,Cr0 3 , — is obtained by the action of Sulphuric Acid 
upon Potassium Bichromate, and occurs in small, crimson, needle-shaped 
crystals, which are deliquescent and very soluble in water. This sub- 



94 ACIDUM CHROMICUM. 

stance is not true Chromic Acid, which does not occur in the free state, 
and the formula of which would be H 2 Cr0 4 . It should be known by one 
of the chemical synonyms mentioned above. It should be kept in glass- 
stoppered bottles, and great caution should be observed to avoid bringing 
it in contact with organic substances, such as cork, tannic acid, sugar, 
alcohol, glycerin, etc., as dangerous accidents are liable to result. It is 
not used internally. 

Potassii Bichromas, Potassium Bichromate, K 2 Cr 2 7 , — large, orange -red prisms of 
disagreeable, metallic taste and acid reaction, soluble in io of water at 59 F. , and in 
\y z of boiling water, insoluble in alcohol. It is used locally in aqueous solution (gr. 
V- 3J to tne J)> an °l internally in doses of gr. j-Q-gr. ij in trituration. 

Physiological Action and Therapeutics. 

Chromic Trioxide is a powerful escharotic and penetrates deeply, but 
it is slow of action and is not very painful. It coagulates albumin and 
parts readily with its oxygen, oxidizing organic matter and decomposing 
ammonia and sulphuretted hydrogen • and is therefore an energetic 
disinfectant and deodorizer. When used as a caustic it is mixed with 
sufficient water to make a paste, which may be employed for the destruc- 
tion of warts, hemorrhoids and other superficial growths ; the neighbor- 
ing parts being protected by cotton soaked in a strong alkaline solution. 
For syphilitic warts and condylomata, lupus, tinea tonsurans, etc., a 
solution of 100 grains to the j§ of distilled water is generally used. A 
solution of 1 in 40 is an excellent and inexpensive antiseptic lotion for 
putrid sores and wounds, syphilitic affections of the tongue, mouth and 
throat, ozena, leucorrhea, and gonorrhea. In uterine catarrh and hem- 
orrhages a solution of 120 grains to the g has been injected into the 
uterine cavity with good results. 

Potassium Bichromate is a good antiseptic and an escharotic of milder 
action than the trioxide. In doses of gij-iv it has proved fatal to life in 
adults, with symptoms of gastro-enteritis, suppression of urine, and 
cardiac paralysis. It is chiefly employed as a local application in satu- 
rated solution to warts and venereal condylomata ; and in dilute solution 
(gr. j-x to the §) for catarrhal conditions of the nasal, buccal or vaginal 
mucous membrane. Internally it has been employed with benefit in 
locomotor ataxia and in dyspepsia simulating gastric cancer; also in 
chronic gastric catarrh, the tongue having a thick yellow coat, in chronic 
diarrhea from intestinal ulceration, and in chronic ulcers of the pharynx 
and mouth. It is a good remedy in syphilitic sore throat, local rheuma- 
tism of the fibrous tissues, periosteal and syphilitic rheumatism, and 
acute catarrh and influenza, chronic nasal catarrh, chronic laryngitis, and 
chronic catarrhal affections of the bronchial mucous membrane, especially 
when the expectoration is tough and stringy. It has also been used with 



ACIDUM FLUORICUM ACIDUM TANNICUM. 95 

some success in diphtheria. In pharmacy it is employed in preparing 
Chromic Acid and Valerianic Acid, and as a test solution. Most of the 
medical galvanic and faradic batteries are run by a mixture of this salt 
with sulphuric acid. Poisoning by it should be treated as directed for 
mineral acids. 



ACIDUM FLUORICUM, Fluoric Acid, HF (Unofficial),— is a strong escha- 
rotic, acting deeply and leaving a dry and painful slough. The dilute acid (i in 200) is 
prepared by acting on fluor spar by Sulphuric Acid, the resulting gas being dissolved in 
water. Its dose is rr^xx-xxx, well diluted. 

Dilute Fluoric Acid has been successfully used as an internal remedy in goitre, and 
the gas has been inhaled with benefit in laryngeal diphtheria. 



ACIDUM GALLICUM, Gallic Acid, HC 7 H 5 5 .H 2 — is a 
nearly colorless solid in long needles and triclinic prisms, having a 
slightly acid and astringent taste, soluble in ioo of water and in 5 of 
alcohol at 59 F., and in 3 of boiling water. It is prepared from a paste 
of powdered galls (see Galla), by fermenting for six weeks, boiling and 
reboiling in water, filtering and crystallizing. According to some au- 
thorities, the Tannic Acid of the galls is split up into Gallic Acid and 
glucose by fermentation ; but according to others the glucose is an im- 
purity and the Tannic Acid is simply converted into two parts of Gallic 
Acid, C 14 H 10 O 9 -j- H2O = (HC v H 5 5 ) 2 . Dose, gr. v-xv, in solution, pill 
or powder. 

Acidum Tannicum, Tannic Acid, Gallotannic Acid, Digallic 
Acid, Tannin, HC u H 9 9 , — is a solid body in light-yellowish scales, of 
strongly astringent taste and acid reaction, obtained from powdered galls 
(see Galla), by exposure for three days in a damp atmosphere, then 
macerating with ether, pressing, and drying the liquid portion. It is 
soluble in 1 of water, in 0.6 of alcohol, at 59 F., and in about 1 of gly- 
cerin with moderate heat ; very soluble in boiling water and in boiling 
alcohol, almost insoluble in ether, chloroform, benzol or benzin. Dose, 
gr. j-xx, in wafer, pill or capsule. 

Preparations. 

Unguentum Acidi Tannici, Ointment of Tannic Acid, — is a 20 per cent, ointment, 
made with Benzoinated Lard. 

Trochisci Acidi Tannici, Troches of Tannic Acid, — each troche contains nearly 
one grain of Tannic Acid. 

Glyceritum Acidi Tannici, Glycerite of Tannic Acid, — has a strength of I part in 
4 of Glycerin. 

Suppositoria Acidi Tannici, Suppositories of Tannic Acid (Unofficial), — have I 
part of Tannic Acid in 5 of Cacao Butter. 

Collodium Stypticum, Styptic Collodion, — has of Tannic Acid 20, Alcohol 5, Ether 
25, Collodion to make 100 parts. 



g6 ACID'UM TANNICUM. 

Vegetable Astringents contain some form of Tannic Acid, as Quercitannic Acid 
from Oak-bark, Rhatania-tannic Acid in Rhatany, etc. The official acid is Gallotannic 
Acid, being that produced from Galls. These astringents depend for their medicinal 
value upon the Gallic and Tannic Acids contained in them. Such are — 

Alnus, Alder Bark. Granatum, Pomegranate. Myrica, Wax Myrtle. 

Castanea, Chestnut. HamameWs, Witch Hazel. Nymphaea, Pond Lily. 

Catechu, Catechu. Hcematoxylon, Logwood. Quercus A\ba,OakBark. 

Diospyros, Persimmon. Heuchera, Alum Root. Rosa Gallica, Red Rose. 

Galla, Ahit Galls. Kino, Kino. Rubus, Blackberry. 

Geranium, Cranesbill. Krameria, Rhatany. Statice, Marsh Rosemary. 



Physiological Action and Therapeutics. 

Gallic Acid, and its congener Tannic Acid, are astringents, the former 
being the feebler of the two. They differ in that tannic acid coagulates 
albumin and gelatin, while gallic acid does not. According to some 
authorities the difference between gallic and tannic acids is one of oxida- 
tion, according to others of hydration ; the latter assuming tannic acid 
to be simply gallic acid anhydride. They constringe the muscular tissue 
in the walls of the minute vessels, thus checking secretion and hemor- 
rhages and cutting short local inflammations. Except in enormous doses, 
they are harmless. 

Tannic Acid is a powerful astringent. It precipitates pepsin and co- 
agulates albumin, impairs digestion, stops peristalsis, and causes consti- 
pation. A part of that taken into the stomach unites with the pepsin 
and albumin, while a part is converted into Gallic and Pyrogallic 
Acids, and in this form is both absorbed and excreted. It is a crystal- 
loidal body, but combines with colloids, and is a valuable antidote in 
poisoning by the alkaloids and tartar emetic, with which it forms tan- 
nates which are nearly insoluble. Its continued use disorders digestion, 
irritates the mucous membranes, and produces emaciation. Injected 
into the veins it forms emboli and thus may cause death, but by the 
stomach it is non-toxic. Tannic Acid is a more powerful astringent 
than Gallic Acid, and hence it is preferred for local use and for astringent 
effect on the intestinal canal. It is well employed in hemorrhoids and 
hemorrhages from the lower bowel, in hematemesis, epistaxis, rectal 
ulcers or fissures, catarrhs and chronic affections of the mucous mem- 
branes, endocervicitis, conjunctivitis, dysentery and diarrheas, eczema, 
impetigo and other forms of skin-disease, otorrhea, bed-sores, prolapsus 
ani, and many other affections. 

Styptic Collodion is used to stanch the bleeding from an open wound, 
to unite and protect incised or lacerated wounds, and to cover and change 
the character of foul ulcers. 

Gallic Acid is preferred to Tannic Acid when an astringent action is 
desired upon remote parts, as the lungs, kidneys, etc., which can only be 
reached through the circulation. In hematuria, distant passive hemor- 



ACIDUM HYDROCHLORICUM. 97 

rhages, albuminuria, diabetes insipidus, bronchorrhea, night-sweats, 
chronic diarrhea, and chronic cystitis, it is a most useful remedy. 

Mineral Acids, Alkalies, per-salts of Iron and salts of Antimony, Lead, and Silver are 
chemically incompatible with preparations containing Tannic or Gallic Acid. Vegetable 
Alkaloids and Gelaiin form insoluble precipitates with Tannic Acid. 

Gallobromol, Dibromogallic Acid, C 6 Br 2 (OH) 3 COOH, (Unofficial), — occurs in small 
white, needle-shaped crystals, soluble in 10 parts of lukewarm water. The solution 
gradually darkens and after a few days becomes brown. Lepine states its internal action 
as similar to that of potassium bromide. In I or 2 per cent, solutions it has been used 
with remarkable success as a local application in gonorrhea of all stages. It seems to 
readily destroy the gonococcus. 

Pyrogallol, Pyrogallic Acid, Tri-hydroxy-benzene, C 6 H 3 (OH) 3 , — is a triatomic 
phenol, obtained chiefly by the dry distillation of Gallic Acid. It occurs in light, white, 
shining laminae, or fine needles, of bitter taste ; soluble in water, alcohol and ether. 
Dose, gr. j-ij. 

Pyrogallol may act as an intense poison. It has been absorbed from the surface with 
fatal results, preceded by vomiting and diarrhea, rigors and fever, black urine full of 
globulin, and disorganization of the blood-corpuscles. It has great affinity for oxygen 
and may be used as an antiseptic and disinfectant in I to 2]/ z per cent, solutions. It 
has been used internally in two-grain doses for internal hemorrhages As an ointment 
(gj- Jj) it ranks next to Chrysarobin as an efficient palliative in psoriasis, and has been 
used with good results in lupus and epithelioma, being supposed to attack the diseased 
nodules only, leaving the adjacent skin uninjured. 

Tannigen Diacetyl-tannin (Unofficial), — is an acetic acid ester of tannin, prepared 
by the action of glacial acetic acid on tannic acid. It occurs as an odorless and tasteless 
powder, insoluble in cold water and ddute acids, but soluble in cold alcohol and in dilute 
solutions of soda, sodium phosphate and borax. It is said to pass through the stomach 
unchanged and to be gradually decomposed in the intestines, thus exerting an astringent 
effect upon the entire intestinal canal. Its uses have been those of an intestinal astrin- 
gent. It appears to be absolutely innocuous. Dose, gr. iij-viij, up to sjij daily. 

ACIDUM HYDROCHLORICUM, Hydrochloric Acid, 

Muriatic Acid, — is a liquid composed of about 32 per cent, of absolute 
Hydrochloric Acid Gas, HC1, and 68 per cent, of water. It is colorless 
and fuming, of specific gravity 1.163, pungent odor, intensely acid reac- 
tion and taste, and is obtained by the action of Sulphuric Acid upon 
Sodium Chloride, the resulting gas being carried through water, which 
dissolves it. It is sometimes used as a caustic. Its union with basic sub- 
stances forms salts, called Hydrochlorates (Muriates), of which four are 
official, viz. — Apomorphine, Morphine, Pilocarpine, and Quinine Hy- 
drochlorates, described under the title of their respective bases. 

Acidum Hydrochloricum Dilutum, Diluted Hydrochloric Acid, — is a 10 per cent, 
solution of the absolute acid in water. Dose, TT\juj-x. 

Acidum Nitro-hydrochloricum, A T itro-hydrochloric Acid, — is described under 
Acidum Nitricum. 

Physiological Action of the Mineral Acids. 
The mineral acids (Hydrochloric, Sulphuric, Nitric, Nitro-hydro- 
chloric, and Phosphoric) resemble each other in general action so closely 
that they may all be described in this place. 

The strong acids are escharotic, abstracting the waters of the tissues, 
7 



i 



98 ACIDUM HYDROCHLORICUM. 

combining with the albumin and other bases, and destroying the proto- 
plasm. They are very diffusible, redissolving the albumin after precipi- 
tating it (except Nitric Acid). Sulphuric and Phosphoric have a strong 
affinity for water, completely decomposing tissues to which they are 
applied, and are therefore the most powerfully escharotic. Nitric Acid 
does not readily redissolve the albumin precipitated by it, which thus 
forms a barrier against the deep action of the acid. Sulphuric Acid 
chars or carbonizes the tissues black, while Nitric and Hydrochloric tan 
them yellow. 

The dilute acids produce a peculiar taste in the mouth and a sensation 
of roughness on the teeth. They stimulate the flow of saliva from the 
parotid and submaxillary glands, but have no action on the sympathetic 
saliva. They promote the alkaline intestinal secretions and excite the 
flow from glands having an alkaline secretion (bile, etc.), when applied 
to the mouths of their ducts, but check that from those whose secretion 
is acid (gastric, etc.). Secretion generally is promoted by Nitric Acid, 
and lessened by Sulphuric, Hydrochloric acting between the other two. 
Given before meals, in small doses, they relieve acidity of the stomach by 
checking the production of the acid gastric juice. At first they aid diges- 
tion, being synergistic to the action of pepsin, but if continued they im- 
pair digestion by lessening the production of the gastric juice. They 
check fermentation and constipate the bowels, except Nitric Acid, which 
relaxes them. They render the urine slightly more acid than its normal 
reaction, but do not acidify alkaline urine as the vegetable acids do. 
They are all astringent to the tissues, Hydrochloric being the weakest 
and Sulphuric the strongest in this respect. 

Antidotes and Antagonists. 

Alkalies to neutralize the acid ; Oil, Albumin, or Milk, to protect the mucous mem- 
brane ; Stimulants, Opium, Amnionia (intravenously), to combat the resulting depression 
of the vital powers. 

Therapeutics of the Mineral Acids. 
All the members of this group are useful in fevers, if well diluted, 
Hydrochloric being usually perferred, especially in typhoid. In atonic 
dyspepsia, acidity of the stomach, and locally in ulcerations of the throat, 
Hydrochloric Acid is best used. Nitric is the acid generally preferred as 
a caustic, its action being effectual and superficial. As such it is applied 
undiluted to phagedenic ulcers and sloughs, warty growths, and to the 
cavity of the womb in chronic inflammation thereof. Dilute Nitric Acid 
is used internally in oxaluria and lithemia, intermittent and remittent 
fevers, and aphonia of singers. Dilute Nitro-hydrochloric is more suit- 
able in chronic hepatic disorders due to malaria ; Sulphuric in hemor- 
rhages, diarrheas, colliquative sweating, and as a prophylactic against 



ACIDUM HYDROCYANICUM DILUTUM. 99 

lead-poisoning. Dilute Sulphuric Acid is used as an acid drink in fevers, 
and before meals in acidity of the stomach. It is very doubtful whether 
the latter has any special influence on the nervous or osseous systems. 

All these acids act injuriously on the teeth, by attacking the enamel. 
They should always be administered largely diluted, taken through a straw 
or glass tube, and the mouth should be thoroughly rinsed at once with an 
alkaline wash. 

ACIDUM HYDROCYANICUM DILUTUM, Diluted Hy- 
drocyanic (Prussic) Acid, — is a liquid composed of 2 per cent, of 
absolute Hydrocyanic Acid, HCN, and 98 per cent, of water. It is 
colorless, faintly acid, of peculiar odor, and is prepared by distilling solu- 
tions of Potassium Ferrocyanide and Sulphuric Acid together, or extem- 
poraneously by adding 6 grammes of Silver Cyanide to a solution of 5 cc. 
of Hydrochloric Acid in 55 of distilled water, shaking together and pour- 
ing off the supernatant liquid, ir^xl have proved fatal. Dose, ttlj-v, of 
a recent preparation ; as, even under the most favorable conditions, it 
will decompose within a year. 

Preparations containing Hydrocyanic Acid. 

Aqua 'L.aurocera.si, C/ierry-laurel Water (Unofficial), — is a water distilled from the 
fresh leaves of Prunus laurocerasus, the common Laurel or Cherry Laurel, a small tree 
of the nat. ord. Rosacea, sub-order Amygdalece. The leaves contain a variable amount 
of Hydrocyanic Acid and a volatile oil. Dose, TTi^v-xxx, cautiously. 

Scheele's Dilute Hydrocyanic Acid (Unofficial), — is a 4 or 5 per cent, solution, 
and is highly dangerous even by inhalation. 

Amygdala Amara, Bitter Almond (see its title) and its essential oil ; also, various 
others members of the sub-order Amygdalea?, including the official Prumis Virginiana, 
perhaps the unofficial Prunus lanrocerasus, and the leaves and kernels of the peach and 
cherry trees, contain a proximate principle Amygdalin, and a ferment Emtilsin, which 
in the presence of water react on each other, forming Hydrocyanic Acid, a volatile oil, 
and glucose. C 20 H, 7 NO U (Amygdalin) + 2H 2 = C-H 6 (Oil of Bitter Almond) -f 
HCN( Hydrocyanic Acid) -f 2C 6 H ]2 6 (Glucose"). 

Hydrocyanic Acid exists ready formed to a considerable extent in the juice of the 
bitter cassava. 

Other Cyanogen Compounds. 

Potassii Cyanidum, Potassium Cyanide, KCN, — a white, opaque salt, of alkaline 
reaction, bitter-almond taste, and a peculiar odor when moist ; soluble in 2 of water, 
sparingly soluble in alcohol. Dose, gr. jq-j. Locally, a solution of gr. j-v to the ^ 
is as strong as should be employed. 

Potassii Ferrocyanidum, Potassium Ferrocyanide, K i Fe(CN) 6 3H 2 0, — large, lemon- 
yellow prisms or tablets, efflorescent, odorless, of sweetish taste and neutral reaction, 
soluble in 4 of water, insoluble in alcohol. Employed in pharmacy as a test solution, 
and in the preparation of Iron Ferrocyanide, Diluted Hydrocyanic Acid and Potassium 
and Silver Cyanides. Rarely used medicinally. Dose, gr. v-xv. 

Physiological Action. 
Hydrocyanic Acid is one of the most powerful and rapid poisons known, 
half a grain having proved fatal almost immediately. Its action on the 
organism is one peculiar to itself, the inhalation of a strong preparation 



• 



100 ACIDUM HYDROCYANICUM DILUTUM. 

producing rapid insensibility and almost immediate exhaustion : — death 
from a full dose occurring by sudden paralysis of the heart, from a less 
but still a fatal dose, by paralysis of respiration. The symptoms are those 
of sudden and complete asphyxia, but some violitional movements may be 
made before death, unless the dose be very large. In cases in which the 
dose, though fatal, permitted of the observance of its effects, they were 
usually divisible into two marked stages, viz. : (i) dyspnea, slow and 
full pulse, giddiness, loss of muscular power; — (2) vomiting, dilated 
pupils, unconsciousness, spasms, muscular rigidity, and cessation of the 
heart's action. In poisonous, but not fatal doses, the following effects 
have been observed : feeble pulse, dilated pupils, turgid and dusky face, 
insensibility, convulsions or rigidity, but no paralysis. Large medicinal 
doses may produce salivation, irritation of the throat, dizziness, buzzing 
in the ears, headache, numbness, dusky countenance, staggering gait, 
sense of constriction of the chest, palpitation of the heart, a frequent or 
an abnormally slow pulse, a sense of great weariness and drowsiness. 
Post-mortem examination usually shows dilated pupils, the eyes having a 
marked glassy lustre, the cadaveric rigidity very great. The blood, in 
cases which have been rapidly fatal, may show the arterial color in both 
the arterial and the venous systems ; but in slow r er cases it is dark and fluid, 
engorging both sides of the heart, the venous trunks, and the cerebral 
sinuses. The paralyzant action of the drug is chiefly exercised on the 
nerve-centres in the medulla ; next on the peripheral afferent nerves, the 
spinal cord, the motor nerves, and finally on the muscular tissue. It stops 
the heart by irritation of the vagus-roots in the medulla, as well as by 
paralyzing the cardiac motor ganglia. It is said to form with hemoglobin 
a compound (cyan-hemoglobin), which does not readily give up oxygen. 
The odor of the acid is fragrant, resembling that of bitter almonds or 
peaches, and may be detected in the lungs shortly after death. The effects 
of a medicinal dose pass off in an hour at the farthest. 

Locally applied to the skin, Hydrocyanic Acid penetrates the epider- 
mis and paralyzes the end-organs of the sensory nerves in the derma. It 
is rapidly absorbed from mucous surfaces. 

Potassium Cyanide has similar action, but in addition has some few 
peculiar to itself. Locally used it produces dermatitis, with an eczema- 
tous eruption, and if applied to an abraded surface freely may cause fatal 
effects. Internally it has proved fatal in doses of 3 to 5 grains, with all 
the symptoms of Hydrocyanic Acid poisoning, but its action is less rapid. 
It is much used in photography, and many cases of poisoning by it have 
occurred in persons employed in that art. 

Antagonists and Antidotes. 
Atropine has antagonistic action, but is too slowly diffused to be of any value. 
Ammonia by inhalation, by the stomach, and by intra- venous injection, with cold affu- 



ACIDUM LACTICUM. 101 

sion to the spine, and artificial respiration, are the measures most likely to avail in cases 
of poisoning where there is time to do anything. Ferrous Sulphate has been considered 
an antidote against Potassium Cyanide, to form Ferrocyanide of Iron (Prussian Blue), 
but it is not efficient. Sodium Thiosulphate is said to be a good antidote. Cobaltous 
Nitrate is an efficient antidote (Antal). 

Therapeutics. 

Hydrocyanic Acid is used for its anti-spasmodic and sedative effects. 
In vomiting, whooping-cough, and coughs of spasmodic character, in 
asthma and other neuroses of the respiratory organs, in affections involv- 
ing the pneumogastric nerve, vertigo, and headache from stomachal de- 
rangements, gastralgia, painful dyspepsia, vomiting, etc., it is very effi- 
cient as a palliative. In acute mania and melancholia it has been used 
with advantage; and in various skin diseases, accompanied by itching, 
tingling, etc., its use as a lotion (ttlxxx-3J ad §j Aquae Rosas) to the un- 
broken surface is prompt in relieving the pruritus and other distressing 
sensations. Only when recently prepared is it of any service ; as, even 
under the most favorable conditions, it will undergo decomposition 
within a year. 

Potassium Cyanide in ointment (gr. v ad 5j) is used to allay pruritus, 
and in solution (gr. iij-v ad gj) is applied locally with benefit in reflex 
headaches, and is used as a wash to remove nitrate of silver stains. It 
has been used internally in doses of gr.j for acute articular rheumatism, 
but such employment of it is highly dangerous. In smaller doses (gr. 
%-%)> it is a useful ingredient of cough mixtures, where Opium or its 
alkaloids are not admissible. 

Potassium Ferrocyanide has been used in doses of 8 to 15 grains as an 
astringent and anodyne, but it is seldom employed in medicine. 

Cherry-laurel Water has been extensively used as a flavoring agent, 
having a very agreeable taste. It is official in the British Pharmacopoeia, 
and is supposed to be a rather elegant mode of administering Prussic 
Acid ; but the uncertainty of its strength is such that it should never be 
used internally, except in very small quantities. It has been employed 
as an anesthetic injection into the urethra prior to catheterization, and 
was formerly employed by ophthalmologists as an eye-wash in painful 
affections of that organ. 

ACIDUM LACTICUM, Lactic Acid, — is. a liquid composed of 75 per cent, of 
absolute Lactic Acid (HC 3 H 5 3 ) and 25 per cent, of water ; nearly colorless, syrupy, 
odorless, of acid taste and reaction, freely miscible with water, alcohol and ether, but 
nearly insoluble in chloroform. It is produced by the lactic fermentation of sugar of 
milk or grape-sugar, has a sp. gr. of 1.213, and is difficult to obtain pure. It enters into 
Syrupus Calcii Lactophosphatis. Dose, 3 ss- % ss, well diluted. 

Lactic Acid is found in the stomach as a product of the food, and combines with bases 
in the blood, forming lactates, which, being oxidized, are converted into carbonates. "It 
aids digestion and promotes the appetite, but in large doses causes flatulence and much 
epigastric pain. Injected into the peritoneal cavity of animals, it excites endocarditis, 



102 ACIDUM NITRICUM. 

and given in diabetes it has produced acute rheumatism and rheumatic endocarditis. 
Hence its supposed causation of acute rheumatism when in excess and free in the blood. 
It dissolves false membranes and also calcium phosphate. Hypnotic properties have 
been ascribed to it. 

Lactic Acid is used with benefit in diabetes, atonic dyspepsia, oxaluria, and in the 
lithic and phosphatic diatheses when due to imperfect digestion and assimilation. As a 
solvent of false membrane in diphtheria it is unquestionably of great service but painful. 
In chronic cystitis it arrests the ammoniacal decomposition of the urine. As the acid 
found in the shops is generally of poor quality, disappointment in its use may be expected. 



ACIDUM NITRICUM, Nitric Acid,— is a liquid composed of 
68 per cent, of absolute Nitric Acid, HN0 3 , and 32 per cent, of water. 
It is colorless, fuming, very caustic and corrosive, of sp. gr. 1.414, 
strongly acid in reaction, and is obtained by the action of Sulphuric 
Acid on Potassium Nitrate. It is only used externally as a caustic. 

Preparations. 

Acidum Nitricum Dilutum, Diluted Nitric Acid, — has of the above 10 parts in 58 
of Distilled Water, and contains 10 per cent, of absolute Nitric Acid. Dose, rt\nj-xv, 
well diluted. 

Acidum Nitrohydrochloricum, Nitrohydrochloric Acid, Nitromuriatic Acid, Aqua 
Regia, — a golden-yellow, fuming, corrosive liquid, composed of Nitric Acid 18 vols., 
Hydrochloric Acid 82 vols. Is wholly volatilized by heat, usually dissolves gold-leaf, 
and a drop added to test-solution of potassium iodide liberates Iodine in abundance. 
Dose, rry-viij, well diluted. 

Acidum Nitrohydrochloricum Dilutum, Diluted Nitrohydrochloric Acid, — con- 
sists of Nitric Acid 4, Hydrochloric Acid 18, Water 78 vols. Dose, TT\v-xx, well 
diluted. 

The action and uses of these agents described with those of the 
other mineral acids, under the title Acidum Hydrochloricum. Some 
special properties are as follows: — 

Nitric Acid is an exceedingly powerful escharotic, but, as it coagulates 
and does not redissolve the albumin of the tissues, it forms a barrier to 
its own excessive action. The vapor may cause edema of the glottis, 
intense bronchitis, etc., and death from suffocation. It is used for the 
destruction of chancres, warts, hemorrhoids, phagedenic ulcers, etc. ; and 
internally in dilute form for bilious affections, as it is supposed to have a 
selective action on the liver. It also lessens phosphatic deposits in the 
urine, and acts as an astringent in the system, diminishing profuse secre- 
tion in bronchorrhea and phthisis. 

Nitrohydrochloric Acid is also supposed to specially affect the liver. 
It is usefully employed in jaundice, dyspepsia, and the so-called bilious 
condition ; also in acidity of the stomach and in frontal headache situ- 
ated just above the eyebrows when unaccompanied by constipation. In 
hepatic disorders it may be used in dilute form as baths, or applied to 
the hepatic region on compresses. The official dilute acid is of little use 



ACIDUM OLEICUM. IO3 

therapeutically, as it rapidly deteriorates, and the same is true of the 
strong acid when old enough for the color to change to a lemon-yellow. 
The most efficient is the strong acid freshly prepared, which is of an 
orange-red color. This should be properly diluted when required for 
use, and should be constantly protected from light. 

ACIDUM OLEICUM, Oleic Acid, HC 18 H 33 2 ,— is one of the 
constituent acids of oils and fats, obtained commercially as a secondary 
product in the manufacture of stearin candles. It is a yellowish, oily 
liquid, semi-solid at 39 F., odorless, tasteless, and of neutral reaction, 
insoluble in water but soluble in alcohol, chloroform, benzol, benzin, 
turpentine, and the fixed oils. It dissolves most of the metallic oxides 
and the uncombined alkaloids, forming the so-called Oleates, which, 
however, are not pure chemical compounds, but merely compounds of an 
oxide or an alkaloid, as the case may be, with oleic acid, dissolved in a 
great excess of the latter. Three of these are official, viz. — 

Oleatum Hydrargyri, Oleate of Mercury, — has 20 of the Yellow Oxide of Mercury 
with 80 of Oleic Acid. 

Oleatum Veratrinae, Oleate of Veratrine, — has 2 of Veratrine in 98 of Oleic Acid. 
Oleatum Zinci, Oleate of Zinc, — has 4 of Zinc Oxide in 95 of Oleic Acid. 

Unofficial Preparations. 

Oleates (Oleata) of Aconitine (2 per cent.), Atropine (2 per cent.), Morphine (10 
percent.), Morphine and Mercury (2 per cent, morphine and 20 percent, mercuric 
oxide), Quinine (25 percent.), Strychnine (2 per cent.), Arsenic (gr. xx of arsenic 
oleate to the ^), Aluminum, Bismuth, Copper, Iron, Lead, Silver, etc., are prepared 
by the manufacturing pharmacists, and are to be obtained in the shops. Most of them 
answer to the description given above, but several are Oleo-palmitates, or double salts 
of Oleic and Palmitic Acids, being prepared from oils which yield the latter acid in con- 
siderable quantity. Drs. Shoemaker and Wolff, of Philadelphia, have introduced, under 
the above names, several solid or semi-solid preparations, which they claim to be chemi- 
cally true oleates, salts having no excess of either their acids or basic radicles. They are 
produced by the double decomposition of sodium oleate with solutions of neutral salts, the 
precipitates, washed and dried, being the oleates required. These oleates are claimed 
to be more stable than the official oleic solutions, and having less oleic acid are much less 
costly. Many of them may be used as dusting powders, or mixed with oil or lard to 
form ointments. 

Oleic Acid is used only in making the Oleates, which were introduced 
by Marshall as substitutes for ointments, being cleaner, more elegant, 
and more penetrating, but decidedly more irritating if applied with 
friction. Their medicinal properties depend upon the bases employed, 
hence their actions and uses will be described under the corresponding 
basic heads. They should usually be diluted with an equal bulk of vaselin 
or olive oil before being rubbed into the skin, as they may produce a 
cutaneous eruption or even pustulation. As a rule, they should be lightly 
spread over the surface with the finger or a brush. As parasiticides, the 
Oleates of Copper and Mercury are most efficient, and in skin diseases 
generally these preparations are rapidly gaining favor. 



104 ACIDUM PHOSPHORICUM — ACIDUM SULPHURICUM. 

ACIDUM PHOSPHORICUM, Phosphoric Acid— is a liquid 
composed of 85 per cent, of Orthophosphoric Acid, H 3 P0 4 , and 15 per 
cent, of water, and is obtained by oxidizing phosphorus with nitric acid. 
It is strongly acid, odorless, colorless, and of sp. gr. 1.710 at 59 F. 

Acidum Phosphoricum Dilutum, Diluted Phosphoric Acid, — has of Phosphoric 
Acid 10 parts in 75 of Distilled Water, and contains io per cent, of Orthophosphoric 
Acid. Dose, TT\,v-xxx, in sufficient water. 

Phosphates of Ammonium, Ferrum, and Sodium, also the Glycero-phosphates, 
Syrupus Ferri, Quinine et Strychnines Phosphatum, and Acidum Hypophosphorosum 
Dilutum, are described under Phosphorus. 

The action and uses of Phosphoric Acid are described with those of 
the other mineral acids under Acidum Hydrochloricum. It may be 
given in larger doses than these other acids without deranging digestion, 
and is therefore "preferred in cases requiring acid treatment for a long 
period, as in diabetes, etc. It is considered of especial value in strumous 
affections, and it is thought to diminish the growth of osseous tumors, 
and to dissolve phosphatic deposits. As it contains no free phosphorus, 
it cannot be used to obtain the effects of that drug. 

ACIDUM PICRICUM, Picric Acid, Carbazotic Acid, Tritiitrophenol, C 6 H 3 - 
(N0 2 ) 3 (Unofficial), — is obtained by the action of Nitric Acid on Carbolic Acid or 
many other substances. It is an efficient test for albumin and sugar in the urine. A satu- 
rated solution is used locally in erysipelas and burns with great advantage. Some of its 
salts (Picrates of Ammonium, Iron, etc.) have been tried therapeutically, without any 
particular results. Antiperiodic and anthelmintic properties and power against trichinae 
have been urged for it, but experience has not supported these claims. Dose, gr. v— xv 
per diem. 

Ammonium Picrate, in doses of gr. % to gr. jss, in pill four times daily, has been 
used in the malarial fevers of India, in over 10,000 cases with most effective results. 

ACIDUM SULPHURICUM, Sulphuric Acid,— is a strongly 
caustic and corrosive liquid, oily, inodorous, of strongly acid reaction, 
and is composed of not less than 92^ per cent, of absolute Sulphuric 
Acid (H 2 S0 4 ) and 7^ per cent, of water. It is obtained from the com- 
bustion of Sulphur arid its oxidation by nitrous fumes. Its specific gravity 
should not be below 1.835, an d it is miscible in all proportions with 
water and alcohol, with evolution of heat. It is occasionally used as a 
caustic. 

Acidum Sulphuricum Dilutum, Dihited Sulphuric Acid, — has of the strong acid 
I part to &}{ of distilled water, and contains 10 percent, by weight of absolute sulphuric 
acid. Dose, rr\v-xv, well diluted. 

Acidum Sulphuricum Aromaticum, Aromatic Sulphuric Acid, Elixir of Vitriol, 
is Sulphuric Acid 10 per cent, by volume, 20 per cent, by weight, diluted with Alcohol 
and flavored with Cinnamon and Ginger. It is not an acid, but rather an ether formed 
by reaction between the acid and the alcohol. Dose, n\v-xv, well diluted. 

The action and uses of Sulphuric Acid generally are described with 
those of the other mineral acids under Acidum Hydrochloricum. Its 



ACIDUM SULPHUROSUM. IO5 

chief use internally is in lead-poisoning to form the insoluble sulphate, 
and as a remote astringent in diarrhea, hemorrhoids, hemorrhages, night- 
sweats, and mucous discharges. In choleraic diarrhea and lead-poison- 
ing it is generally administered in combination with Opium. The only 
hemorrhages in which it is efficient are those from mucous surfaces. It 
is excreted chiefly by the kidneys, part escaping by the bowels as sul- 
phates, part also by the skin. Like the other mineral acids, it does not 
increase the acidity of the urine to any considerable extent. Its princi- 
pal actions are those of an astringent, an anhydrotic and a hemostatic. 



ACIDUM SULPHUROSUM, Sulphurous Acid,— is a color- 
less liquid, of sulphurous taste and highly acid reaction, composed of not 
less than 6.4 per cent., by weight, of Sulphurous Acid Gas (S0 2 ) and 93.6 
per cent, of water. It is prepared by heating Sulphuric Acid with char- 
coal and dissolving the evolved gas in distilled water. Dose, n^ v— 3 j , 
largely diluted with water. 

Sodii Sulphis, Sodium Sulphite, Na 2 S0 3 .7H 2 0, — colorless, transparent, monoclinic 
prisms, efflorescent in dry air, of cooling, saline, and sulphurous taste, and neutral or 
feebly alkaline reaction ; soluble in 4 of water and in 0.9 of boiling water, very slightly 
soluble in alcohol. Dose, gr. v-xxx or even up to 3J. 

Sodii Bisulphis, Sodium Bisulphite, NaHS0 3 , — opaque prismatic crystals, of faint, 
sulphurous odor, a disagreeable taste, and acid reaction ; soluble in 4 of water and in 
72 of alcohol, in 2 of boiling water, and in 49 of boiling alcohol. By strong heat it is 
converted into sulphur and sulphate of sodium. Dose, gr. iij-xxx. 

Sodii Hyposulphis, Sodiutn Hyposulphite, Na 2 S 2 3 .5H 2 0, — large, colorless, mono- 
clinic prisms or plates, efflorescent in dry air, of cooling and bitter taste, and neutral or 
faintly alkaline reaction; soluble in 1. 5 of water and in 0.5 of boiling water, which 
partly decomposes it ; insoluble in alcohol. Dose, gr. v-xx. 

Incompatibles. 

All oxidizing substances change the sulphites into sulphates, and the Mineral Acids 
decompose them. 

Sulphurous Acid has great affinity for oxygen, and is a powerful dis- 
infectant and deodorizer, and very destructive to all plant life. The gas 
is irritant to the glottis when inhaled, and may produce dangerous inflam- 
mation of the respiratory passages. 

Sulphurous Acid Gas (Sulphurous Anhydride) is extensively used as a 
disinfectant, being the most powerful and. convenient agent for this pur- 
pose. Sulphur is burned on a shovel or plate in the room to be fumi- 
gated, all outlets having been carefully closed. The gas is injurious to 
many fabrics. Sulphurous Acid is used locally in many throat affections 
as a spray or by a mop. In diphtheria, stomatitis, aphthae, ulcers of the 
tonsils, syphilitic and tuberculous laryngitis, chronic bronchitis, etc., it 
may be thus applied with great benefit. Morbid fermentation in the 



106 ACIDUM TARTARICUM ACONITUM. 

stomach, with growth of penicillium and sarcinas, is quickly stopped by 5 
to 60-minim doses in water, or by the sulphites in 20-grain doses. In 
parasitic skin diseases and foul wounds these agents are extremely useful 
as local applications. 

The Sulphites and Hyposulphites are partly decomposed by the acid 
of the stomach, sulphurous acid being given off, and the balance being 
converted into sulphates act as purgatives, and are absorbed, undergoing 
elimination as sulphates by the kidneys and bowels. They were formerly 
supposed to enter the blood and tissues as sulphites, and to arrest morbid 
processes of the zymotic character, but both these assumptions have 
proven erroneous. The Sulphites were formerly used in zymotic and 
septic fevers as internal antiseptics on theoretical grounds, but their 
supposed value has not been realized. 

ACIDUM TARTARICUM, Tartaric Acid, H 2 C 4 H 4 6 ,— is a crystalline acid, 
prepared from Potassium Bitartrate by neutralizing a solution thereof with chalk and 
calcium chloride, then decomposing the calcium tartrate thus formed by sulphuric acid, 
evaporating and purifying. It occurs in colorless, transparent prisms, which are odorless, 
of acid taste and reaction, and soluble in 0.8 of water and in 2.]/ 2 of alcohol at 59 F. 
Twenty grains exactly neutralize 27 of Potassium Bicarbonate, 22 of Sodium Bicarbon- 
ate, or 15^2 of Ammonium Carbonate. Dose, gr. x-xxx. 

Tartaric Acid is an ingredient of the Effervescing Powders (see under Potassium). 
Four Tartrates and one Bitartrate (see Index) are official, and are described, with their 
actions and uses, under the titles of their respective bases. For Potassium Bitartrate see 
under Potassium. The Alkaline Cupric Tartrate Volumetric (Fehling's) Solution is 
described in Part III under the title Poisoning. 

The actions and uses of Tartaric Acid are similar to those of the other Vegetable 
Acids, as described under AciDUM Aceticum. It is chiefly employed in the preparation 
of effervescing refrigerant drinks and effervescing granulated salts. 



ACONITUM, Aconite, — is the tuber of Aconitum Napellus, the 
Monk's-hood or Wolf's-bane, a perennial plant of the nat. ord. Ranun- 
culaceae, found in mountainous regions of Europe, Asia and N. America. 
This plant has deep-blue, helmet-shaped flowers, and leaves which have 
deeply-cut, wedge-shaped segments, exciting slowly when chewed a sen- 
sation of tingling in the tongue and lips. The root is conical and taper- 
ing, with a thick bark enclosing a seven-rayed, star-shaped pith, odor- 
less, taste sweetish at first, soon becoming acrid. A minute portion, 
cautiously chewed, causes prolonged tingling and numbness. Its active 
principle is the alkaloid Aconitine (see p. 107), which it contains in the 
proportion of .03 per cent. It also contains gum, sugar, Aconitic Acid, 
and several other principles, viz. — Aconine, Napelline, Pseudaconitine, 
Lyctonine, etc., concerning which there is much diversity of opinion. 
Dose, gr. y 2 -\). 

Other aconite-roots are those of A. Cammarum , A. ferox, and the Chinese or Japan- 
ese Aconite, A. Chinense vel Japonicum. From the latter an alkaloid is obtained, 
named Japaconitine, which is even more poisonous than Pseud-aconitine. The Indian 
variety [A. ferox) contains Pseud-aconitine, but does not yield Aconitine. The former is 



ACONITUM. 107 

considered to be more active than the latter, and Japaconitine more so than either of the 
other two. 

Preparations . 

Extractum Aconiti, Extract of Aconite, — is at least four times as strong as the 
extract official in the U. S. P., 1870, which was prepared from the leaves, and is yet to 
be found in the shops. Dose, gr. Ye-^i- 

Extractum Aconiti Fluidum, Fluid Extract of Aconite, — an alcoholic preparation, 
of which each drop represents nearly one grain of the powdered drug. Dose, TtL/^-ij. 

Tinctura Aconiti, Tincture of Aconite, — has of Aconite 35, Alcohol and Water to 
100. Is about 25 times stronger than the tincture of the leaf. Dose, TTL^-iij. 

Tinctures of Aconite-root vary greatly in strength. In Fleming's Tincture 79 parts 
of aconite are used in preparing 100 of the tincture, in that of the B. P. 16, in the 
French 20, the German 10, while the Linimentum Aconiti (B. P.) is really a very strong 
tincture, of the strength of I to I ]/ z . Probably the best and safest preparation for ordi- 
nary use is a 10 per cent, tincture, of which the maximum single dose for an adult is 
stated in the P. Ger. at Tujx, and the maximum daily dose at ttvxxxv. 

The best rule for the administration of Aconite is to give fractional parts of a minim 
of the tincture (V^yi to %) every 15 minutes until the desired effect is produced. 

Unofficial Preparations. 

Aconitina, Aconitine, C 33 H 43 N0 12 , — a white, and usually amorphous solid, of alka- 
line reaction, soluble in 150 of cold and 50 of hot water ; much more soluble in alcohol 
and ether. Is difficult to obtain of constant strength, some samples being all but inert, 
others extremely active. As obtained in the shops it is usually a mixture of several 
alkaloids. The Aconitine Crystalisee of Duquesnel, which, according to Squibb, is a 
nitrate of aconitine, is considered to be the most active of those in the market. Dose, 

err 1 1 

Oleatum Aconitinae, Oleate of Aconitine, — is a 2 per cent, solution in Oleic Acid, 
for external use. Duquesnel's crystals will not dissolve in Oleic Acid (Squibb). 

Napellina, Napelline, — is weaker than Aconitine, and has been used in doses of 
gr. ^-f . It has been studied by Laborde, who claims for it most valuable hypnotic 
properties, and proposes to use it as a substitute for opium and chloral. 

St. Jacob's Oil (a patent medicine), — is a weak Aconite Liniment, which also con- 
tains Ether, Alcohol, Turpentine, red coloring matter and water (Squibb). It contains 
Turpentine (82 per cent.), Aconite, Ether, Alcohol, Carbolic Acid, Capsicum and a 
small quantity of Origanum (Murrell). 

Physiological Action. 

Aconite is a powerful depressant of the sensory nerve ends, the ner- 
vous and muscular apparatus of the heart and respiration and the spinal 
nervous system. It is also antipyretic, diaphoretic and diuretic. It acts 
directly on the peripheral ends of the sensory nerves, but paralyzes both 
the motor and sensory nerves — the sensory being affected first and from 
the periphery inwards, while the motor nerves are affected from the 
centres outwardly. It stimulates at first but soon relaxes the inhibitory 
apparatus of the heart, and paralyzes finally the vagus ends, the cardiac 
muscle and its contained ganglia, the respiratory centres, and the spinal 
cord in all its functions — sensory, reflex and motor ; but does not affect 
the cerebrum. 

The primary stimulation which the drug produces upon the vagus centre 
in the medulla slows the heart-rate at first ; but its depressant action upon 
the motor cardiac centres and the vagus end-organs in the heart is soon 



108 ACONITUM. 

manifested, and finally the vagus centre shares in- the increasing paralysis, 
which affects the vasomotor centre as well as the cardiac nervous appa- 
ratus. The heart-rate becomes very rapid near the end, from paralysis 
of the vagus terminals in its structure. 

The taste of Aconite is bitter, acrid and pungent. Soon after the in- 
gestion of even a small quantity, a sensation of numbness and persistent 
tingling are felt in the tongue and lips. Full medicinal doses cause a 
sense of constriction in the fauces, irritation of the gastro-intestinal mu- 
cous membrane with increased secretion ; sometimes nausea and vomiting, 
and severe pains in the joints and muscles; always more or less salivation, 
diaphoresis and diuresis ; reduced respiratory power, cardiac rate and 
force; lowered arterial tension and temperature. 

A lethal dose produces great muscular weakness, dim sight, dilated 
(sometimes contracted) pupils ; shallow, irregular, and labored respiration, 
slow and weak pulse, cold surface, clammy sweat, great anxiety, numbness 
and tingling in the extremities, lowered body-temperature (2 to 3 ), 
abolished sensation, impaired reflexes and motility, and finally death from 
paralysis of the heart and respiration, with or without convulsions, con- 
sciousness being preserved until near the end, when C0 2 narcosis sets in. 
In two recorded cases, edema of the entire body resulted from eating 
the leaves of the growing plant. 

Aconite is rapidly diffused and slowly excreted, the effects of a full 
medicinal dose continuing for three or four hours. Applied externally, 
it paralyzes the sensory nerves of the part, producing its characteristic 

numbness and tingling. 

Antagonists. 

Caffeine, Atropine, Morphine, Ether, Ammonia and Amyl Nitrite antagonize its 
effects on the heart and respiration. Digitalis counteracts its cardiac action and the 
relaxation of cardiac inhibition. In Aconite poisoning, the stomach should be evacuated, 
warmth applied to the extremities, stimulants administered, artificial respiration if nec- 
essary, and the recumbent posture strictly maintained. Caffeine may be administered 
hypodermically and by the mouth. 

Therapeutics. 

Aconite was well known to the ancients, by whom it was regarded as 
the most virulent of all poisons. It was introduced into medicine by 
Baron Storck, of Vienna, in 1762, and its pharmacology and therapeutics 
were the subject of an essay by Fleming in 1844, f° r which he was 
awarded a gold medal by the University of Edinburgh. 

Aconite antagonizes the fever process, and rightly used is therefore one 
of the most valuable drugs we possess. It has well been called the " thera- 
peutic lancet," and is certainly responsible to a great extent for the 
disuse of venesection. Its power over the circulation, respiration and 
transpiration renders it of the greatest value in all affections characterized 
by a high, resisting pulse, a dry, hot skin, and elevated body-temperature. 



ACONITUM. IO9 

The chief indication for its use is vascular excitement in sthenic sub- 
jects ; it is contra-indicated when there is adynamia, weak action of the 
heart, cardiac degeneration or dilatation, and gastro-intestinal irritation 
or inflammation. Aconite is not a remedy for use in continued fevers, 
and its prolonged administration is not indicated except under very 
exceptional circumstances. Even in the inflammatory and febrile con- 
ditions for which it is usefully employed it will be found of greatest value 
in their early and sthenic stages, its later use being often injurious. 

Aconite is very efficient in acute affections of the bronchial mucous 
membrane, in coryza, tonsillitis and asthma due to exposure, also in both 
catarrhal and spasmodic croup. One of the best methods of " breaking 
up a cold " is to administer small doses of the tincture at frequent inter- 
vals for several hours, followed by 10 grains of Dover's powder at bed- 
time. As a febrifuge and sedative it is useful in simple and catarrhal 
fever, also in scarlatina, measles and erysipelas. In the early stage of 
acute inflammations of serous membranes, as meningitis, pleurisy and 
pericarditis, it has great power for good, but its employment in these 
affections should be restricted to the period before the stage of effusion. 
In acute peritonitis it is a valuable adjunct to Opium in cases presenting 
the sthenic characteristics which indicate its employment. In the early 
stage of pneumonia its sedative influence upon the respiration may be 
utilized with benefit, but it should not be used beyond the time when the 
heart begins to undergo much strain. In acute articular and muscular 
rheumatism it is frequently of great service, and if used from the begin- 
ning of the attack in rheumatic fever it will generally prevent the cardiac 
complications which are so dreaded in that disease. 

Aconite has proved very efficient in neuralgia, especially if the attack 
is accompanied by high vascular excitement, also when the branches of 
the fifth nerve are affected. In cardiac affections characterized by over- 
action or hypertrophy and absence of dilatation or valvular lesions it 
gives great satisfaction, particularly in exophthalmos, nervous palpitation 
and tobacco heart. Even when valvular disease is present it may be 
cautiously used in extreme hypertrophy to control the forcible cardiac 
action. 

When diarrhea or dysentery follows a chill and can be ascribed to cold 
and exposure, the patient having high fever and cutting pains in the ab- 
domen, Aconite will be found a very serviceable remedy. In sudden 
suppression of menstruation following a chill, getting the feet wet, or 
similar evidences of exposure, this agent is efficient in removing the 
discomfort and causing the reappearance of the flow. In congestive 
dysmenorrhea it frequently gives marked relief. In the early stage of 
gonorrhea drop doses of the tincture, given hourly until some physio- 
logical effect is produced, will lessen the severity of the inflammatory 



IIO ADEPS. 

symptoms and prevent chordee. In the so-called urethral fever it is 
highly recommended, and a drop or two of the tincture given immedi- 
ately after the passage of a urethral sound will prevent the chill which 
often succeeds that operation. 

Externally :, Aconite is used with benefit as a local anodyne in super- 
ficial neuralgias, herpes zoster, pruritus and chilblain. For the relief of 
vague, wandering pains in the limbs, liniments containing this tincture 
will prove more effective than those of any other form. For odontalgia 
the tincture may be rubbed on the gum in the vicinity of the aching 
tooth, or it may be introduced upon a pledget of cotton into a dental 
cavity. Any preparation containing this drug should be used with great 
caution upon an abraded cutaneous surface, as it is rapidly absorbed by 
the unprotected derma. 

Aconite is best administered in small doses of the tincture well diluted 
and frequently repeated. Doses of n^^ to j£ every 15 minutes give 
better results than larger ones at longer intervals. 

Aconitine has proved remarkably efficient in trigeminal neuralgia. 
Napelline has also been praised for its influence over this affection, and 
as a hypnotic it is commended by several authorities. 



ADEPS, Lard, — is the prepared internal fat of the abdomen of 
Sus scrofa (the Pig), purified by washing, melting and straining. It 
occurs as a soft, white, unctuous solid, of bland taste and neutral reac- 
tion, entirely soluble in ether, benzin, and bisulphide of carbon ; com- 
posed of 38 per cent, of stearin and margarin, and 62 per cent, of olein. 
Lard forms 70 per cent, of Ceratum, and 80 per cent, of Unguentum, 
and enters into the composition of several of the official cerates. 

Fats are formed of the immediate principles, Stearin, Margarin and Olein, which are 
regarded as salts composed of stearic, margaric and oleic acids with a common base, 
glycerin ; also odorous and coloring principles. 

Preparations. 

Adeps Benzoinatus, Benzoinated Lard, — has 2 per cent, of Benzoin in powder, in- 
corporated by stirring. 

Oleum Adipis, Lard Oil, — is a fixed oil expressed from lard at a low temperature. 

The action of the Oils and Fats is described under Morrhile Oleum 
(which see). 

Lard is only used as an ingredient of ointments and cerates. Lard Oil 
is used in making the Unguentum Hydrargyi Nitratis, but has been pro- 
posed as an inferior substitute for Cod-liver oil in cases where the taste of 
the latter is particularly offensive. 



ADONIS. I I I 

Official Derivative and Analogues. 

Acidum Stearicum, Stearic Acid, — is an organic acid, usually obtained from the 
more solid fats, chiefly tallow. In its impure, commercial form, it occurs as a hard, 
white, glossy solid, odorless and tasteless, permanent in the air ; insoluble in water, sol- 
uble in 45 of alcohol, also in ether. It is used as a substitute for wax, and is an ingre- 
dient of the Suppositoria Glycerini. 

Adeps Lanae Hydrosus, Hydrous Wool-fat, Lanolin, — is the purified fat of the 
wool of sheep, mixed with not more than 30 per cent, of water. A yellowish-white, 
ointment-like mass, having a faint, peculiar odor; insoluble in water but miscible with 
twice its weight thereof. 

Under the name Lanolin this substance was in use for several years before it became 
official. It is a cholesterin fat, and a very old medicament, having been mentioned by 
Ovid, Herodotus, Pliny and Aristophanes ; yet the process of obtaining it from the suds 
from the washings of sheep's wool is patented in this country by Liebrich. It differs 
from all other fatty substances chiefly in resisting saponification and the action of water, 
having no tendency to become rancid ; and readily passes through the integument, car- 
rying with it any medicament with which it is charged. It is a perfectly neutral base, 
and therefore is not liable to decompose any ordinary substance. The difficulty about its 
use has been its very disagreeably sheepy smell, but recent samples seem in great measure 
to be devoid of this objectionable quality. It is particularly useful in chronic skin dis- 
eases where there is infiltration, and where a penetrative action is desired* for medica- 
ments locally applied. In a few- cases of acute and subacute eczema it has proved 
irritating, but as a rule it is perfectly bland. Where a simple protective action is alone 
desired it is inferior to Lard, Vaselin or Cold Cream. 

Cetaceum, Spermaceti, — is a peculiar, concrete, fatty substance obtained from the 
sperm whale. It occurs in white, pearly masses, which are odorless, of bland taste and 
neutral reaction, becoming rancid in the air, soluble in ether, chloroform, carbon disul- 
phide and boiling alcohol. It is a constituent of — 

Ceratum Cetacei, Spermaceti Cerate, — contains Spermaceti 10 parts, White Wax 35, 
Olive Oil 55. 

Unguentum Cetacei, Spermaceti Ointment (B. P.), — contains Spermaceti 5, White 
Wax 2, Almond Oil 18, Benzoin y z . The last-named ingredient renders the ointment 
irritating and therefore unsuitable for use on the eye, for hemorrhoids, etc. 

Unguenttwi Aquce Rosce, Ointment of Rose Watei, Cold Cream, — contains Spermaceti, 
Almond Oil, Rose Water, etc. [See under Rosa.] 

Spermaceti consists of Cetin (Cetyl Palmitate) with several other fats in small quanti- 
ties. Its action is solely that of an emollient, and it is rarely used internally, though an 
alcoholic preparation was once a regular prescription for coughs, bronchial irritation, and 
for a recently delivered woman. The Cerate is employed as a bland ointment for 
blisters, abrasions and ulcers, but it is too stiff for easy application, and the unofficial 
Ointment is preferred in practice. The latter on lint to broken blisters from walking af- 
fords great relief, and may be smeared on the feet to prevent injury from a rough tramp 
over broken ground. 

Sevum, Suet, — is the internal fat of the abdomen of Ovis Aries (the Sheep), purified 
by melting and straining. It should be kept in well-closed vessels and not used after it 
has become rancid, as it will on exposure to air. It is a white, smooth, solid fat, of 
bland taste and neutral reaction, insoluble in water or cold alcohol, soluble in 44 of boil- 
ing alcohol, 60 of ether, and slowly in 2 of benzin. It consists chiefly of Stearin, but 
also has Palmitin and Olein, and is a constituent of Unguentum Hydrargyri. It is a 
harder fat than lard and more liable to turn rancid. It is used in ointments and lini- 
ments to give them greater consistency, but may be applied alone as a dressing to ulcers. 
In physiological action and therapeutics it follows the other oils and fats. [See under 
Morrhu^e Oleum and Oliw-e Oleum.] 



ADONIS (Unofficial), — is the plant Adonis vernalis, the Pheasant's 
Eye or False Hellebore, a perennial herb of the nat. ord. Ranunculaceav 
which grows wild in Europe and Asia. It contains Aconitic Acid, also 



112 .ETHER. 

the toxic glucoside Adonidin, which is the active principle and is found 
in small quantity in all parts of the plant. 

Preparations. 

Tinctura Adonis, Tincture of Adonis, — Dose, gss-ij. 

Infusum Adonis, Infiision of Adonis, — has from 4 to 8 parts of the plant in 200 of 
water. Dose, 3 ss every 4 to 6 hours. 

Adonidinum, Adonidin, — a canary-yellow, hygroscopic powder, of intensely bitter 
taste and neutral reaction, soluble in water and in alcohol. Dose, gr. Jg to A, repeated 
3 or 4 times a day. 

Physiological Action and Therapeutics. 

Adonis, when fresh, has acrid, irritant and vesicant properties, which 
disappear when the plant is dried. It affects the heart in the same man- 
ner as Digitalis, but more promptly, slowing, regulating and strengthen- 
ing the beats and thereby raising the blood-pressure in the arteries. In 
consequence of the latter action it is a diuretic and removes edema and 
dropsy. It also slows and deepens the respiration, and relieves dysp- 
nea. In toxic dose it paralyzes the terminals of the vagus, excites the 
accelerator apparatus of the heart, and finally causes paralysis of the 
cardiac motor nerves. It is rapidly eliminated and does not accumulate 
in the system. Adonidin has similar action, which is almost exactly like 
that of digitalin, but stronger, and about ten times as powerful as that of 
digitoxin (Brunton). In large doses it causes either vomiting or diar- 
rhea (Huchard). 

In Russia [this plant is a household remedy for cardiac and renal 
dropsy, and in Siberia it is used as an abortifacient. It is useful in 
cases of uncompensated heart disease, in which, by reason of arrhythmia 
and feeble cardiac energy, grave circulatory disorders exist, especially 
dyspnea and dropsy. It is recommended in functional irregularity of 
the heart and in palpitation without any cardiac lesion (Da Costa). It 
acts more promptly than digitalis and may be administered for months 
without cumulative effect, hence it is preferred to digitalis in those 
cases of mitral or aortic regurgitation in which the latter drug is not well 
tolerated. In general it is less certainly beneficial in valvular disease 
than digitalis, and should only be used when the latter fails (Nothnagel). 
In connection with the bromides this drug has been successfully used in 
epilepsy. 

^THER, Ether, Ethyl Oxide (C 2 H 5 ) 2 0,— in its absolute form is 
not official, the strongest preparation containing 4 per cent, of alcohol 
and some water. Considered as a generic term an ether is analogous to 
a salt as an alcohol is to a metallic hydrate. The particular ether offi- 
cially so named is Ethyl Oxide, prepared from Ethyl Hydrate (Ethylic 



iETHER. 113 

Alcohol) by a dehydrating agent with the aid of heat, and then purified 
by various processes. The agent used is Sulphuric Acid, hence this ether 
is improperly called " Sulphuric Ether," but the acid simply dehydrates 
the alcohol and remains in the retort, becoming constantly more diluted 
by the abstraction of water from the alcohol. Consequently H 2 is the 
difference between Alcohol and Ether. (C 2 H 6 0) 2 — H 2 = (C 2 H 5 ) 2 0. 
The official ethers are the two first named in the following list. 

JEther, Ether, — is a volatile and inflammable liquid, composed of 
about 96 per cent, of absolute Ether (Ethyl Oxide), and about 4 per 
cent, of Alcohol containing a little water. Sp. gr. 0.725 to 0.728 at 
59 F. It is the preparation employed for anesthetic use, and is gener- 
ally though improperly called " Sulphuric Ether," a term which belongs 
to Ethyl Sulphate (C 4 H 10 SO4). The dose of Ether for internal adminis- 
tration is ttLx-^j, in syrup; hypodermically for heart failure, r^xv-xxx. 
It is best prescribed as Spirit of Ether, which mixes readily with water. 

Water dissolves a tenth of its volume of Ether, and reciprocally Ether takes up about 
the same proportion of water. It is colorless, of a strong and characteristic odor, hot 
and pungent in taste. It evaporates speedily in the open air, with the production of 
considerable cold. When good, it evaporates from the hand, without leaving a disa- 
greeable odor. It boils at about the temperature of the body (98. 6° F.), and its vapor is 
very heavy and very inflammable. It dissolves Hydrargyrum Bichloride, Hydrargyrum 
Iodidum Rubrum, Iodine and Bromine freely ; Sulphur and Phosphorus sparingly. It 
is also a solvent of the fixed and volatile oils, many resins and balsams, caoutchouc, and 
most of the organic vegetable alkaloids. It does not dissolve Potash or Soda, in which 
respect it differs from Alcohol. 

iEther Aceticus, Acetic Ether, Ethyl Acetate, C 2 H 5 C 2 H 3 0, — is an 
inflammable liquid, transparent and colorless, of ethereal and acetous 
odor, soluble in alcohol, ether, chloroform, and in 8 of water. It is a 
constituent of Spiritus Odoratus and Tr. Ferri Acetatis. Dose, wix-^j. 

Hydrobromic Ether, Ethyl Bromide, C 2 H 5 Br (Unofficial), — is not 
inflammable. Dose, internally and hypodermically, rrLx-gj. 

Hydriodic Ether, Ethyl Iodide, C 2 H 5 I (Unofficial), — is a colorless 
liquid, non-inflammable, and insoluble in water. Dose, inhaled, m^xv. 

For the Chlorinated Ethers see under Chloroform. 

Preparations. 

Oleum iEthereum, Ethereal Oil, — is a volatile liquid, consisting of equal volumes 
of heavy Oil of Wine and Ether. Used to prepare the Spt. ^Etheris Comp. As it occurs 
in commerce is usually a worthless preparation. 

Spiritus iEtheris, Spirit of Ether, — has of Ether one-third, Alcohol two-thirds. 
Dose, tt\x-3J. 

Spiritus j*Etheris Compositus, Hoffmann? s Anodyne, — contains Ether Z 2 }i P er 
cent., Alcohol 65, Ethereal Oil 2 l / 2 . Dose, n\v~3J. 

Spiritus Athens Nitrosi, Spirit of Nitrous Ether, Sweet Spirit of Nitre, — is an 
alcoholic solution of Ethyl Nitrite, C 2 H 5 N0 2 , containing 5 per cent, of the crude ether. 
It turns acid with age, and should not be kept long. It is a constituent of Mist. Glycyr- 
rhizae Co. (3 per cent.). Dose, gss-^ss. Its incompatibles are Potassium Iodide, 
Ferric Sulphate, Tinct. Guaiaci, Tannic and Gallic Acids, and Antipyrin. 



114 .ETHER. 

Anesthetic Mixtures. 

Ntissbauni 1 s has — Ether 3 pails, Chloroform I, Alcohol I. 

Vienna General Hospital uses — Ether 9, Chloroform 30, Alcohol 9. 

The " Vienna Mixture" — Ether 3, Chloroform I. 

Medico- Chirurgical Society of London (1864) approved a mixture originally introduced 
by Dr. Geo. Harley, and known as the " A. C. E. Mixture." It consists of Alcohol I, 
Chloroform 2 and Ether 3 parts. 

Schleich's Solutions — are three in number, and are made up by volume and not by 
weight, as follows: (No. 1), Ether 6, Chloroform 1^, Benzin (Petroleum Ether) y z . 
(No. 2), Ether 5, Chloroform 1%, Benzin ]/ z . (No. 3), Ether 2%, Chloroform I, 
Benzin ]/ z ; or Ether 80 cc, Chloroform 30 cc, Benzin 15 cc. The latter is adapted 
to major operations and has a boiling point of 107. 4 . 



Physiological Action of Ether. 

Ether is anodyne, antispasmodic, diaphoretic and anthelmintic; a 
cardiac and cerebral stimulant, an anesthetic, and a narcotic poison. 
Given internally, it is a most powerful stimulant of secretion, acting es- 
pecially on the secretions of the stomach, salivary glands and pancreas. 
On the cerebrum and the motor and sensory nerves its action is similar 
to that of alcohol, but more prompt and less protracted. It is eliminated 
rapidly, chiefly by the lungs. Externally it is a powerful refrigerant and 
local anesthetic; also rubefacient when rubbed into the skin. 

Ether when inhaled produces at first faucial irritation, a sense of stran- 
gulation and cough ; then a stage of excitement (cerebral intoxication), 
in which the face is flushed and the respiration and pulse are accelerated. 
A tetanic convulsive stage generally follows, the face being cyanosed, 
the muscles rigid, and the respiration stertorous. This soon subsides, 
and complete insensibility is established, the muscles being then relaxed, 
the reflexes abolished, and the cerebral functions suspended, the lower 
centres in the medulla carrying on the processes of respiration and circu- 
lation. If the inhalation be continued, these also become paralyzed, 
death usually resulting from slow paralysis of respiration, the heart pul- 
sating long after breathing has ceased. If the inhalation be discontinued 
before the lower centres are affected, the patient gradually emerges from 
the condition of insensibility, and, as the narcosis subsides, vomiting is 
usually experienced. 

Dr. Brunton found that in a hot climate Ether will decompose within a few hours, 
and hence, during his investigations for the Hyderabad Chloroform Committee, he found 
it impossible to obtain pure ether. This may account for the preference for Chloroform 
as an anesthetic which is so universal in the Southern States. 

Ether is less irritant than Choloform to the mucous membranes when 
swallowed, but its vapor is more irritant to the air-passages. The one 
grave danger following its administration is the subsequent development 
of a broncho-pneumonia, rarely a lobar pneumonia. Acute mania has 
followed its inhalation for anesthesia, but only in a few cases. Ether is 
a cardiac and vaso-motor stimulant and raises the blood-pressure ; Chlo- 



.ETHER. 115 

roform is a cardiac and vasomotor depressant and lowers the blood-pres- 
ure. Ether has been often administered with safety in cases of organic 
heart disease. It does not clot the blood. Its vapor is very inflammable, 
less pleasant to inhale than that of Chloroform, is slower in action, has 
a longer stage of excitement, and a less profound narcosis, and causes a 
greater degree of vomiting. It is much less dangerous than Chloroform, 
death from the inhalation of Ether occurring slowly and usually by par- 
alysis of respiration — from Chloroform, it is almost always sudden, and 
is generally believed to occur by paralysis of the heart. Ether has un- 
doubtedly been the direct cause of a number of deaths, besides several 
which occurred some hours after the termination of its anesthesia ; but 
the sudden deaths produced by it have nearly all occurred in patients 
who had some lung disease or some enervating lesion, as intestinal 
obstruction, tumor of the brain, cancer or kidney disease. When bron- 
chitis or renal disease exists Ether is positively dangerous. The mortality 
of ether-anesthesia is about 1 in 16,500 cases. 

Modes of Dying in Anesthesia. 

(1.) From sudden paralysis of the cardiac ganglia, early in the inhalation, by reflex 
action proceeding from some peripheral injury before complete anesthesia is produced. 
Thus, in the extraction or teeth, a small quantity of Chloroform having been administered, 
the heart is enfeebled, and the action of the cerebral hemispheres suspended, but not 
that of the basal or medullary ganglia. If at this stage the 5th nerve be irritated, by 
the intimate relation of its nucleus with that of the pneumogastric reflex inhibition may 
be transmitted over the latter, arresting the cardiac ganglia. The stage of incomplete 
anesthesia is always a dangerous one in which to perform any operation around the dis- 
tribution of the 5th nerve. 

(2.) In the stage of rigidity, from tetanic fixation of the respiratory muscles, the blood 
backing up on the venous side, and arresting the heart's action, respiration ceasing before 
the cardiac action is stopped. 

(3.) In the stage of complete relaxation, by paralysis of respiration ; or by paralysis of 
the tongue, causing obstructed respiration. 

(4.) In the same stage, by paralysis of the motor ganglia of the heart. 

(5.) From depression of the functions by chloroform narcosis, and from shock, — and 
may occur in the anesthetic state, or afterwards. 

Contraindications for Anesthesia are : fatty degeneration or dilatation 
of the heart, renal and pulmonary disease, fainting fits, enlarged tonsils, 
cerebral tumor, diabetes mellitus and chronic alcoholism — particularly the 
first and last named. 

Dangerous Symptoms should be met by withdrawing the vapor and in- 
verting the patient head downwards, drawing the tongue forwards, and 
applying a cold douche to the face and chest. Atropine hypodermically 
is an agent of great value in combating the cardiac failure, — artificial 
respiration and faradization of the respiratory muscles if breathing ceases. 
Strychnine, hypodermically, as a cardiac and respiratory stimulant, has 
many advocates, and has done good service, especially in chloroform 
narcosis. Amy I Nitrite by inhalation, or Ammonia f hypodermically. 
Heat to the body and limbs. 



Il6 .ETHER. 

Co?7iparative Safety of Anesthetics. 

A comparison of these agents in respect to their safety has been made by Dr. Richard- 
son, who considers Methylic Ether to be the safest of all, and the others as follows : 

Safe are — Ethyl Bromide, Ethyl Chloride, Ether, Ethene (defiant gas), Ethene Chlo- 
ride, Methyl Bromide, Methyl Chloride, Methyl Ether, Methene Chloride, Methane 
(marsh gas), Nitrous Oxide. 

Of doubtful value are — Amylene, Amyl Chloride, Butyl Chloride, Benzene (benzol), 
Carbon Disulphide, Carbon Dioxide, Carbon Tetrachloride, Methyl Alcohol, Methylal, 
Spirit of Turpentine. 

Dangerous are — Amyl Hydride, Butyl Hydride, Carbon Monoxide, Ethyl Hydride. 
Chloroform and Ethene Dichloride are considered useful, but requiring care. 

Physiological Action of Other Ethers. 

Hydriodic Ether is an antispasmodic and a general stimulant; also an 
anesthetic if inhaled for a sufficiently long time. It use as a medicinal 
agent is chiefly to bring the system rapidly under the influence of Iodine. 
It increases appetite, stimulates the action of the heart, gives vivacity to 
the general feelings and activity to the intellect. 

Hydrobromic Ether has a not unpleasant odor, produces but little irri- 
tation of the air-passages, has very brief stages of excitement and rigidity, 
and but a short stage of insensibility, with prompt awakening and but 
little of the mental confusion and excitement consequent on the use of 
the other anesthetics. It is not inflammable, acts quickly, and is a good 
local anesthetic. Its action in other respects corresponds with that of 
Ether. 

Nitrous Ether is a mild diaphoretic, a diffusible stimulant, a carmin- 
ative, and an efficient diuretic. On the blood it acts similarly to Amyl 
Nitrite, diminishing oxygenation, relaxing the peripheral vessels, accel- 
erating the heart's action, and thus lowering arterial tension. Relaxing 
the renal and cutaneous vessels, it is diuretic and diaphoretic. 

Acetic Ether has a pleasant odor and taste, forming agreeable combi- 
nations with other carminatives as a stimulant and antispasmodic. 

Therapeutics. 

When diluted with alcohol Ether mixes readily with water, and maybe 
administered internally with advantage in indigestion of fats, and to aid 
the digestion of cod-liver oil. It is also given in hysteria to relieve the 
paroxysm and flatulence, and in hepatic colic from calculi, Ether with 
Turpentine (Durande's solvent remedy), which acts only as an anodyne 
and antispasmodic, is considered by some as of great value. Subcu- 
taneously Ether is used in the algid stage of cholera, sudden cardiac de- 
pression, neuralgia, and in the adynamia of hemorrhage, pneumonia and 
the eruptive fevers. Local anesthesia by the Ether-spray affords great 
relief in neuralgia of superficial nerves, lumbago, chorea, and spinal irri- 
tation. In minor surgical operations it is a valuable method. 

As a General Anesthetic the vapor of Ether is less prompt than that of 



iETHER. 117 

Chloroform, but is equally efficient and much safer. It should be inhaled 
in as concentrated a form as possible, and will then produce insensibility 
in from 5 to 10 minutes. If a light be in the room it should be high 
above the patient. A grate-fire or gas-stove in the vicinity is very dan- 
gerous. [Compare the article on Chloroform.] Besides its surgical 
uses ether-anesthesia is employed in neuralgia, cancer, tetanus, chorea, 
colic, delirium, puerperal mania and convulsions, infantile convulsions, 
hystero-epilepsy, epileptic seizures, laryngismus stridulus, whooping- 
cough and asthma. The unpleasant after-effects maybe greatly modified 
if not entirely prevented by the previous administration of Morphine 
(gr. -J— J) and Atropine (gr. ttg) subcutaneously. 

Schleich' 's Method is based upon the theory that the safest general anesthetic is one 
which has a maximum evaporation point slightly above the body-temperature of the 
patient, so that its elimination by the lungs during each act of expiration may be nearly, 
but not quite, as much as its absorption during the previous act of inspiration. Such an 
anesthetic is obtained by mixing Ether, Chloroform and Benzin in various proportions, 
the result giving true chemical solutions [only mixtures according to some chemists], 
the evaporation points of which may be varied at the will of the anesthetist and adapted 
to the patient's body -temperature at the time of administration. By this method the 
dangers belonging to either agent when given alone are avoided. Ether, having a low 
evaporation point, 93 F., must expand in the pulmonary alveoli, distending them, 
obstructing respiration, causing cyanosis, and promoting bronchial secretion and liability 
to subsequent pueumonia. Chloroform, having a high evaporation point, 149 F., must 
be eliminated by the lungs more slowly than it is absorbed, and accumulating in the 
blood it endangers the heart and strains the organs of elimination to remove it subse- 
quently. The maximum evaporation point of the A. C. E. mixture is about II9 F. , a 
good deal nearer the body- temperature than the evaporation point of chloroform, and 
hence it is safer than the latter anesthetic alone. Schleich's three solutions (see ante, 
page 114) have been used by many anesthetists with great satisfaction. Dr. Meyer of 
New York has reported on 100 cases, in which there were scarcely any unpleasant 
symptoms, no ill results whatever, and in only 4 per cent, was there albuminuria subse- 
quently, and that was slight and transient. Stone of Omaha reports on 250 cases with- 
out a death, the operations being of all degrees, the anesthesia quickly produced and 
practically no unpleasant results following ; but he attributes much of his success to his 
use of his own mask and the Overholt dropper. Dr. Rodman of New York has re- 
ported on 700 cases, with very unfavorable conclusions. [Jour. Amer. Med. Ass., Nov. 
4, 1899.) 

Heiuitt''s Method, which is preferred in England, is to administer nitrous oxide gas 
first and follow with ether in a closed inhaler. This method is rapid and safe, the pre- 
liminary choking sensation of ether is avoided, and unconsciousness is quickly produced. 

Hydrobromic Ether had a short period of popularity as an anesthetic, 
but fell into disrepute after a few cases of death under its influence, which 
were probably not due to the agent used (Levis' and Sims' cases). Its 
action is less prolonged than that of Ether, but it has many advantages, 
requiring only 3J to ^ij, rapidly given, and being noninflammable. Its in- 
halation has been of especial value in hysteria, epilepsy, chorea and other 
spasmodic disorders ; and it has been employed subcutaneously in place 
of Ether in the treatment of such spasmodic affections as whooping- 
cough, chorea, etc. 

The Compound Spirit of Ether (Hoffmann's Anodyne) is an admira- 
ble agent in gastralgia, colic, flatulence, syncope, etc., also in the various 



HO AGARICUS ALBUS AGARICUS MUSCARIUS. 

manifestations of the hysterical paroxysm. In combination with the 
camphorated tincture of Opium it is often remarkably efficient in check- 
ing the diarrhea of hot weather. 

Spirit of Nitrous Ether is used as a diaphoretic, a diuretic and a 
carminative ; also in expectorant mixtures, as an antipyretic in febrile 
affections, and to relieve pain in angina pectoris, dysmenorrhea and 
asthma. When its diuretic effect is desired it should be administered in 
iced water, and the patient should be lightly covered : but when its dia- 
phoretic action is required, it should be preceded by a hot drink, and 
the patient should be well covered. 

Hydriodic Ether may be obtained in glass capsules containing five 
minims each, and is used by inhalation in chronic pulmonary disorders, 
cardiac dyspnea, spasmodic affections of the bronchi and larynx, asthma, 
and catarrhal laryngitis. It is not employed as an anesthetic. 

Pental, Tri-methyl-ethylene, C 5 H 10 (Unofficial), — is a colorless liquid, highly inflam- 
mable, insoluble in water, but miscible in all proportions with alcohol, ether and chloro- 
form. Sp. gr. 0.678. It is obtained by heating amylene hydrate in the presence of acids. 

Pental is an efficient anesthetic, equal to Nitrous Oxide in its rapidity of action and 
safety, but superior thereto in its more prolonged action and its having no unpleasant 
after-effects. Under it there is seldom any stage of exhilaration, and consciousness is 
sufficiently retained to enable response to commands, even when insensibility to pain is 
reached. It does not lose its effect by repeated inhalations. Compared with Chloroform, 
it acts more promptly, and has no evil after-effects ; with Ethyl Bromide, it is somewhat 
slower in action but more lasting in effect, and can be prolonged as may be necessary ; 
with Nitrous Oxide, it can be continued for a longer time, is more safe, and free from 
after-effects of unpleasant character. 

AGARICUS ALBUS, White or Purging Agaric (Unofficial),— is the fungus 
Polyporns officinalis, which grows on the European larch. It occurs in large, white, 
spongy pieces ; and contains Agaricic or Laricic Acid, also from 40 to 70 per cent, of 
resins. The term Agaricin was formerly applied to the impure Agaricic Acid containing 
about 3 per cent, of Agaricol, which is physiologically inert. 

The taste of Purging Agaric is first sweetish, then becoming very acrid and bitter. 
The powder inhaled causes violent sneezing, and taken internally in full doses it produces 
watery stools. Small doses check diarrhea and dysentery, and diminish the secretions 
of the bronchi and mammae. 

Agaricus Albus was formerly employed as a drastic purgative, in doses of gr. xxx 
to ^j. It has lately'been used, with much success, in 15-grain doses of the powder, or 
3 grains of the alcoholic extract, to check the night-sweats of phthisis. Agaricic Acid 
has proved very valuable in checking persistent sweating from any cause, especially that 
occurring after influenza. The dose is gr. ^ to ^ : and it should not be given hypoder- 
mically. 

AGARICUS CHIRURGORUM, Surgeon's Agaric (Unofficial),— is the inte- 
rior portion of the fungus Polyporus fomentcu'ius, which grows on the trunks of beeches, 
birches, and oaks in Europe. It is prepared for use by boiling in weak lye and beating 
with mallets, and then occurs in light, thin, yellowish-brown pieces, soft and pliable, 
without odor or taste. It is almost pure cellulose. It was formerly used as a mechan- 
ical hemostatic, and for the purpose of moxa. When soaked in a strong solution of the 
Nitrate or Chlorate of Potassium and dried, it is very inflammable, and is called Spzmk. 

AGARICUS MUSCARIUS, Amanita Muscaria, Fly-Agaric 
(Unofficial), — is a poisonous mushroom, of disagreeable odor and burn- 
ing acrid taste, used in infusion with milk for poisoning flies, and by the 



AGARICUS MUSCARIUS. 1 19 

Tartars as an intoxicant. It contains an actively toxic alkaloid, Musca- 
rine, C 5 H 13 N0 2 , of syrupy consistence, odorless and tasteless, soluble in 
water and alcohol, and readily dissolved out by water and dilute acetic 
acid, so that a doubtful mushroom may be easily rendered innocuous. 
Muscarine is produced synthetically by the oxidation of choline, but it 
is doubtful whether the article so prepared is as active as the natural 
alkaloid. 

Muscarine Nitras, Muscarine Nitrate, (Unofficial), — a viscid, yellowish-brown 
liquid. Dose, gr. ^ - ^ 6 (Merck) ; gr. A-f (Ringer). It may be used hypodermically. 

Physiological Action. 
Agaricus acts as an intoxicant to the cerebrum, producing more vertigo 
and delirium than Alcohol, followed by profound sopor with lowered re- 
flexes, perhaps coma and death. The action of Muscarine is very like 
that of Pilocarpine and almost completely opposed to that of Atropine. 
It is a powerful respiratory and cardiac depressant, paralyzing the respira- 
tory centre and arresting the heart in diastole by paralyzing its motor 
ganglia while stimulating its inhibitory apparatus. It lowers the arterial 
tension, produces profound salivation, lachrymation and sweating, con- 
tracts the pulmonary vessels, causing intense dyspnea, and increases the 
intestinal, hepatic and pancreatic secretions, but markedly diminishes the 
renal. It disturbs the gastro-intestinal tract, causing tetanic intestinal 
contractions, severe colic, vomiting and purging. It produces spasm of 
the accommodation, marked myosis and contraction of the pupil when 
given internally, but dilates the pupil widely when locally applied. 
[Gelsemium does so also.] Under its action the body-temperature is 
decidedly reduced, and the excretion of waste-products is lessened. It 
is eliminated unchanged by the kidneys. 

Antagonists . 

Atropine exactly opposes Muscarine, and vice versa ; no example of physiological 
antagonism being so complete in all particulars. When a frog's heart is arrested by the 
topical action of a minute quantity of Muscarine, the application of a little Atropine 
will immediately paralyze the inhibition and restore the pulsations. An equally prompt 
antagonism runs through their entire spheres of action. Digitalin is to some extent 
antagonistic ; so also is Physostig)nine. 

Therapeutics. 
Muscarine has been as yet little used in medicine, but it will probably 
prove to be a valuable drug. It has been long used, with marked benefit, 
for the night-sweats of phthisis, given in doses of 5 minims of a one per 
cent, solution, hypodermically. It promises to be of great value in in- 
flammation characterized by copious exudation, especially eye-inflam- 
mations, catarrhal jaundice, recent hemorrhoids, acute bronchitis, pul- 



120 AILANTHUS ALBUMIN AND ALBUMINOIDS. 

monary hemorrhage, incipient pulmonary congestion, diabetes of both 
forms, and in constipation due to intestinal torpor and deficient secre- 
tion, accompanied by a torpid liver and difficult digestion of fats. In 
the latter affection it should be given in small doses, gr. -^, thrice daily. 
A tincture of Agaricus has been found beneficial in ataxic typhus, chorea 
and chilblain. 

AILANTHUS, Tree of Heaven (Unofficial),— is the bark of Ailanthus glandulosa, 
a well-known shade tree, of the nat. ord. Simarubaceae, indigenous to China, but culti- 
vated elsewhere. It contains an oleo-resin and a volatile oil, on which its properties 
probably depend. Dose, gr. x-^j. 

Extractum Ailanthus Fluidum, Fluid Extract of Ailanthus, — Dose, Tl^x-^j. 

Tinctura Ailanthus, Tincture of Ailanthus, — Dose, TT^x-gij. 

Ailanthus is a decided nauseant, and a drastic purgative, causing also vertigo, weak- 
ness, cold sweats, dull headache, pains in the back, numbness and tingling in the limbs. 
It paralyzes the cerebrum and spinal cord of animals, impairment of motility beginning 
in their hind extremities. The cardiac action, at first increased, soon slows, the pulse 
becoming small and weak, and the respiration depressed, death occurring from paralysis 
of respiration. It is a good teniafuge. 

Ailanthus is used against tapeworm, a decoction of the fresh bark ( 5jj to ^iv), or the 
oleo-resin in drachm doses, being very efficient. It has also been well employed in 
malignant scarlatina, with dark and partial eruption, insensibility, delirium and other 
cerebral symptoms. 

ALBUMIN AND ALBUMINOIDS.— Albumin (Albumen) is 
the typical member of a group of organic proximate principles which 
have the same general chemical composition but very different physical 
properties, and are called albuminoids, proteids, or nitrogenous princi- 
ples. These all contain N, together with C, O, H, and Sulphur. The 
chief members of the group are Albumin, Fibrin and Casein, often 
termed the histogenetic bodies, because they are essential to the build- 
ing up of the animal organism. Each of the three is resolved by 
caustic potassa and heat into Protein, which may then be thrown down 
by acetic acid. The albuminoids are originally formed in the vegetable 
kingdom, occurring in all parts of plants but especially in their seeds. 
[See ante, page 28.] When eaten by animals they undergo digestion 
into soluble compounds (peptones), which pass into the blood and are 
retransformed into serum-albumin before being built into the tissues. 
Albumin is the most important member of the group, as it forms the 
principal portion of all animal tissues, varying from 1 part per 1000 in 
the cerebro-spinal fluid to 383 per 1000 in the crystalline lens. The com- 
position of its molecule is very complex and varies widely within cer- 
tain limits in different organs and conditions, but C 72 22 H 112 N 18 S is given 
as its approximate formula. 

Albumin is amorphous, soluble in water, coagulated by heat, and occurs in three native 
forms, viz. — (i) Serum- albumin, which is yellow, elastic, transparent, soluble in water 
but precipitated by alcohol and by strong acids, and coagulated by heat at 104 F. (2) 
Egg-albumin, differs from the first by precipitating when shaken with ether, and in other 



ALBUMIN AND ALBUMINOIDS. 121 

respects. It is soluble in water and coagulated by heat. (3) Plant- albumin, occurs in 
nearly all vegetable juices and especially in the seeds of plants. It is coagulated by heat 
and strongly resembles egg-albumin. 

Official Albuminous Substances. 
Albumen Ovi, Egg-albumen, — the liquid white of the egg of the do- 
mestic hen, Gallus Bankiva, var. domestica, is official in the B. P., and 
contains, in 100 parts, Albumin 12, with 3 of mucus and salts, dissolved 
in 85 of water. * 

Many writers use the spelling albumen for the name of the proximate principle albu- 
min. Others distinguish between the white of egg (albumen) and its chief constituent 
(albumm). 

Vitellus, Yolk of Egg, — is the yolk (or yelk) of the hen's egg, and 
occurs as a viscid, reddish-yellow, opaque liquid, of bland taste and al- 
kaline reaction, coagulated by heat and by alcohol. It may be regarded 
as a dense emulsion of oil suspended in water by means of albumin. It 
contains, in 100 parts, Vitellin 16 to 18, Cholesterin 0.4, Lecithin 7, Fat 
21 to 31, also salts, etc., and from 48 to 55 of water. Vitellin is described 
as a mixture of albumin and casein (Fowne), or as a proteid related to 
casein mixed with about one-fourth of albumin (Nat. Disp.). 

Glyceritum Vitelli, Glycerite of Yolk of Egg, Glyconin, — consists of Vitellus 45, 
Glycerin 55, rubbed together until thoroughly mixed. 

Gelatin, — is an albuminoid derivative of the proteids ossein and 
collagen, obtained from bones, tendons, cartilage, skin and other fibrous 
animal structures by prolonged boiling in water. It swells up in cold 
water, is soluble in boiling water, and its aqueous solution solidifies 
(gelatinizes) on cooling. Its composition is similar to that of albumin 
but it does not yield protein. Gelatin is the basis of soup, beef-tea, and 
other preparations made from meat with boiling water. It is official in 
the form — 

Ichthyocolla, Isinglass, — the swimming-bladder of several species of sturgeon, 
occurs in horny, semi-transparent sheets, iridescent, soluble in 24 of boiling water, and 
forms on cooling a transparent jelly. It is the purest form of Gelatin known. 

Emplastrum Ichthyocollae, Isinglass Plaster, Court Plaster, — consists of Isinglass 
10, Glycerin I, Alcohol 40, Water and Tincture of Benzoin, spread on taffeta and 
allowed to dry. 

Chondrus, Irish Moss, Carragheen, — is a sea-weed consisting of two 
algse, Chondrus crispus and Gigartina mammilosa, dried and bleached. 
It contains mucilage 55^2, water 19, mineral matter 14, albuminoids 9^, 
and cellulose 2 per cent. A jelly may be prepared by boiling 2 oz. in a 
quart of water for an hour, then straining and adding 3 oz. of sugar 
while hot. The dose is indefinite. 

Irish Moss is horny, translucent, pale yellowish-white, of sea- weed odor and mucilag- 
inous, saline taste. It swells in cold water but does not dissolve. On boiling with 
30 parts of water for ten minutes it yields a solution which gelatinizes on cooling. It is 



122 ALBUMIN AND ALBUMINOIDS. 

a demulcent and nutrient of some slight value in bronchial and catarrhal affections ; but 
as it contains no starch it is not as valuable as Iceland Moss (Cetraria) as a food for the 
sick. [See under the title Amylum.] Another member of the Algge is the Fucus 
Vesicidosits, which is described under its own title. 

Unofficial Analogues of Albumin. 

Fibrin, — is the proteid which causes the clotting of plasma, lymph, 

and the blood when shed. It does not exist in the living, circulating 

blood, but is formed by the mutual action of fibrinogen, fibrino-plastin 

and fibrin-ferment, which arise as products of the breaking up of white 

blood-corpuscles. In normal blood it occurs to the extent of 0.2 per 

cent., is increased in inflammation and diminished in hemophiles. 

Fibrin has the same general composition as albumin but contains more O and S. , Its 
special characteristic is its power of spontaneous coagulation. It is insoluble in water 
and in ether, and is changed into syntonin (acid-albumin) by dilute hydrochloric acid. 

Casein is the proteid contained in milk. Its composition is the same 
as that of albumin, but it differs therefrom in not being coagulated by 
heat and by being thrown by organic acids which do not precipitate 
albumin. It is, by some authorities, supposed to be a combination of 
albumin and potash. 

Gluten, is a nitrogenous constituent of the seeds of wheat and other 
cereals, the former containing it in the proportion of from 8 to 15 per 
cent. It is made up of a number of albuminous principles which differ 
but slightly from each other, the chief ones being gluten-fibrin, gluten- 
casein, gliadin and mucedin. 

Unofficial Albuminous Preparations. 
Beef, among meats, has the highest nutritive value. The average of 
many analyses shows its composition to be as follows: In 100 parts, total 
albuminoids 20^, fat 2^, extractives, 1^, salts ij^, water 73^, also a 
minute quantity of creatin. 

Extracts of Meat prepared by boiling down the flesh of animals, as Liebig's 
Extract, are stimulants, not nutrients, as they contain practically none of the nutritious 
(albuminous) constituents of meat but only the salts and flavoring matter (E. Smith). 

Meat -juices, prepared by a cold process of extraction and partial digestion, are 
claimed to retain the fibrin, gelatin and coagulable albumin. Many such are on the 
market, under the trade-names Bovinine, Bovril, etc. 

Chittenden, by analyses of various meat extracts, has shown that they possess very 
little nutritive value as compared with fresh lean beef. In most of them the fat is less 
than I per cent. , and the total amount of available proteid is far below I per cent. Some 
are even less nutritious than ordinary beef-tea. 

Beef Peptonoids is the trade-name of a powdered preparation which is claimed to 
consist of the nutritive constituents of beef with milk and wheat gluten, partially pep- 
tonized and containing 95 per cent, of nutritious material. Liquid Peptonoids is intended 
to represent the same combination in liquid form, all the constituents being entirely 
digested and ready for assimilation. Panopepton is a similar preparation. 

Sanose is a food preparation which is claimed to contain 100 per cent, of albuminous 
material, of which 80 is casein and 20 is albumose. 



ALBUMIN AND ALBUMINOIDS. 123 

Somatose is a dry powder, which is said to contain nearly 90 per cent, of albumoses, 
80 grains corresponding in nutrient value to about \yi ounces of fresh beef. 

Milk contains all the elements necessary for the growth and nutrition 
of animal tissues in the most digestible form. Its chief albuminoid con- 
stituent is Casein, but it also contains fat, sugar, salts and water, which 
vary in proportion according to the animal and its food. Cow's Milk, 
of sp. gr. 1,030, averages, in 100 parts, of albuminoids 4, fat 4, sugar 5, 
salts y 2 , and water 86J4. Goat's Milk is very near to that of the cow 
in composition, but Asses' Milk has much less of casein and salts, very 
little fat, and more sugar and water. Woman' s Milk contains about the 
same proportion of casein as asses' milk, more fat than cow's milk, more 
sugar than the others, and less salts than any except asses' milk. 

Buttermilk contains, in 100 parts, casein 4^, sugar 2^, fat j^, salts ^, lactic acid 
%, and water 92. 

Condensed Milk is prepared by adding refined sugar and an alkali to fresh cow's 
milk, then evaporating the mixture in vacuum pans until it has a thick, semifluid consist- 
ency. Desiccated Milk occurs in the form of a dry powder, and is highly esteemed by 
the armies of Europe. 

Peptonized Milk is prepared by adding to fresh cow's milk one-third part of water, 
in which, after boiling and cooling, there is dissolved a pinch of Sodium Bicarbonate, 
and ^j or gij of Liquor Pancreaticus is added to each pint. The mixture is then al- 
lowed to stand in a warm place for an hour, when it is ready for use. Peptogenic Milk 
Powder, containing the requisite proportions of the alkali and the pancreatic ferment, 
may be obtained in the drugstores and will prove satisfactory. 

Cheese is obtained from the milk of animals, especially the cow, by coagulating the 
casein by means of rennet or an acid, and after separation submitting it to pressure. It 
contains, in 100 parts, albuminoids (casein, etc.) 28 to 45, fat 6 to 30, salts 4 to 5, and 
water 36 to 44 ; the proportions of each varying according to the quality of the milk 
used. 

Kumyss, Koomiss, — is an effervescing fermented liquor originally pre- 
pared by the Tartars from mare's milk, but now imitated with cow's milk 
by adding sugar of milk, fermenting in open tanks, skimming off the 
casein and butter, then bottling during active fermentation. Its success- 
ful preparation depends on its undergoing slow fermentation in a cold 
room, at 50 F. or less. If the temperature be higher, the fermentation 
will be of the acetous variety, and will result in sour milk with heavy 
curd, feeble effervescence and repulsive taste. 

Wolff's Formula, for its preparation in small quantity, is as follows : — Dissolve % ss 
(a tablespoonful) of grape sugar in ^iv of water. Dissolve gr. xx (a teaspoonful) of 
Fleischmann's compressed yeast or well washed and pressed out brewer's yeast in t !| ij 
of cow's milk. Mix the two solutions in a quart champagne bottle, and fill it within 
two inches of the top with good cow's milk. Cork well, secure the cork with wire, 
keep it in a cellar or ice chest, maintaining a temperature of 50 F. or less, and agitate 
twice daily. In three or four days it is ready for use, but should not be kept longer than 
four or five days. Draw it with a champagne tap. 

Kumysgen is a powder containing the elements necessary for the preparation of 
Kumyss, for which a special bottle and tap are also furnished by the manufacturers. It 
is a very convenient manner of making this preparation, and the product tastes just as 
well as that made in the ordinary way. Whether it acts as well therapeutically remains 
to be ascertained. 



umyss. 


Kefir. 


I 


4 


2 


2 


*Y* 


2 


I 


I 


I# 


I 


92 


90 



124 ALBUMIN AND ALBUMINOIDS. 

Kefir is the name of a fermented drink prepared from the milk of a cow or mare 
by the addition of a mushroom-like ferment found near the snow-line in the Caucasian 
Mountains. It is used by the natives of the Asiatic plains as a remedy for struma, 
anemia, lung and stomach diseases. Kefir is richer in albuminoids than Kumyss, is less 
alcoholic and less acid. 

The following table shows the average composition of Milk, Kumyss and Kefir : — 

Cow's milk. 

Albuminoids (casein, etc.), 4 

Butter, 4 

Sugar of milk, 5 

Lactic Acid, — 

Alcohol, . . — 

Water and salts, 87 

Physiological Action. 

The normal adult human organism, doing ordinary work, loses daily 
by its metabolism 4}^ oz. of albuminous or proteid matter, besides 14^ 
oz. of carbo-hydrates, 3 oz. of fat, 1 oz. of salts and 2^ quarts of water, 
these quantities being largely increased during the performance of laborious 
work. A corresponding amount of these substances must be daily ingested 
in order to supply material for the repair of the tissues and for the pro- 
duction of heat and other forms of force. The albuminoids are most 
important alimentary principles, their chief office being the repair of the 
tissues, and they being the only foods containing nitrogen, an essential 
element in the formation of every structure which manifests any form of 
energy. They can replace each other in supplying nutrition to the tis- 
sues, their composition is identical with that of the same substances in 
the blood and other tissues, and they consist wholly of nutritive material 
in concentrated and digestible form. They undergo digestion in the 
stomach by the acid gastric juice, also in the intestine by the pancreatic 
juice, the respective ferments of which convert them into soluble peptones, 
the form in which they enter the blood. The digestive changes through 
which they pass are — (1) proteid, the albuminoid as ingested; (2) acid- 
albumin or syntonin in the stomach, alkali- albumin in the intestine ; (3) 
propeptone or hemialbumose ; and (4) peptone. The chief products aris- 
ing from their oxidation within the body are C0 2 , H 2 and Urea, the 
latter containing nearly all their nitrogen. They are mainly obtained 
by the ingestion of animal food, as flesh, milk, eggs, etc., but they are 
also contained in vegetable products, especially the seeds of certain plants, 
and those of leguminous plants (peas, beans, lentils, etc.) contain more 
proteid material than any kind of meat. 

The increased ingestion of albuminoid food, by persons who have 
previously used it sparingly, improves the quality of the blood by increas- 
ing the number of the red corpuscles, and causes a rise in the sp. gr. of 
the urine and a greater excretion of urea and uric acid. Individuals who 
consume albuminoids in excess of their requirements are lean but muscular, 



ALBUMIN AND ALBUMINOIDS. 



125 



irritable in temper and prone to excessive sexual appetite. The exclusive 
use of animal food develops a superabundance of muscular force, so that 
a nation of meat eaters is usually one of hunters possessing a warlike and 
savage disposition. 

Disease may be produced by food of any kind through excess or defi- 
ciency in quantity, special characteristics of quality, or imperfect diges- 
tibility. Albuminoid food in excess produces congestion and enlarge- 
ment of the liver and probably of other organs. If exercise is not taken 
at the same time, the albuminoids are imperfectly oxidized, and dele- 
terious products are retained in the system, or the eliminating organs 
are irritated by the passage through them of material which they are not 
adapted to remove. A great excess of albuminoids, without other food, 
produces in a few days marked febrile symptoms, malaise and diarrhea ; 
and if persevered in albumin appears in the urine. Gout probably arises 
in the same way, partly from the use of alcohol, which delays metamor- 
phosis, partly from using too much albuminoid food, and partly from 
want of exercise. A diet which is deficient in albuminoids causes a les- 
sening of bodily activity and the gradual oncome of an adynamic condi- 
tion which predisposes the subject to infectious diseases and modifies the 
course of many affections, typhoid fever running its course in such cases 
with less elevation of temperature than is usual and with less excretion of 
urea. Complete deprivation of albuminoids produces loss of muscular 
strength, mental debility and feverish and dyspeptic symptoms, followed 
by anemia and prostration. 

The advantages of a meat diet are : — its large amount of nitrogenous 
material, the presence in it of iron and important salts, and also much 
fat, the latter performing to great extent the office of the carbo-hydrates 
in supplying fuel to the body. It is easily cooked, is very digestible 
whether raw or cooked, and is more readily assimilated than any vegetable 
food. Its great disadvantage is that it contains neither starch nor sugar, 
hence it cannot supply all the carbon needed by the body unless so large 
a quantity of it be taken (4^ lbs. of beef daily) as would soon impair 
the digestive apparatus. 

Beef contains alimentary principles which are most important for the 
nutrition of the body. When of good quality, neither too old nor too 
young, having the fat and muscle suitably proportioned and unaltered by 
disease, and properly cooked, it is the best of the animal foods. 

Milk is an excellent albuminous food, but its proteid, casein, is coag- 
ulated by the acids in the stomach, even by the acid of the gastric juice, 
and is tolerated with difficulty by many persons, especially in the large 
quantity which must be taken to itself maintain the nutrition of the 
organism. As an exclusive diet, for anyone above the infant age, it soon 
palls upon the appetite, and causes a sense of emptiness at the epigas- 



126 ALBUMIN AND ALBUMINOIDS. 

trium, a coated tongue and an unpleasant taste in the mouth. The sub- 
ject of an exclusive milk diet is usually constipated, the stools being hard 
and of ochre-yellow color, but if diarrhea is produced it shows that the 
milk is not digested. The urine is greatly increased in quantity and the 
body-weight is gradually diminished to a certain point, where it remains. 
The pulse is quickened at first and arterial tension is lowered, but the 
pulse-rate falls as soon as the body ceases to lose weight. A sense of 
weakness is usually experienced, but many persons are greatly debilitated 
and some complain of vertigo. 

Kumyss has an acidulous and peculiar taste. In large quantity it can 
take the place of other food for a time, each quart equalling 4 oz. of 
solids. It is a powerful diuretic, especially in cold weather, and in warm 
weather it causes free perspiration. It is stimulant and tonic, increases 
the nutrition of the body and produces considerable somnolence. The 
stomach tolerates it well, even when it rejects all other food. It is easily 
assimilated and very nutritious. 

Eggs, like milk, constitute an almost complete food, as they contain 
all the elements required by the blood. According to Pavy an egg 
weighing 2 oz. has no grains of albuminous material, 82 grains of fat 
and 11 grains of saline matter. The white, consisting chiefly of albumin 
dissolved in water, contains the larger proportion of nitrogenous material, 
and the yolk contains the greater quantity of fat. 

Gelatin is a valuable food, as it increases vital action in the same di- 
rection, if not in the same degree, as albumin (E. Smith). Like albumin, 
however, it must not be relied on alone, but should be mixed with a 
proper quantity of other foods. 

Therapeutics. 
The chief affections in which nitrogenous food is required are diabetes 
mellitus, anemia, obesity, phthisis and other wasting diseases, and long- 
continued fevers. In fever there is an excessive consumption of the 
proteids of the body and the eliminative processes are very active, the 
discharge of urea being often enormous. All this increases the demand 
of the organism for albuminoid food, but the digestive power of the 
stomach is, at the same time, greatly reduced, the secretion of gastric 
juice being diminished. In carcinoma of the stomach and some other 
affections hydrochloric acid is absent from the gastric juice, and in many 
diseases gastric digestion is feeble or imperfectly performed. Hence it 
becomes important to furnish albuminoid foods in such form that they 
may be assimilated with the least possible expenditure of digestive 
energy. Peptones can be prepared outside the body and administered as 
food, but when artificially made they have little nutritive value, are un- 
able to supply the need of the organism and are exceedingly disagreeable 



ALBUMIN AND ALBUMINOIDS. 



127 



to the patient. Albumoses, the intermediate products, are readily 
absorbed, and being free from taste and from causing digestive troubles 
they are very suitable foods for invalids and for subjects of weak or im- 
paired digestion. 

Raw beef, scraped to a pulp, freed from fat and seasoned with salt and 
pepper, has been extensively used in the treatment of chronic diarrheas 
of children and adults, also in debilitated conditions from any cause 
wherein it becomes necessary to administer an easily digested nitrogen- 
ous aliment. Its chief objection is the liability of tape-worm following 
the use of uncooked meat. 

Blood is rich in nutritive elements and has been much employed as a 
food in wasting diseases, especially phthisis, the subjects of which often 
resort to slaughter-houses to drink the fresh blood of animals. The 
result is that the nutrition is improved, often to a remarkable extent, but 
the practice is open to the danger of the patient swallowing parasites. 

Beef-tea, when made with boiling water, contains less than one per cent, of gelatin, 
the only nutritive principle yielded by meat to a hot aqueous solution. The other ex- 
tractives obtained by boiling (creatin and creatinin) are simply effete muscular material 
on the way to the formation of urea. Hence beef-tea, bouillon and similar preparations 
of meat contain little except the stimulating salts and are almost wholly devoid of nutri- 
tive properties. Cold drawn infusions of meat are of considerable value as foods as they 
contain much albuminous material. 

Albumen Ovi (white of egg), besides being a valuable food, is used in 
medicine as an antidote in poisoning by corrosives and irritants, espe- 
cially corrosive sublimate, copper sulphate, silver nitrate and the lead 
salts. Shaken with alum it coagulates and forms the so-called Alum 
Curd, which is highly esteemed as an astringent and cooling application in 
acute conjunctivitis, also for burns and erysipelas. White of egg, diluted 
with water, sweetened and flavored, forms an agreeable and nutritious 
drink in gastritis. It is spread on silk or gold-beater's skin to make an 
adhesive plaster, which only requires moistening before application. 

Yolk of Egg is more nutritious and digestible than the white, and is 
highly esteemed in dyspepsia. The yolk of a hard-boiled egg crumbles 
easily and is readily acted on by the gastric juice. It forms a useful 
article of diet in exhausted conditions of the system, but its chief use in 
medicine is for emulsionizing oils and camphors. The Glycerite has the 
consistence of honey and forms an opaque emulsion with water. It is a 
very good vehicle for cod-liver oil, and an excellent protective applica- 
tion for burns, erysipelas, fissure of the nipples, and many cutaneous dis- 
orders. It is also used as a cosmetic, and may be employed as an 
aliment. 

Gelatin is undoubtedly nutritious, but is usually employed as the basis 
of flavored jellies, which are esteemed rather as delicacies than as foods. 
Isinglass is also nutritious but has no advantage over any other form of 



128 ALCOHOL. 

gelatin. It is used for clarifying liquids and in solution as a test for 
tannic acid. The plaster, commonly called court-plaster, is a useful 
protective agent for cuts, sores, etc. 

Milk is the only food which is proper for infants up to the age of eight 
months, their digestive organs being unable to manage the farinaceous 
aliments. For those who are deprived of their natural milk the best 
substitute is cow's milk diluted with about one-third part of water and 
sweetened with sugar, which should be given at a temperature of ioo° F. 
and at intervals of about three hours. The addition of lime-water in- 
stead of ordinary water will make it more digestible. As an exclusive 
diet for older children and adults, milk is employed with great benefit in 
many gastric and intestinal disorders, especially dyspepsia, gastric 
catarrh, gastric ulcer and cancer, chronic intestinal indigestion, and 
chronic diarrhea and dysentery ; also in albuminuria, diabetes, ascites, 
anasarca, eczema, gout, aneurism, and in irregular and tumultuous car- 
diac action due to valvular disease of the heart. Skimmed milk is better 
borne than unskimmed milk in many affections of the gastro-intestinal 
tract. Milk is the only food available in typhoid fever and may be 
wholly depended on as aliment in that disease. It is especially useful in 
scarlet fever, both as a nutrient and a diuretic. In intestinal indigestion, 
cholera morbus, cholera infantum, and the ileo-colitis of children, it is 
necessary to supply only such foods as are digested in the stomach, in 
order to give the intestine rest, hence milk, eggs, meat-juices and meat- 
broths are the suitable articles of diet in these affections. 

Buttermilk contains lactic acid, which does not exist in ordinary milk, 
and in consequence it is more easily digested than the latter. It is partic- 
ularly useful in gastric disorders, albuminuria and diabetes. 

Kumyss is an invaluable article of diet in many wasting diseases, espe- 
cially phthisis. It is of great benefit in dyspepsia, the diarrheas of 
children, convalescence from acute maladies, chronic affections of the 
kidneys, chronic bronchitis, and other cachexise. In cases of feeble 
digestive power an ounce every hour is sufficient, but as its digestion and 
assimilation increase it may be given almost ad libitum, and when used 
with other food a half-pint may be taken after each meal. Each quart is 
estimated to contain four ounces of solid food, besides from i to 3 per 
cent, of alcohol. 

ALCOHOL, Alcohol {Ethyl Alcohol, Ethyl Hydrate), C 2 H 5 OH. 
The official alcohol is Ethyl Alcohol, which is represented in the pharma- 
copoeia by the several preparations named Brandy, Whiskey, and Wine, 
as also under the following four forms, viz. — 

Alcohol Absolutum, Absolute Alcohol, C 2 H 5 OH, — is Ethyl Alcohol, 
containing not more than 1 per cent, by weight of water. A transparent, 



ALCOHOL. 129 

inflammable, colorless, mobile and volatile liquid, very hygroscopic, of 
characteristic, agreeable odor, and burning taste. Sp. gr. not higher 
than 0.797 at 59 F. Used in the manufacture of Chloroform. 

Alcohol, — a liquid composed of about 91 per cent, by weight, or 94 
per cent, by volume, of Ethyl Alcohol, C 2 H 5 OH, and about 9 per cent, 
by weight, of water. It is a transparent, inflammable, colorless, mobile 
and volatile liquid, of agreeable odor and burning taste, of sp. gr. 0.820 at 
59 F. Miscible with water in all proportions and without any trace of 
cloudiness ; also miscible with ether or chloroform. Obtained by the 
distillation of fermented saccharine fluids. Used in preparing all the 
tinctures and spirits, also in some liniments, liquors and mixtures. 

Alcohol Deodoratum, Deodorized Alcohol, — a liquid composed of 
about 92^ per cent., by weight, or 95.1 per cent., by volume, of Ethyl 
Alcohol, and about 7^ per cent., by weight, of water. Sp. gr. about 
0.816 at 59 F. Dose, ^ss-ij, diluted with water. 

Alcohol Dilutum, Diluted Alcohol, — a liquid composed of about 41 
per cent., by weight, or about 48.6 per cent., by volume, of Absolute 
Alcohol, and about 59 per cent, of water. It is prepared by mixing 
together equal volumes of Alcohol and Distilled Water. Sp. gr. about 
0.936 at 59 F. 

An Alcohol is a volatile organic compound, which contains no N, has a great affinity 
for water, and reacts with acids, forming therewith H 2 and ethers. Alcohols are there- 
fore analogous to the metallic hydrates, as are Ethers to salts. Methyl Alcohol is 
obtained by the destructive distillation of wood, Phenyl Alcohol (Phenol) by that of 
coal-tar, and the fermented Alcohols (Ethyl, Amyl, etc.) from any vegetable substance 
containing sugar (or starch and the ferment Diastase, which converts the starch into 
sugar), by fermentation through the agency of the yeast-plant, which splits the sugar into 
Alcohol and C0 2 . The product contains much water, and is then distilled in order to 
separate the alcohol, which passes over first, with a certain amount of water, the greater 
part of the latter being left behind. In this country Alcohol is so produced from grain 
(chiefly barley), and is termed High Wine, being disposed of by the distillers to certain 
wholesale liquor dealers, many of whom proceed to " rectify "it by mixing and blend- 
ing it with water, essential oils of corn, rye, etc., ethers, burnt sugar, and occasionally 
small quantities of genuine whiskey, brandy, etc. The product is then labeled " Old 
Tom Gin," •' Old Crow Whiskey," etc., according to the requirements of the retail 
dealers. True Whiskey is distilled from the mash of fermented grain (corn, wheat, and 
rye, or a mixture of all three), and should be not less than two years old, to be official ; 
Brandy from the fermented juice of fresh grapes, and should be not less than four years 
old. Wines are the product of the fermented juice of grapes, without distillation. 

Alcohol may be produced synthetically by shaking Olefiant Gas (C 2 H 4 ) with strong 
Sulphuric Acid, then diluting and distilling. Absolute Ethyl Alcohol, which is only 
used for chemical testing and for the manufacture of Chloroform, is obtained by shaking 
Alcohol with Potassium Carbonate, decanting and distilling with slaked lime. 

Alcohol very slowly oxidized forms Aldehyde (C 2 H 4 0) ; if less slowly Acetic Acid 
(C 2 H 4 2 ) ; if quickly, as in burning, C0 2 and H 2 0, which are in all cases the ultimate 
products of its continued oxidation. 

An Aldehyde is obtained from an alcohol by removing therefrom two atoms of hydro- 
gen, hence its name — Al (cohol) dehyd (rogenatum). Aldehydes lie in chemical consti- 
tution between the alcohols and the acids, and have the power of reducing silver salts 
in darkness, which is shared also by living protoplasm. The principal aldehydes are — ■ 

Acetic Aldehyde, Aldehyde, Ethyl Aldehyde, Ethylidene Oxide, C 2 H 4 0, — a colorless, 
mobile liquid, antiseptic, locally irritant, anesthetic when inhaled, and a powerful de- 
pressant of the respiration, too dangerous for use. 
9 



I 



I30 ALCOHOL. 

Formic Aldehyde, Formaldehyde, CH 2 0, — is a gaseous body prepared by subjecting 
methyl alcohol to oxidation. It is readily absorbed by water, and is put on the market 
in the form of a 40 per cent, aqueous solution named Formalin, which is a powerful 
antiseptic, disinfectant and deodorant, and is described under its own title. 

Paraldehyde, CgH 12 3 , — is a polymeric form of Aldehyde and a valuable hypnotic. It 
is described under its own title. 

A Ketone bears the same relation to an aldehyde that an Ether does to an alcohol, 
being an aldehyde in which the hydrogen has been replaced by a radical. The most 
important Ketone is — 

Hypnone, Phenyl-methyl-acetone, C 6 H 5 (CO) (CH 3 ), — a hypnotic agent of moderate 
energy, described under the title Chloral. 

Principal Unofficial Alcohols. 

Methyl Alcohol, Methyl Hydrate, Wood-spirit, CH 3 OK,— also called 
Carbinol, Methol, Hydroxymethane, is a non-fermented alcohol, obtained 
from the destructive distillation of wood. Ordinarily it contains many- 
impurities, which give it a very disagreeable odor, and mixed with ethyl 
alcohol it renders the latter so disagreeable as to be unfit for drinking. 
Such a mixture is sold, under the name Methylated Spirit, for use as a 
solvent in the arts, as a combustible in lamps, etc. 

Amyl Alcohol, Amy I Hydrate, Potato-spirit, Fusel Oil, C 5 H n OH, — 
is a fermented alcohol obtained from the potato, also occurring in the 
crude spirit produced by the fermentation of saccharine solutions with 
yeast, and separated by the excessive distillation thereof, passing over 
after the ethyl alcohol. It is oxidized into Valerianic Acid. From it is 
prepared Amyl Nitrite, by distilling with nitric and sulphuric acids and 
copper wire. It is an oily liquid, of penetrating and oppressive odor 
and burning taste : sparingly soluble in water, but soluble in all propor- 
tions in alcohol, ether and essential oils. 

Official Alcoholic Preparations. 

Spiritus Frumenti, Whiskey, — obtained from the distillation of the mash of fer- 
mented grain ; rye, wheat or corn (U. S ), barley (Scotch), and at least two years old. 
Sp. gr. 0.917 to 0.930. Has an alcoholic strength of 44 to 50 per cent, by weight ; also 
Ethers developed by the action of acetic and butyric acids on the alcohol, and traces of 
Amyl Alcohol (fusel-oil) even in the best. Dose, gij-^ij. 

Spiritus Vini Gallici, Brandy, — obtained from the distillation of the fermented 
juice of grapes, and at least four years old. Sp. gr. 0.925 to 0.941. Has an alcoholic 
strength of 39 to 47 per cent, by weight, and CEnanthic and other Ethers developed by 
age Pale Brandy is colored by the cask, the dark has caramel to color it. Is often 
prepared artificially by adding to high wines Acetic or Nitric Ether, Caramel, and Log- 
wood or Catechu for astringency. Dose, ^ij-^ij. 

Spiritus Rectificatus, Rectified Spirit, — official in the B. P., is Alcohol with 16 per 
cent, of water, obtained by the distillation of fermented saccharine fluids. Sp. gr. 
0.838. Is often spoken of as "56 over proof," meaning that to reduce 100 volumes of 
it to the strength of proof spirit requires 56 volumes of water. 

Spiritus Tenuior, Proof Spirit, — official in the B. P., is prepared by mixing Recti- 
fied Spirit 5 volumes with 3 of Distilled Water; has a sp. gr. of 0.920, and contains of 
absolute alcohol about 49 per cent, by weight, about 57 per cent, by volume. 

Vinum Album, White Wine, — should contain from 10 to 14 per cent, by weight of 
absolute alcohol, and is made by fermenting the unmodified juice of the grape, freed 
from seeds, stems and skins. California Riesling, Ohio Catawba, etc. Dose, ^j~o^ v « 



ALCOHOL. I3I 

Vinum Rubrum, Red Wine, — should contain from 10 to 14 per cent, by weight of 
absolute alcohol, and is made by fermenting the juice of colored grapes in presence of 
their skins. Native Claret, Burgundy, etc. Dose, ^j-Jiv. 

Unofficial Alcoholic Preparations. 

Rum, — is obtained from the distillation of fermented molasses, and has about 42 per 
cent, by weight of alcohol. 

Gin, — has about the same alcoholic strength as rum, and approaches very nearly to the 
official Spiritus Juniperi Compositus. It is usually distilled from rye or barley, and fla- 
vored, in Holland, with juniper berries and hops, in England, often with oil of turpen- 
tine, various cheap aromatics, acetate of lead, sulphate of zinc, cayenne pepper, etc. 
Pure gin is slightly diuretic, from the oil of juniper contained in it. 

Spiritus Odoratus, Perfumed Spirit, Cologne-water, — prepared by adding to 8co 
parts of Alcohol, Water 158, Acetic Ether 2, Oil of Bergamot 16, Oil of Lemon 8, Oil 
of Rosemary 8, Oil of Lavender Flowers 4, and Oil of Orange Flowers 4 parts. A 
perfume and ingredient of lotions. 

Vinum Aromaticum, Aromatic Wine, — consists of Stronger White Wine 94 per 
cent., with Lavender, Origanum, Peppermint, Rosemary, Sage and Wormwood, of each 
I per cent. It was official in the U. S. P. 1880. 

Vinum Portense, Port Wine, — is not a natural wine, spirit being added during the 
process of manufacture, and the alcoholic strength raised to 30 or 40 per cent. 

Vinum Xericum, Sherry Wine, — a dry, spirituous white wine, generally made to 
order by the dealers, and having from 20 to 35 per cent, of alcohol. 

Sparkling Wines, as Champagne, Hock, Catawba, — are more or less sweet, and 
charged with carbonic acid, being bottled before fermentation is completed and the grape 
sugar all converted into alcohol. They contain 8 to 10 per cent, of absolute alcohol. 

Sweet Wines, as Burgundy, Tokay, Muscatel, Malaga, Angelica, Madeira, etc., — 
are of low alcoholic strength, 6 to 7 per cent, unless fortified. 

Light Red Wines, as Claret, Red Rhine, Concord, — have 5 to 7 per cent, alcohol, 
tannic acid, grape coloring matter, etc. 

Dry Acid Wines, as Rhine and Moselle, California Hock, Kelley Island Catawba, — 
in these fermentation is complete, and the alcoholic strength from 5 to 7 per cent. 

Beer, Ale and Porter, — are fermented liquors, made from malted grain, with hops 
and other bitters added. Beer is made by slow fermentation, the yeast sinking ; Ale by 
rapid fermentation, the yeast floating. Their alcoholic strength is from 2 to 3 per cent, 
in beer, to 4 to 6 per cent, in ale and porter, — and they also contain malt extract, carbonic 
acid, lactic acid, various aromatics, potassium and sodium salts, etc. 

Kumyss, — is obtained by the fermentation of milk, that of the mare being used in 
Tartary, where it is employed as a food. It contains from I to 3 per cent, of alcohol, 
sugar, lactic acid, casein, fat, salts, carbonic acid and ethers. [See page 123.] 

Physiological Action of Alcohols. 
The Alcohols of the series to which the above-mentioned belong are 
all narcotic poisons when taken in sufficiently large doses ; and have the 
general effect of paralyzing the nerve-centres in the inverse order of their 
development. The symptoms produced may be divided into stages, 
viz. — (1) Stimulant, (2) Narcotic and Anodyne, (3) Anesthetic, (4) Para- 
lytic ; therein closely following the action of the volatile anesthetics 
derived from them, though wanting in the profound degree of anesthesia 
which the latter produce. Ethyl Alcohol, the effects of which are detailed 
below, has the most typical action, and in poisoning by it all these stages 
follow each other in regular order. In poisoning by Methyl Alcohol the 



' 



132 ALCOHOL. 

excitement is greater, the subsequent stages succeed each other more 
rapidly, and if the dose be insufficient to cause death, the effects pass off 
more quickly. They all lower the body-temperature. 

The post-mortem appearances, after acute poisoning by the alcohols, show changes in 
the blood, stomach, intestines, liver, lungs and kidneys ; some of which are probably due 
to the asphyxiation resulting from the paralysis of respiration. The Blood is dark and 
clotted in the heart. The Stomach and Intestines are congested and softened, especially 
so if the ingested alcohol has been undiluted. The Liver is very much congested, soft 
and friable. The Spleen is gorged with blood and softened. The Lungs are congested 
and show small extravasations of blood, and in the Kidneys also hemorrhages are found. 

Physiological Action of Ethyl Ahcohol. 

Externally applied, Alcohol is a powerful antiseptic and disinfectant, 
also refrigerant, astringent, anhidrotic, rubefacient, and slightly anes- 
thetic. Applied to the exposed skin it quickly evaporates, cooling the 
surface, temporarily contracting the superficial vessels, and checking the 
secretion of the sweat-glands. If its evaporation is prevented, as by cov- 
ering with a watch-glass or a piece of rubber, or if the alcohol is rubbed 
in, it absorbs water from the tissue and hardens it. It also coagulates the 
albumin of the part, but the coagulum is soon redissolved by the fluids of 
the tissues. It then dilates the vessels of the derma, producing a sensa- 
tion of warmth and a rubefacient effect upon the skin. Upon the mucous 
membrane of the mouth and pharynx similar effects are produced by the 
same application. If the alcohol is concentrated, a burning sensation is 
felt immediately; also an increased flow of saliva and quickened pulse, 
due to reflex action. Then follows a slight local anesthesia of the part, 
and if the alcohol be held there for some time, the mucous membrane 
becomes whitish and opaque, from coagulation of the albumin, abstrac- 
tion of water from the tissue and congestion of its vessels. This soon 
disappears, as resolution of the albumin occurs. 

Internally, in moderate quantity and single dose, Alcohol acts briefly 
as a cerebral, cardiac and general stimulant ; in large doses as an anes- 
thetic, an intoxicant and deliriant, and finally as a narcotic poison and 
paralyzant of the nerve-centres. It is somewhat antipyretic, also diuretic 
and antispasmodic, and is hypnotic in many cases. 

A single dose of a strong alcoholic preparation, for example an ounce 
of neat brandy, introduced into the stomach, immediately produces im- 
portant and valuable reflex effects. The cardiac rate is quickened, and 
its force is increased ; the vessels of the entire body are dilated, especially 
those of the skin ; the blood-pressure is raised, and a sense of glowing 
heat is produced. These reflex effects are well seen in the prompt resto- 
ration of a fainting person by the administration of a single dram of 
whiskey or brandy. By the same means the nausea, paleness and other 
unpleasant symptoms produced by tobacco are promptly counteracted. 



ALCOHOL. 133 

Internally, in small quantity diluted, Alcohol dilates the gastric vessels, 
reddens the mucous membrane of the stomach, produces a sense of 
warmth and comfort, stimulates the gastric glands to increased production 
of gastric juice, and increases the activity of the gastric movements. 
Taken moderately, immediately before or during meals, it promotes the 
appetite and assists digestion ; lessens the elimination of waste-products 
(urea and C0 2 ), causes a subjective sensation of heat, and slightly raises 
the body-temperature. It briefly stimulates the heart, prolonging its 
systole and reducing the length of the diastole, and increases the func- 
tional activity of all the organs. The effects of large doses are very in- 
jurious ; the vaso-motor nerves are partially paralyzed for a time, causing 
dilatation of the arterioles throughout the body ; the pepsin of the gastric 
juice is precipitated, the gastric and hepatic vessels are congested, the 
walls of the stomach are rendered hyperemic, and the gastric glands and 
hepatic cells are over-stimulated to the production of pathological secre- 
tions. If the ingestion is continued, even in moderate quantities fre- 
quently repeated, chronic gastritis ensues, gastric mucus is poured out 
in large amount, the gastric glands soon atrophy, and the permanent 
dyspepsia of drunkards is set up, with morning vomiting of glairy mucus. 
The further effects of large doses are the total arrest of digestion, the 
production of intoxication, perhaps hallucinations and delirium, also 
great incoordination of thought and motion, depressed sensibility, depres- 
sion of the heart and respiration, lowered arterial tension and body- 
temperature, abolished reflexes, stupor, and, if the dose be sufficient, 
coma and death. 

Upon the Blood Alcohol acts to first increase and then diminish the 
ameboid movements of the white corpuscles, and so affects the red cor- 
puscles as to prevent the oxyhemoglobin from readily parting with its 
oxygen. It consequently diminishes the oxidation of the tissues, and 
may lead to imperfect combustion of fat, which then accumulates. The 
result is obesity in many persons who habitually consume large quantities 
of alcoholic beverages, especially if these contain much saccharine 
material. 

Upon the Heart and Circulation the first effects of Alcohol are those 
of slight and brief stimulation by reflex action. After its absorption the 
same effects are exhibited in a more marked degree. The pulse becomes 
fuller, the action of the heart is quickened and its force increased, due 
mainly to direct stimulation of its accelerator nerves. The vaso-motor 
system is inhibited, causing dilatation of all the vessels of the body, espe- 
cially those of the periphery, and producing a sense of increased body- 
heat. The blood-pressure is raised, the great increase of cardiac action 
overcoming the results of the vascular dilatation. The mental and bodily 
functions are all stimulated for a time, the person feels better for the dram, 



134 ALCOHOL. 

his muscular power seems to be increased, more urine is passed, and per- 
spiration is freer. But these effects are very transitory, and after a brief 
period of stimulation reaction sets in, and the entire organism is depressed 
to a lower point than where it was before the ingestion of the alcoholic 
stimulant. Large doses do not stimulate the heart at all, but immediately 
depress it, both by reflex action and by direct paralysis after their absorp- 
tion. A toxic dose may paralyze the heart almost immediately by direct 
depressant action, but usually, after a very brief period of excitement, 
insensibility is produced, also stertorous breathing, dilated or contracted 
pupils, complete muscular resolution, and death by paralysis of the heart 
and respiration. The action of alcohol upon the heart clearly exemplifies 
two therapeutic laws : (i) That excessive stimulation is necessarily fol- 
lowed by depression, and (2) that drugs which in moderate doses excite 
a function are very apt in large doses to paralyze it. 

The extremists, who find no good whatever in alcohol, hold that it is a fallacy to apply 
the term "stimulant" thereto, — that alcohol is a paralyzant from first to last, — that its 
apparent cardiac stimulation is in reality the result of its narcotism of cardiac inhibition, — 
and that every special sense is blunted by even small doses of this poison. They calmly 
ignore the fact that their premises apply to every stimulant in its special field of action as 
well as to alcohol in its sphere, and forget that their conclusion (that alcohol has no place 
in medicine except as a poison) applies by the same reasoning to every other stimulant. 
Hence, to be consistent, they should advocate the banishment of all stimulant drugs from 
the materia medica. 

On the Skin and Kidneys Alcohol is mildly diaphoretic and diuretic, 
acting partly by its vascular dilatation, partly by stimulation of glandular 
activity. On the Intestines it has a slightly astringent effect at first, but 
in those who use it habitually to excess the bowels are always very loose, 
and the evacuations watery. 

Upon the Nervous System Alcohol has specific and selective action. 
By a moderate dose this entire system is briefly stimulated, chiefly as a 
result of increased blood supply due to the vascular dilatation and car- 
diac elevation. Reaction, however, soon occurs, and if the dose be very 
large, the period of exaltation quickly passes into one of profound cere- 
bral depression, but this is usually preceded by marked incoordination of 
thought and of muscular movement, shown by incoherency of language, 
difficult speech, and staggering gait. The reflex activity of the spinal 
centres is abolished next, the urine and feces are discharged involunta- 
rily ; the depression extends to the respiratory centre, breathing becomes 
difficult and the face cyanosed ; profound coma supervenes, respiration 
and the heart are paralyzed, and the patient dies. 

The reflex depression occurs early in the case, and accounts for the 
impunity with which a drunken man will often bear an injury which 
would cause death by shock to a sober one. 

The action of Alcohol upon the nervous system illustrates well, in the order of its 
events, the physiological fact that excessive stimulation is followed by depression ; as well 



ALCOHOL. 135 

as the law that drugs which affect the functions progressively exhibit their earliest powers 
upon those functions which are highest in development (being those latest acquired by 
the individual and last to appear in the species), and influence next the next lower, until 
finally the lowest, namely those of respiration and circulation. The primary stimulation 
and subsequent depression of function proceeds therefore, in a descending scale from the 
highest or least firmly fixed and latest acquired function, to the lowest or most firmly fixed 
one. Thus, by Alcohol, the intellect is affected very early and the judgment abolished 
very soon , even though the imagination, the emotions and the powers of speech remain stim- 
ulated. Soon these follow the same course, imagination is abolished, the patient loses 
command over his emotions, cries and laughs immoderately and without reason ; next 
loses control over his organs of speech, talking incoherently and thickly, and then can 
only make a noise. At the same time other delicate and lately developed movements, as 
those required for writing, feeding, etc., are incoordinately performed and soon paralyzed. 
General muscular movements, being less highly and earlier developed, are next to become 
implicated, being first incoordinatd, and soon abolished. The paralysis of reflex action 
follows, though lowered earlier in the case, then paralysis of respiration and finally 
paralysis of the heart. 

The antipyretic action of Alcohol is partly due to its power of lessen- 
ing oxidation, but chiefly to the dilatation which even moderate doses 
produce in the vessels of the surface. This dilatation subjects the warm 
blood from the interior of the body to the cooling influence of the at- 
mosphere, also to the cooling due to evaporation from the skin ; and if 
kept up by repeated drams in a freezing temperature will soon so chill 
down the blood as to kill the subject. 

Under ordinary conditions the contraction of the cutaneous vessels, in a person ex- 
posed to cold, prevents the warm blood from approaching the surface in any great quan- 
tity and becoming cooled ; but this mechanism is temporarily paralyzed by every dose of 
alcohol, admitting the hot blood to circulate freely over the surface, and to be rapidly 
cooled down until the patient may be absolutely frozen to death as a result of repeatedly 
taking " something to keep him warm." This fact is well known to Arctic travelers and 
to the lumbermen of the northern forests, who have been taught by bitter experience to 
let alcohol alone when exposed to severe cold. 

Delirium Tremens occurs after an alcoholic debauch, usually in cases 
where the stomach is so deranged as to prevent the ingestion or assimila- 
tion of food. So long as the toper can eat and digest his food he is 
practically not liable to this affection. It generally begins in from two 
to four days after the patient has lost his appetite and commenced to 
reject or vomit his food ; and is marked by great restlessness, obstinate 
insomnia, a peculiar tremor of the tongue and limbs \ also delusions 
connected with the sense of sight, the patient imagining that he sees 
animals around him (dogs, rats, snakes, beetles, etc.). The delirium is 
constant and active, may become violent and pass into mania, or the 
patient may die suddenly while in this state, without any warning symp- 
toms. In several cases observed by the writer the delirium appeared four 
and five days after the last alcoholic dose was taken, though the patient 
was eating, sleeping, and working during the interval, apparently conva- 
lescent. Under treatment, and especially if sleep is brought on, the 
delirium usually subsides gradually, and the patient recovers. 

Chronic Alcoholism is the result of the ingestion for a considerable 



I36 ALCOHOL. 

length of time of an excessive quantity of alcohol, even though perhaps 
never sufficient to cause acute intoxication. One of the earliest symptoms 
usually observed is the vomiting of watery fluid or glairy mucus in the 
morning after rising. The bowels are generally loose, and the evacua- 
tions watery. The skin has a greasy look and a satiny feel, and the 
cutaneous capillaries on the face may become permanently dilated, giving 
to the cheeks a characteristic, dusky-red hue, and a flaming red color to 
the nose. In old drunkards, the latter organ often becomes covered on 
its tip with dusky-red tubercular enlargements, making it a very unsightly 
appendage. The stomach and liver are in a state of chronic congestion, 
the food is not digested and often to a great extent abandoned, the 
patient, in fact, living upon alcohol. Eructations of gas and flatulence 
are constant and distressing ; the body is usually puffed and bloated, the 
eyes bleary, red and watery. [One of the most graphic descriptions of 
the drunkard's personal appearance is that by Trollope, in " Orley Farm," 
Chapter 57.] 

After a time the connective tissue of the liver increases (hyperplasia), 
its parenchymatous structure atrophies or undergoes fatty degeneration, 
the organ contracts (cirrhosis), the portal circulation is impaired, the 
veins of the abdominal integument become prominent, and soon ascites 
ushers in the final stage. Cirrhosis of the kidneys may accompany that 
of the liver. The general impairment of function extends early to the 
nervous system, the mental powers are dulled, the temper becomes irri- 
table, and tremor appears in the tongue, lips and hands. As a result of 
the prolonged use of alcohol very serious pathological changes take place 
throughout the organism. It exerts its essential and most injurious influ- 
ence on the vital organs by its presence in the circulation, being thus 
brought into direct contact with the cellular tissues of the vital organs. 
It sets up hyperplasia of the connective tissue, resulting in sclerosis, espe- 
cially in the stomach, brain, liver and kidneys ; produces fatty degenera- 
tion (steatosis) of the blood, the arterial walls and the parenchyma of the 
various organs, depresses the brain, the heart and the arterial tension. 
Chronic disease of the heart, the arteries and the mucous lining of the 
stomach and intestines, gout, diabetes, Bright's disease of the kidneys, 
paralysis, ataxia, peripheral neuritis, epilepsy, amaurosis, and insanity 
may result from the continued use and abuse of alcohol. The malt liquors 
(beer, ale, etc.) are less prone than spirits to affect the brain, but are even 
more apt to set up fatty degeneration of the heart and liver. The heart 
is very liable to undergo gradual hypertrophy, partly by reason of the 
constant whipping up it receives from every dram of alcohol taken, and 
partly as a result of renal cirrhosis. Several of the largest hearts ever 
seen by the writer at autopsies, some of which were veritable instances 
of cor bovinum, occurred in subjects of chronic alcoholism associated with 



ALCOHOL. 137 

employment involving exposure and great anxiety, as in masters of steam- 
ships, superintendents of mines, etc. 

Impurities in Alcohol increase greatly its toxic action ; so that inferior 
brandy from a public liquor shop has a lethal action nearly one-half 
greater than that of pure ethyl alcohol. (Dujardin-Beaumetz.) 

Alcoholic Coma may be easily confounded with that of apoplexy, opium narcosis, con- 
cussion of the brain, acute pneumonia, uremia and epilepsy, the differential diagnosis 
being almost impossible to make with accuracy when the coma is deep. The pupils afford 
no trustworthy indication, as they may be either dilated or contracted in alcoholism. 
They are often unequally contracted in apoplexy, and in apoplexy of the pons varolii they 
may be equally and minutely contracted, as in opium-poisoning. The difficulty of diag- 
nosis is increased by the common practice of giving a dram of whiskey as a reviver, so 
that a stranger found insensible on the street and brought to a hospital may smell of 
alcohol without having been a subject of alcoholism. When no accurate history of the 
case can be obtained the diagnosis is impossible in many cases. 

Alcohol is rapidly diffused throughout the organism, which oxidizes a 
portion of it, about an ounce and a half for the adult in 24 hours, the 
oxidation yielding force, which is utilized as nervous, muscular, and 
glandular power. A large quantity is decidedly poisonous, as it sets up 
structural changes in the various organs, and lowers the power of resis- 
tance to morbific influences. It renders its victims particularly liable to 
phthisis, and has frequently caused directly an intractable form of that 
disease, pulmonary sclerosis. It makes patients bad subjects for with- 
standing any severe illness, especially pneumonia, or to successfully 
undergo severe surgical operations. 

The portion not oxidized is excreted unchanged by the lungs, the skin 
and the kidneys, but does not appear in any quantity in the urine unless 
very large amounts have been ingested. The very young and the very 
old bear more alcohol relatively than the adult. It has been proven to 
exist normally in the human organism, and within the limit above stated 
it is undoubtedly a food, as is shown by the fact of its retention and com- 
bustion in the body, supplying the place of other foods, so that the quan- 
tity of food which without it would be insufficient, with its aid becomes 
sufficient to maintain the body-weight. 

Treatment of Acute Alcoholic Poisoning. 

If a very large dose has been taken recently, the stomach should be evacuated of what 
is unabsorbed. Then Ammonia may be given by inhalation cautiously, warmth applied 
to the extremities, cold affusion to the head, faradism of the muscles of respiration. 
Milk, mucilaginous drinks, black coffee, are useful afterwards. Lupidin as a substitute 
stimulant, or Capsicum in 20 to 30 grain doses. Chloral,m. doses of 30 grains, repeated 
in two hours, to secure sleep, is very efficient, or 30 grains each of Chloral and Potas- 
siztm Bromide, for the same purpose. Chloral is said by teachers to be dangerous in old 
alcoholic cases, but the daily experience of physicians of inebriate asylums does not cor- 
roborate this statement. Nutritious, digestible diet in liquid form and small quantity fre- 
quently repeated, is an essential feature of the treatment. Ammonuim Chloride, gss in 
y 2 pint of water at one draught, and the Liquor Ammonii Acetatis, in doses of :|j, are 
said to have marvellous power in straightening up a drunken subject, restoring the facul- 
ties, and antagonizing stupor. 



I38 ALCOHOL. 

Treatment of Delirium Tremens. 

Two principal objects are aimed at, — to support the strength by nutritive diet, and to 
overcome the obstinate and exhausting insomnia and restlessness. For the latter pur- 
pose the mixture of Chloral and Potassium Bromide above mentioned is by far the most 
efficient agent, and the dose (gr. xxx of each) may be repeated every two hours until 
sleep is secured. Digitalis has been administered in large doses to quiet the delirium, 
and successfully in some cases, but this is a very dangerous treatment. (Brunton.) 
Opium or Morphine may be used in cases which show signs of exhaustion, but should be 
confined to such alone. Its general employment in this affection is decidedly injurious. 
Bismuth, with Magnesia and Hydrocyanic Acid, for the vomiting. Nutrient Enemata 
may be required, if the patient is unable to retain food. Alcohol should not be given. 

Treatment of Chronic Alcoholism. 

The continued ingestion of alcohol in excessive quantities is not a disease, as sentimen- 
talists would have us believe, but is simply a vicious drug-habit, and may be overcome, 
like any other drug-habit, by the exercise of the subject's will-power alone in abstaining 
therefrom. The effort to gradually reduce the amount consumed simply prolongs the 
agony and is much less efficient than the total and immediate withdrawal thereof entirely. 
This should be carried out in an inebriate asylum in most cases. Strychnine is a specific 
remedy for alcoholism, and the basis of all the so-called " cures " which are extensively 
advertised under the gold-extracting title of " Gold Cure." Ten to twelve minims of a 
solution of Strychnine Nitrate, gr. iij in £x of distilled water, should be injected hypo- 
dermically 3 or 4 times a day for two weeks, and less often for two weeks more, gradually 
reducing the dose and frequency of administration. 

Therapeutics of Alcohol. 

The external and local use of alcohol in medicine includes many appli- 
cations of its antiseptic, astringent, refrigerant and rubefacient qualities. 
Diluted, in the proportion of four parts to one of water, it makes an 
excellent lotion for bruises, sprains, and other slight injuries, where it is 
desired to cool the part and check impending inflammation. A per- 
fumed spirit, as Cologne Water, is commonly used as a lotion to the fore- 
head for the relief of headaches. Alcohol does good service as an appli- 
cation to prevent bed-sores and cracked nipples, as it hardens the inflamed 
skin by abstracting water therefrom and coagulating the albumin tempo- 
rarily. Diluted alcohol is applied on the surface of the body in fevers, 
to cool the skin and check excessive sweating. Alcoholic liniments (Lin- 
imentum Camphorae, etc.) are rubbed into the cutaneous tissue for their 
rubefacient effect, to aid the absorption of inflammatory products and to 
relieve pain, in chronic rheumatism, lumbago, myalgia, etc. As a gargle 
or spray, diluted alcohol is one of the very best local agents in tonsillitis, 
pharyngitis, and other inflammatory affections of the throat, especially 
diphtheria, in which disease it fulfils several important purposes, acting 
as an efficient local antiseptic, astringent and anesthetic. Among miners, 
hunters, frontiermen and others, lotions of whiskey or brandy are in 
common use as applications to wounds and sores, and they could not find 
a more efficient agent for the purpose, when conjoined with thorough 
cleanliness of the lesions. 

Internally, in small quantities taken just before or during a meal, alco- 
hol is an efficient aid to digestion, especially in the aged and feeble, or 



ALCOHOL. I39 

persons who are greatly exhausted by overwork. In the atonic indigestion 
of nervous and depressed subjects and in cholera infantum, good brandy 
is universally found to be beneficial. Care must be taken, however, not 
to exceed the amount which agrees with the case, for large quantities 
precipitate pepsin, paralyze the gastric secretions, and set up a subacute 
gastritis, which will become a chronic one if the indulgence is persisted 
in, with eventual atrophy of the gastric glands. 

In the form of a sparkling wine, as champagne, or as brandy and soda- 
water, alcohol may control vomiting from many causes, especially that of 
yellow fever and sea-sickness. A single full dose of strong whiskey or 
brandy is often a very efficient combatant of fainting or of collapse, by 
its prompt reflex stimulation of the circulation. Diarrhea of simple 
form may be checked by a dram of good brandy, acting as a tonic 
astringent to the intestines. An attack of acute coryza, or a cold from 
exposure beginning with a chill, may frequently be aborted by a full dose 
of spirits in hot water taken just before going to bed, for the purpose of 
relaxing the peripheral vessels and thus promoting diaphoresis and restor- 
ing the disturbed balance of the circulation. In anemia and chlorosis 
good red wines are almost indispensable, also in convalescence from 
acute diseases, sudden and profuse hemorrhages, and many other morbid 
conditions. In phthisis alcohol does good service if it promotes assimila- 
tion and assists digestion, shown by increase of the body-weight during 
its employment. It is invaluable in poisoning by cardiac depressants and 
snake-venom, and in cardiac failure from any cause. 

In many fevers, Alcohol is often very serviceable, but may do harm if 
used therein without discrimination. Its powers of lessening oxidation, 
of being itself oxidized in the body and acting as a food, of reducing 
body-temperature and promoting perspiration and sleep, are all indica- 
tions for its beneficial employment in most febrile conditions ; while its 
stimulant action on the heart may be available in such diseases as typhoid 
fever, lobar pneumonia, etc., to tide that organ over a brief period of 
depression or a condition of impending collapse. Furthermore, for some 
unexplained reason, it often slows the pulse in fever, and when it does so 
its moderate use will be of general benefit to the patient. The danger is 
that if continuously given in such affections it may fail to make the 
required impression when an emergency calling for it occurs. The best 
rule to observe for its administration in typhoid, diphtheria, pneumonia 
and other fevers is to withhold it until the first sound of the heart becomes 
feeble and dull, and then to use it boldly but not excessively. Many 
authorities urge its continuous administration in diphtheria, probably 
from a belief in its antiseptic action on the poison in the blood, similar 
to that which it undoubtedly exercises against the venom of the. rattle- 
snake. It is an absolute necessity in the treatment of acute lobar pneu- 



I4O ALETRIS ALLIUM. 

monia, if the patient has been accustomed to its daily use as a beverage ; 
but in other subjects of this disease it is best given at the crisis only, to 
tide the patient over a brief period of extreme danger. 

Recent researches as to the action of alcohol upon vital resistance to infection, by Drs. 
Abbott and Delearde, seem to show that it has a decidedly injurious influence upon 
animals inoculated with cultures of the germs of certain infectious diseases. Alcoholized 
rabbits died when inoculated with Streptococcus pyogenes and Bacillus coli communis in 
attenuated cultures which did not kill non-alcoholized control ones. Animals vaccinated 
against tetanus and afterwards alcoholized, soon lose their immunity ; and those vacci- 
nated against tetanus and at the same time alcoholized, do not readily acquire immunity. 
Similar results were obtained with regard to rabies and anthrax. The conclusion is drawn 
that strong doses of alcohol should not be administered to persons suffering from certain 
infectious diseases, as pneumonia, or from certain intoxications, as that produced by snake- 
venom, during which an increase in the number of leucocytes appears to be a necessary 
part of any process leading to the cure of the patient. 

The use of alcoholic beverages in moderate quantity by healthy persons 
is violently condemned by extreme total abstinence advocates, who make 
use of garbled quotations from medical authorities to support their argu- 
ments. Physicians generally agree with Mr. Lawson Tait, who declared 
himself " fully persuaded after thirty years of life, as hard in work and 
as full of responsibility as well could be, that the moderate use of alcohol 
is a necessity in our modern life." Dr. Robert Farquharson sums up the 
case for moderate drinking as follows : "All stimulant is unnecessary for 
the young and for people living perfectly healthy lives. But, under the 
stress and struggle of modern civilization, few of us beyond middle age 
are placed under normal physiological conditions, and a little alcohol 
helps us to round the corners, and to plane away the asperities of 
existence. In turns it may be a stimulant, or a sedative, or a tonic, or a 
digestive, or an actual food ; and unless we run on into excess, no 
physical damage can possibly be done to our tissues. The argument 
in its favor, when wisely and prudently used, seems complete. It does 
us good, and can do us no harm." 

ALETRIS, Colic-root (Unofficial), — is the rhizome of Aletris farinosa, the Star- 
wort, an indigenous perennial plant which grows in grassy places and in sandy woods. It 
contains starch, and a bitter principle, but no tannin. This plant was formerly official, 
and is now widely advertised by the proprietors of an Aletris Cordial, as being tonic, 
emetic, purgative, diuretic, carminative, sialogogue and anti-rheumatic, also "the most 
powerful of uterine stimulants," a specific for dysmenorrhea and a wonderful remedy 
for colic, dropsy, and chronic rheumatism. It is little more than a simple bitter in small 
doses, though in very large ones it may prove emeto-cathartic. Dose, of the powdered 
root, gr. x; of the infusion (3J to the pint), ^ ss. 

ALLIUM, Garlic, — is the bulb of Allium sativum , a plant of the nat. oid. Liliacese, 
indigenous to Asia, but cultivated in Europe and America. Its odor is pungent and dis- 
agreeable and its taste warm and acrid. It contains a Volatile Oil, which consists 
mainly of the Sulphide of Ally] (C 3 H 5 ) 2 S, on which its qualities depend. Allied species 
are Allium Cepa, the Onion, and Allium Porrtwi, the Leek. 

Syrupus Allii, 'Syrup of Garlic, — contains 20 per cent, of Garlic, Sugar and Dilute 
Acetic Acid. Dose, ^j-iv, according to age. 



ALNUS ALOE. I4I 

Garlic, Leeks and Onions are stimulants to the digestion and to the nervous system, and 
are supposed to have a special influence upon the bronchial secretion. Garlic is also 
thought to be emmenagogue and anthelmintic. It promotes diaphoresis and diuresis, and 
acts as a tonic and carminative. Many persons use it as a condiment. Large doses will 
often produce gastric irritation, flatulence, hemorrhoids, headache and fever. In domes- 
tic practice it is frequently employed as an external application in the cutaneous eruptions 
of children, and as a poultice or liniment in infantile disorders of many kinds. Inter- 
nally it is of real benefit in feeble digestion and flatulence, chronic catarrhal affections of 
children, nervous and spasmodic coughs, and nervous vomiting. 

ALNUS, Alder-Bark (Unofficial), — is the bark of Alnns serrulata, the common 
American Alder, a small tree of the nat. ord. Betulacese. It has similar properties to 
those of A. glutinosa, the European Alder, and A. urcana, the Tag Alder, and contains 
a tannic acid, an oil, and a resin. The bark and leaves are astringent and bitter, and are 
chiefly used as gargles for the throat, as local applications to wounds and ulcers, and to 
restrain the secretion of milk. Dose of the powdered bark gr. x, in decoction or infu- 
sion, several times a day. The Tag Alder is highly recommended as a hemostatic. 



ALOE, Aloes, — is official in the two following-named varieties, also 
as the Purified Aloes preparation, and the neutral principle, Aloin. 

Aloe Barbadensis, Barbadoes Aloes, — is the inspissated juice of the 
leaves of Aloe vera, a plant of the nat. ord. Liliaceae. It occurs in 
opaque, hard, orange-brown masses, of saffron-like odor and bitter taste. 

Aloe Socotrina, Socotrine Aloes, — the inspissated juice of the leaves 
of Aloe Perryi, nat. ord. Liliaceae, inhabiting the island of Socotra and 
the eastern coast of Africa near the Red Sea. The plant has orange- 
colored flowers and resembles in appearance the American aloe or cen- 
tury-plant {Agave americand). Aloes occur in soft masses of a yellowish- 
brown color, fragrant odor and bitter taste, soluble in alcohol and in 
boiling water. It contains a peculiar volatile oil, a resin, and Soaloin, 
C 15 H 16 7 , a variety of the principle Aloin, which is common to all 
varieties of aloes, — also Aloetic and Chrysa??imic Acids. Dose, gr. j-v. 

Aloe Capensis, Cape or Natal Aloes, from Aloe ferox, is another 
variety of the same plant. 

Aloinum, Aloin, — a neutral principle obtained from several varieties 
of Aloes, chiefly the above-named, which yield respectively Barbaloin and 
Soaloin. These principles are soluble in 60 parts of water, 20 to 3.0 of 
alcohol, and in 380 to 470 of ether. Soaloin is soluble in 9 parts of 
acetic ether. Dose, gr. ss-ij. 

Preparations. 

Aloe Purificata, Purified Aloes, — prepared from Socotrine Aloes by melting and 
mixing with -1th of Alcohol, straining and evaporating. The product is in irregular, 
dull-brown, brittle pieces, almost entirely soluble in alcohol. From it are prepared the 
following preparations. Dose, gr. j-v. 

Extractum Aloes, Extract of Aloes, — prepared by mixing I part of Socotrine Aloes 
with 10 parts of Boiling Distilled Water, standing 12 hours, decanting, straining and 
evaporating. Dose, gr. ss-v. 

Tinctura Aloes, Tincture of Aloes,— has of Aloes 10, Glycyrrhiza 20, Diluted 
Alcohol to 100 parts. Dose, 3 ss-ij. 



142 ALTH^A. 

Tinctura Aloes et Myrrhae, Tincture of Aloes and Myrrh, — Aloes 10, Myrrh io, 
Glycyrrhiza io, Alcohol and Water to ioo parts. Dose, ^ss-ij. 

Pilulae Aloes, Pills of Aloes, — each has Aloes and Soap, 2 grains of each. 

Pilulae Aloes et Asafetidae, Pills of Aloes and Asafetida, — each pill contains gr. 
I 1 /^ of each ingredient. 

Pilulae Aloes et Ferri, Pills of Aloes and Iron, — each pill contains gr. j each of 
Aloes, Sulphate of Iron and Aromatic Powder, with Confection of Rose. 

Pilulae Aloes et Mastiches, Pills of Aloes and Mastic, Lady Webster 's Pill, — each 
pill has of Aloes gr. ij, Mastic gr. ss, Red Rose gr. ss. 

Pilulae Aloes et Myrrhae, Pills of Aloes and Myrrh, — each pill contains of Aloes 
gr. ij, Myrrh gr. j, Aromatic Powder gr. ss, mixed with Syrup. 

Pulvis Aloes et Canellae, Powder of Aloes and Canella (Unofficial), — contains the 
powdered bark of Canella alba. Dose, gr. v— xx. 

Pilulae Lapacticae, Lapactic Pills (Unofficial), — each pill contains of Aloin gr. \, 
Strychnine gr. -^, Extr. Belladonna gr. \, Ipecac gr. T X g. Dose, ij-viij. 

Aloes is also a constituent of Pilulae Rhei Composite and Tinctura Benzoini Com- 
posita (which see, under Rheum and Benzoinum respectively). 

Physiological Action and Therapeutics. 

Aloes is a tonic-astringent and resin-bearing purgative, an emmena- 
gogue and an anthelmintic against the thread-worm. As a cathartic it 
acts chiefly on the lower half of the large intestine, doses of gr. j-iv 
producing in about 10 hours copious soft evacuations with some griping 
pain. This effect is produced whether the drug be taken internally or 
absorbed from an exposed surface, so that it probably diffuses into the 
blood and is eliminated by the mucous membrane of the colon. It is a 
stomachic tonic in small doses, a stimulant of the hepatic functions, and 
an excitant of the pelvic circulation. It may cause abortion in the 
female and priapism in the male, and is said to have frequently produced 
hemorrhoids, which if existing it will aggravate. Given to nursing 
mothers it imparts a purgative quality to their milk. 

Aloes is chiefly used in combination with Iron, Myrrh, Nux-vomica, 
etc., for amenorrhea and chronic constipation with atonic dyspepsia and 
hypochondriasis. It is curative in certain forms of hemorrhoids, espe- 
cially those occurring after delivery and where the condition is not one 
of active pelvic congestion. It is also used internally and as an injec- 
tion in gonorrhea, and for simple atonic jaundice. It must be avoided 
in irritable rectum, hemorrhoids of active form, menorrhagia and preg- 
nancy, unless given in small doses and with care. The Pil. Aloes et 
Ferri is perhaps the most generally useful agent in the anemia, amenor- 
rhea and constipation of girls at the period of puberty. 

ALTHAEA, Marsh-Mallow, — is the root of Althcea officinalis, a European plant 
of the nat. ord. Malvaceae. It contains about 35 per cent, each of vegetable mucus and 
starch, with 2 per cent, of Asparagin, also pectous matter, sugar, fixed oil, but no tan- 
nin. It is a constituent of Massa Hydrargyri and Pilulae Phosphori, and is much used 
as an excipient in extemporaneous pharmacy. Dose, indefinite. 

Syrupus Althaeae, Syrup of Althaa, — has of Althaea 5 per cent., and should be 
freshly made. Dose, indefinite. 



ALUMEN ALUMINUM. I43 

Althaea is one of the best mucilaginous drugs, but has no active medicinal properties. 
It is used in Europe to make pectoral teas and syrups, and is extensively employed as a 
mucilaginous demulcent. The powdered root makes a good emollient poultice. In the 
Phar. Ger. a Compound Althaea Tea is official, which under the common name, " Ger- 
man Breast Tea," is a popular demulcent drink in bronchial affections, coughs, etc. 

Asparagin is an organic principle, occurring in large rhombic crystals, and found in 
many other plants, as in the shoots of asparagus, vetches, potatoes, liquorice, the sweet 
almond, the root of the locust, etc. It is considered a derivative of Succinic Acid, and 
has diuretic properties, besides being sedative to the circulation. It may be used in 
ascites, especially in children, in the anasarca of Bright's disease, and in gout. Dose, 
gr. ij-iij, in water. 



ALUMEN, Alum, Potassium Alum, — is Aluminum and Potassium 
Sulphate, A1 2 K 2 (S0 4 ) 4 -f- 24H 2 0, which, when the 24 molecules of water 
are driven off, becomes Alumen Exsiccatum, Dried Alum, A1 2 K 2 - 
(S0 4 ) 4 . Alum occurs in large, octahedral crystals, or cubes, of sweetish 
astringent taste and acid reaction. It is soluble in 9 parts of water and 
in 0.3 of boiling water, but is insoluble in alcohol. The Ammonia-alum 
(Alumini et Ammonii Sulphas) was formerly official, and is still sold and 
dispensed as Alum. Dose, gr. x-xx, — as an emetic 3J for a child. 

Alumen Exsiccatum, Dried Alum, — is a white, granular powder, slowly soluble in 
20 parts of water at 59 F., and quickly soluble in 0.7 of boiling water. Dose, gr. x-xx. 

Alum is an astringent, coagulating albumin and stimulating muscular 
contraction. At first it excites the flow of saliva and then markedly 
diminishes it. It coagulates pepsin and arrests digestion, stops peristal- 
sis, and usually causes constipation, though sometimes inducing diarrhea. 
Although coagulating albumin, even in weak solution, it enters the blood, 
constricts the capillaries, arrests secretions, especially those of mucous 
surfaces, and stops capillary hemorrhage. In teaspoonful doses it is an 
efficient and non-depressant emetic. In large doses it is a gastrointes- 
tinal irritant, one ounce and five-eighths of dried Alum having caused 
the death of an adult in eight hours. 

Alum is used locally as an astringent in chronic catarrhs, leucorrhea, 
gonorrhea, hemorrhoids, bed-sores, ulcers, relaxed throat, colliquative 
sweats, catarrhal ophthalmia and granular lids. The dried powder is 
escharotic, destroying granulations and warty growths, and is used by in- 
sufflation in chronic nasal catarrh. Internally it is beneficial in gastric 
catarrh, gastralgia, enteralgia, passive hemorrhages, lead colic and con- 
stipation. As an emetic it is employed in croup, and it is a good anti- 
dote in lead-poisoning. Alum is best administered alone, as it forms 
precipitates with a large number of drugs. 

ALUMINUM. — This metal is not official, though of its salts two are official besides 
Alum. They are — 

Alumini Hydras, Aluminum Hydj-ate, Hydrated Alumina, Al 2 (OH) 6 , — is a white, 
light, amorphous, tasteless powder, insoluble in water or alcohol, but soluble in strong 
alkaline or acid solutions. Dose, gr. iij-xx in powder or mixture. 



144 AMMONIACUM AMMONIUM. 

Alumini Sulphas, Aluminum Sulphate, A1 2 (S0 4 ) 3 -\- l6H 2 0, — is a white crystalline 
powder, soluble in 1.2 of water at 59 F., almost insoluble in alcohol. Used locally. 

The Hydrate is a feebly astringent and desiccant powder, occasionally used in inflam- 
matory skin affections as a local application, and internally in diarrhea. 

The Sulphate is antiseptic and astringent. It has been used internally in diarrheas, 
but is chiefly employed in a 5 per cent, solution locally to ulcers, or in stronger solution 
(giij ad ^vj) in foul discharges from mucous surfaces. A saturated solution is a mild 
caustic, and may be used daily as a local application to enlarged tonsils, nasal polypi, 
ulceration of the os uteri, and various chronic enlargements. The Benzoinated Solution 
of Alumina is an unofficial preparation used for the same purposes. 

Alumnol (Unofficial), — is an aluminum salt of naphtol-sulphonic acid, and is 
readily soluble in cold water. It is markedly antiseptic and astringent, and though pre- 
cipitating gelatin and albumin, the precipitate is soluble in an excess of either, so that 
when it is used on purulent discharges they do not clog up cavities, and desirable pene- 
tration below the surface is accomplished. It has been used both dry and in solution, 
as a dressing for wounds, ulcers, etc., also for acute inflammatory and parasitic affections 
of the skin, and in acute and chronic inflammations of mucous membranes. In I to 3 
per cent, solution it makes a good injection for gonorrhea, the weaker solution destroy- 
ing gonococci without increasing inflammation (Chotzen). A 4 per cent, solution is 
used by ophthalmologists to check lachrymal discharge during an examination of the eye. 
It neither irritates nor causes pain. It is four times as expensive in this country as in 
Germany, where it originated. 

AMMONIACUM, Ammoniac, — is a gum-resin, obtained from Dorema Ammo- 
niacum, a Persian plant of the nat. ord. Umbelliferae. When triturated with water it 
readily yields a milk-white emulsion, and contains a Volatile Oil, which differs from that 
of Asafetida, in that it is neither sulphuretted nor phosphoretted. It also contains resin, 
gum, gluten, etc. Dose, gr. x-xxx. 

Emulsum Ammoniaci, Emulsion of Ammoniac, — an emulsion with water of 4 per 
cent, strength, the resin being suspended by the contained gum. Dose, §ss-j. 

Emplastrum Ammoniaci cum Hydrargyro, Amjjwniac Plaster with Meraay. — 
Ammoniac 72, Mercury 18, Oleate of Mercury 8 per cent., containing also Lead-plaster 
and Dilute Acetic Acid. 

Ammoniac is a stimulating expectorant and a laxative, and has a mildly irritant action 
on the skin. Its actions are similar to those of Asafetida, but much less powerful. It 
is not much used, but may be employed with benefit in chronic bronchial affections, 
especially of the aged, the mixture with Ammonium Chloride or Carbonate facilitating 
expectoration and lessening wheezing. It is also recommended in asthma, and in glan- 
dular enlargements and indolent swellings the plaster is employed as a stimulating alter- 
ative and resolvent. 



AMMONIUM, NH 4 , — is a hypothetical compound radical, which 
does not exist in the free state, but in combination with acids forms salts 
which closely resemble those of the elements Potassium and Sodium. 
Many of its salts are official, as well as the aqueous solutions of the gas 
Ammonia, NH 3 , which is produced during the putrefaction of all organ- 
isms and many organic nitrogenous compounds. Ammonia exists in the 
air and in the soil in the free state, and is contained in the products of 
the dry distillation of many nitrogenated compounds. The so-called 
" gas-liquor," a by-product in the manufacture of illuminating gas, when 
neutralized by hydrochloric acid, yields Ammonium Chloride, NH 4 C1, 
and from this salt are derived all the other ammonium compounds em- 
ployed in medicine. 



AMMONIUM. 145 

Preparations of Ammonia. 

Aqua Ammoniae, Ammonia Water, — is an aqueous solution of Ammonia, contain- 
ing 10 per cent, by weight of the gas. It is a colorless liquid of pungent odor, acrid 
taste and strongly alkaline reaction. Dose, YX\v-gss, well diluted. 

Aqua Ammoniae Fortior, Stronger A?fimonia Water, — contains 28 per cent, by 
weight of the gas. Sp. gr. 0.901 at 59 F. 

Spiritus Ammoniae, Spirit of Ammonia, — is a 10 per cent, solution of the gas in 
alcohol. Sp. gr. about 0.810. Dose, rr\x- t 3J, diluted. 

Spiritus Ammoniae Aromaticus, Aroi?iatic Spirit of Ammonia, — contains Ammo- 
nium Carbonate, Aqua Ammoniae, Oils of Lemon, Lavender, and Nutmeg, Alcohol and 
Water. Used in the Tinct. Guaiaci Ammoniata and the Tinct. Valerianae Ammoniata. 
Dose, gss-ij. 

Linimentum Ammoniae, Ammonia Liniment, — has of Aqua Ammoniae 35 parts, 
Cotton-seed Oil 60, Alcohol 5 parts. 

Ammonium Salts and their Preparations. 

Liquor Ammonii Acetatis, Solution of Atnmonium Acetate [Spirit of Mindererus), 
is prepared by neutralizing dilute acetic acid with ammonium carbonate. It contains 
about 7 per cent, of the acetate and is an ingredient of Liquor Ferri et Ammonii Ace- 
tatis. It should be freshly made as it soon deteriorates. Dose, gj-^j- 

Ammonii Benzoas, Ammonium Benzoate, NH 4 C 7 H 5 2 , — minute four-sided, lami- 
nar crystals, soluble in 5 of water and 28 of alcohol at 59 F. Dose, gr. v-xv. 

Ammonii Bromidum, Ammonium Bromide, NH 4 Br, — prismatic crystals or a gran- 
ular salt, soluble in 1^ of water and 30 of alcohol at 59 F. Dose, gr. ij-xx, well 
diluted. Children bear it well if epileptic from reflex causes; a child I year old will 
tolerate gr. v every 4 hours (Barton). 

Ammonii Carbonas, Ammonium Carbonate, NH 4 HC0 3 .NH 4 NH 2 C0 2 , — occurs in 
white masses consisting of both the bicarbonate and carbonate, which on exposure to 
air become a white powder (acid carbonate). Soluble in 5 parts of water. Dose, gr. 
iij-x. For children small doses, gr. }{-i], frequently repeated. 

Ammonii Chloridum, Ammonium Chloride [Sal-ammoniac), HN 4 C1, — a white, 
crystalline powder, of saline taste, and slightly acid reaction ; soluble in 3 of water and 
very sparingly in alcohol. Dose, gr. j-xx. 

Trochisci Ammonii Chloridi, Troches of Ammonium Chloride, — each contains 1% 
grains of the Chloride. Dose, j-x troches. 

Ammonii Iodidum, Ammonium Iodide, NHL — a deliquescent, granular, white 
salt, soluble in I of water and in 9 of alcohol at 59 F. Dose, gr. ij-x. 

Ammonii Nitras, Ammonium AHtrate, NH 4 N0 3 , — colorless crystals or fused masses, 
soluble in 0.5 of water and in 20 of alcohol at 59 F. Only used to prepare Nitrous Oxide 
Gas for anesthesia by heating to 365 F. 

Ammonii Valerianas, Ammonium Valerianate, NH 4 C 5 H 9 2 , — in white, quad- 
rangular plates, deliquescent ; very soluble in water and alcohol. Dose, gr. j-v. 

Raspail's Eau Sedative (Unofficial), — consists of Aqua Ammoniae ^ij, Sodii 
Chloridum ^ij, Spiritus Vini Camphorat. 3iij, Aqua ^xxxij. For local use. 

Physiological Action. 
The gas Ammonia is intensely alkaline and irritant to mucous mem- 
branes ; inhaled producing spasmodic cough and a sense of suffocation. 
Its prolonged inhalation will induce violent inflammation of the air-pas- 
sages and edema of the glottis. It stimulates the nasal branch of the fifth 
nerve, exciting the vaso-motor centre by reflex action, and thus raising 
the arterial tension. Applied to the skin and allowed to evaporate, it has 
a slight rubefacient effect, but if evaporation be prevented it penetrates 
the epidermis, and has a powerfully vesicant action. The Aqua, swal- 



I46 AMMONIUM. 1 

lowed undiluted, may cause death quickly by suffocation from the action 
of its vapor upon the air-passages ; if not, it may excite gastro-enteritis 
accompanied by coma, differing in the latter respect from potassium or 
sodium poisoning. After absorption it stimulates both the respiration 
and the circulation by direct action on their respective nerve-centres. 
Ammonia exists normally in the circulation, where it keeps the fibrin in 
solution and thus maintains the fluidity of the blood. It increases the 
glycogenic function of the liver, and is converted finally into urea. It 
is a powerful irritant to muscular tissue, causing tetanic contraction and 
subsequent rigor mortis when directly applied. 

All Ammonium Salts stimulate and finally paralyze the spinal cord, 
motor nerves and muscles, in animals, but the order and intensity of 
the action vary with the salts employed, some having a predominating 
influence on the cord, others on the motor nerves. In general they may 
be said to form a series, of which the members at one end stimulate the 
cord, and those at the other paralyze both the cord and the motor nerves. 
At the stimulant end are Ammonia and the Chloride ; at the paralyzant 
end the Iodide; the Bromide, Phosphate and Sulphate lying between 
(Brunton). In medicinal doses they act on man as stimulating expec- 
torants, in large quantity they injure the structure of the red blood- 
corpuscles, and if long continued they produce rapid emaciation by im- 
pairing digestion and increasing tissue-waste. 

The Chloride has decided cholagogue powers, increases the excretion 
of urea, in 20-grain doses is purgative, and is considered to have a select- 
ive action upon the gastric mucous membrane. The Carbonate is a pow- 
erful and very diffusible stimulant ; when administered internally in 
moderate doses it is probably decomposed by the HC1 of the gastric 
juice, nascent ammonia being set free and absorbed. It stimulates the 
respiratory centre, acts as a stimulating expectorant, and in very small 
doses stimulates the secretion of the gastric juice. It is also emetic, and 
has been supposed to prevent iodism when administered conjointly with 
Potassium Iodide. -The Solution of the Acetate is an active diaphoretic 
if the body be warm, or a diuretic if it be cool. In wineglassful doses it 
will counteract many of the immediate effects of alcohol. The Phosphate 
is diuretic, and is believed to decompose the insoluble sodium urate in 
the blood, converting it into the soluble salts ammonium urate and sodium 
phosphate, and thus promoting its elimination. The Benzoate is also 
diuretic, and like Benzoic Acid passes out of the system in the urine as 
hippuric acid. It stimulates the liver, and acidifies the urine where there 
is phosphatic tendency thereof. The Nitrate and Sulphate are only used 
for the preparation of other salts, while the Iodide, Bromide and Vale- 
rianate correspond in action to that of their titular bases, and are described 
under the respective titles, Iodum, Bromum and Valeriana. 



AMMONIUM. 147 

Antidotes and Antagonists. 

When Ammonia is inhaled in excess give HC1 vapors by inhalation to form the chlo- 
ride ; if taken in solution, give Vegetable Acids, also demulcents to protect the mucous 
surfaces. Its physiological antagonists are the cardiac sedatives, Aconite, Digitalis, 
Veratrum, etc. 

Therapeutics. 
The strong Solution of Ammonia may be used as a rubefacient and 
vesicant, and its vapor, by cautious inhalation, in syncope and the results 
of shock. Locally, it is a good application to bites of the less venomous 
reptiles and to the stings of insects. The Carbonate is used internally in 
the eruptive fevers, delirium tremens, continued fevers, pneumonia, etc., 
where much depression exists; as a stimulating expectorant in chronic 
bronchitis, in the broncho-pneumonia of children, and in cardiac asthma. 
It is highly recommended in scarlet fever in doses of 3 to 5 grains every 
one, two, or three hours, all acid drinks or fruits being prohibited while 
it is being administered. With ten-minim doses of tincture of capsicum 
in an ounce of some bitter infusion it is exceedingly efficient, in 5- to 10- 
grain doses, for the sinking sensations and craving for stimulants experi- 
enced by subjects of alcoholism. It may be used as an emetic in 
bronchitis, when the tubes are choked with mucus and the circulation of 
ihe patient is weak. It may also be employed by inhalation, and admin- 
istered internally, for similar purposes as Liquor Ammoniae. 

In doses of 5 grains, administered hypodermically in the vicinity of wounds caused by 
poisoned arrows, the Carbonate was repeatedly used by Dr. Parke, Stanley's surgeon in 
Africa, with entire success in saving life when so employed immediately after injury. 
Those so wounded at too great a distance to receive this treatment invariably died within 
a short period of time. 

The Chloride has high repute in catarrh of the stomach, with anorexia, 
bad taste in the mouth, flatulence, coated tongue, etc., in short, the 
symptoms of so-called " biliousness " ; also, in chronic congestion of the 
liver, jaundice from catarrh of the bile-ducts, nervous and sick headaches, 
myalgia, amenorrhea, muscular rheumatism and neuralgia. In the latter 
affection it should be given in 30-grain doses several times a day. It is 
also efficient in bronchial catarrh without fever, and in chronic bronchitis 
when the secretion is scanty and tough. It is remarkably efficient in 
straightening up a victim of acute alcoholism ; administered to one on 
the verge of delirium tremens, in dose of j£ drachm in half a pint of 
water, swallowed at one draught, it is said to restore the patient's faculties 
so quickly as to astonish those who have never seen it so employed. 
Locally, in solution, it has been well employed as a lotion for inflam- 
matory swellings, as sprains, inflamed joints, orchitis, etc. ; also to allay 
itching in prurigo, to remove ecchymoses and glandular enlargements. 
Eau Sedative is often a good local application in headaches. 

The Solution of the Acetate is especially beneficial in the exanthemata, 



I48 AMYGDALA. 

influenza, coryza, anomalous febrile conditions of children, acidity and 
vomiting ; also in acute alcoholism and in erysipelas when there is feeble 
circulation, cyanosis and delirium. It is frequently combined with spirit 
of nitrous ether, as a diuretic and diaphoretic in febrile affections. The 
Phosphate is particularly applicable to gout and lithemia, and is a very 
efficient cholagogue. The Benzoate is useful in cystitis with alkaline urine 
and phosphatic deposits, as it acidulates the urine, at the same time 
stimulating and disinfecting the mucous coat of the bladder. 

Aqua Ammonias has been administered by intra-venous injection, with 
efficacy and safety, in sudden or threatened thrombosis, impending car- 
diac paralysis during chloroform anesthesia, and in poisoning by hydro- 
cyanic acid and other cardiac depressants. In the same manner, it has 
been employed, but unsuccessfully, in poisoning by the bite of venomous 
reptiles. Ten drops of the strong Liquor are diluted with three parts of 
water, and carefully injected into a vein, all air being rigorously excluded 
from entrance thereinto. 

The therapeutics of the Iodide, Bromide and Valerianate are enume- 
rated under the titles Iodum, Bromum and Valeriana respectively. 



AMYGDALA, Almond. — The seeds of two varieties of Prunus 
Amygdalus, nat. ord. Rosaceae, namely Amygdala amara and Amygdala 
dulcis, are official, together with several preparations, some prepared from 
one variety, some from another, while one is from either and one from 
both. Amygdalitis C 20 H 27 NO n , is a crystalline glucoside, existing in 
Amygdala amara but not in Amygdala dulcis; while the ferment Emulsin 
is common to both varieties. The reaction which occurs between these 
two substances in the presence of water produces Hydrocyanic Acid. 
(See ante, page 99.) 

Amygdala Amara, Bitter Almond, — is the seed of Prunus Amygda- 
lus, var. amara, a tree of the nat. ord. Rosaceae, indigenous to Asia, but 
cultivated in many other parts of the world, especially in Spain and the 
Balearic Islands. The seed has an embryo of bitter taste, which, when 
triturated with water, emits an odor of Hydrocyanic Acid. 

Amygdala Dulcis, Sweet Almond, — is the seed of Prunus Amygdalus, 
var. dulcis, a tree of the nat. ord. Rosaceae. The bitter and sweet almond 
trees are identical botanically, and the fruits and seeds of the two varieties 
resemble each other closely, only differing in taste and the presence of 
Amygdalin (see above). The sweet almond is largely cultivated about 
Malaga and in California. 

Preparations. 

Oleum Amygdalae Amarse, Oil of Bitter Almond, — is a volatile oil, of peculiar and 
aromatic odor, bitter, burning taste, and neutral reaction ; soluble in 300 of water, but 
freely in alcohol and ether. Dose, tfLX~)> m m i xture - 



AMYL NITRIS. 1 49 

This essential oil, one of the products of the reaction between Amygdalin and Emul- 
sin (see ante, -p. 99), contains a varying quantity of Hydrocyanic Acid (3 to 14 percent.), 
which may be removed by distillation with caustic potash. Nitrobenzol, Oil of Mirbane, 
closely resembles the oil of bitter almond, and like it is used for flavoring. It contains 
no Hydrocyanic Acid, but is a dangerous poison, producing toxic effects when inhaled, 
even in small doses. 

Aqua Amygdalae Amarae, Bitter Almond Water, — is a weak solution of the Oil in 
Distilled Water (1 to 1000). Is only a flavored water. Dose indefinite. 

Spiritus Amygdalae Amarae, Spirit of Bitter Almond, Essence of Bitter Almond, 
has of the Oil I, dissolved in Alcohol 80, and Water added to 100 volumes. Dose, to 
be regulated by the quantity of alcohol desired. 

Syrupus Amygdalae, Syrup of Almond, — has of Bitter Almond 4 percent., of Sweet 
Almond 14. Dose indefinite. 

Emulsum Amygdalae, Emulsion of Almond, — made of Sweet Almond 6 per cent., 
with Acacia, Sugar and Water. A demulcent drink, used as a vehicle for cough mix- 
tures. Dose, 3 ij- ^ ss. 

Oleum Amygdalae Expressum, Expressed Oil of Almond, — is the fixed oil which 
is expressed from either Bitter or Sweet Almond. Used in Unguentum Aquae Rosse, and 
as a bland local application in skin affections. 



Physiological Action and Therapeutics. 

The bitter and sweet varieties of the species Prunus Amygdalus differ 
in action only through the agency of the principle Amygdalin contained 
in the former. The Sweet Almond is demulcent and nutritive, while the 
fixed oil expressed from either variety is a bland application, having the 
same action as Olive Oil. The action of the Bitter Almond and its oil is 
due to the Hydrocyanic acid contained in them (see ante, p. 99). 

The Oil of Bitter Almond is used as a flavoring agent, and may be 
employed locally or internally in lieu of Hydrocyanic acid. The Syrup 
is somewhat sedative, but is generally used as a demulcent or for flavoring 
purposes. The Emulsion is used in catarrhal affections and as a vehicle 
for cough-mixtures. The poisonous character of the Bitter Almond and 
its essential oil (Oleum Amygdalae Amarae) should be kept in mind when 
prescribing them. Of 39 cases of poisoning by bitter almond prepara- 
tions, the oil caused 28, the spirit 4, the almonds themselves 4, the water 
2, and the emulsion 1. 

The Expressed Oil of Almond is a good demulcent, also laxative in 
doses of 3J to ^ij. It is used externally for excoriations, chapped hands 
and inflammatory affections of the skin, and may be applied in the ex- 
ternal auditory canal for earache. Almond Bread is made from the cake 
remaining after the fixed oil is expressed from the sweet almond. The 
cake is ground into a meal or flour, and is an excellent substitute for 
wheat bread in the diet of diabetics, as it contains no starch. 

AMYL NITRIS, Amyl Nitrite,— is a liquid containing about 80 
per cent, of Amyl Nitrite, C 5 H n N0 2 , together with variable quantities of 
undetermined compounds. It occurs as a clear, yellowish liquid, of 



150 AMYL NITRIS. 

ethereal and fruity odor, aromatic taste, and neutral or slightly acid 
reaction, extremely volatile, insoluble in water but freely soluble in 
alcohol, ether, chloroform and benzin. It is produced by the action of 
nitric acid upon amylic alcohol, and when impure may contain nitric or 
hydrochloric acid. Dose, — internally ^b^-j dissolved in alcohol, — by 
inhalation n^ij-v ; but larger doses are probably safe. 

Analogous Compounds. 

Glonoinum, Glonoin, Nitroglycerin, Trinitrin, Glyceryl Trinitrate, C 3 H 5 (N0 3 ) 3 , — 
is a clear, oily liquid, insoluble in water, but soluble in alcohol, ether, oils, etc., produced 
by the action of Nitric and Sulphuric acids upon Glycerin. It is a dangerous explosive, 
and should not be kept in stronger solution than I per cent. Dose, TT^ ^q to 30 or 
more, according to susceptibility. Official in the Spirit. 

Spiritus Glonoini, Spirit of Glonoin, Spirit of Nitroglycerin, — is a I per cent, solu- 
tion in alcohol. Dose, TTL^-x. The strong tincture sold by the homeopathic pharma- 
ceutists and official in their American Pharmacopoeia is a 10 per cent, solution, or ten 
times the strength of the above. It is an extremely dangerous preparation, both as an 
explosive and as a medicine. (See American Homoeopathic Pharmacopoeia, 2d ed., 
Boericke & Tafel, 1883, page 235.) 

Tabellae Nitroglycerini (B. P.), Tablets of Nitroglycerin, — are tablets of chocolate, 
each containing gr. j^ of pure Nitroglycerin. Dose, j-ij. 

Sodii Nitris, Sodium Nitrite, NaN0 2 , and Potassii Nitris, Potassium Nitrite (the 
latter unofficial), — are used as substitutes for Amyl Nitrite and Nitroglycerin. The 
former is a white, crystalline powder, deliquescent in the air, in which it gradually oxi- 
dizes to sodium nitrate ; has a mild, saline taste, but no odor; very soluble in water, 
slightly in alcohol. Dose, gr. ss-iij, according to individual susceptibility. 

Ethyli Nitris, Ethyl Nitrite, C 2 H 5 N0 2 , — constitutes about 5 per cent, of Spiritus 
^Etheris Nitrosi. (See page 1 13 ante.) 



Physiological Action. 

Amyl Nitrite and the other Nitrites agree closely in their general 
action, producing great vascular dilatation by paralyzing either the sym- 
pathetic system, the vaso-motor centre or the muscular coat of the arteri- 
oles, — which, is yet undecided. They cause tumultuous action of the 
heart by relaxing its inhibition; lowered respiration, from paralysis of 
the respiratory muscles and impairment of the ozonizing function of the 
blood; diminution of sensation, motility, and reflexes; a sense of heat, 
but lowered body-temperature ; also throbbing pain in the head, beating 
carotids, quickened pulse, flushed face and vertigo. The effect of an 
ordinary inhalation of Amyl Nitrite on man is very transitory, excepting 
the headache, which may last several hours. Of all the nitrites it is the 
most prompt but least enduring in action, and is best administered by 
inhalation. It causes sugar to appear in the urine and increases the 
quantity of urine voided. Mixed with blood it forms methemoglobin, 
which is not so readily deoxidized as hemoglobin, and under its influence 
the blood in the body becomes of a dark chocolate color both in the 
arteries and in the veins. 

Nitroglycerin acts similarly, but less promptly, and its action is more 



AMYL NITRIS. I5I 

enduring. Its headache is of intensely frontal character, and persists for 
hours after the other effects have passed off. It is more suitable than 
amyl nitrite for internal administration. Sodium Nitrite is also slower 
in action than amyl nitrite, and does not cause so much throbbing head- 
ache as nitroglycerin. It may be given in solution with water. The 
action of all these agents is probably due to the nitrous acid contained 
in them. 

Antagonists. 

Ergot, Belladonna, Strychnine, Brucine, Digitalis, Picrotoxin and all other agents 
which increase the functional activity of the spinal cord and sympathetic are antagonistic, 
though by reason of their slower rate of diffusion the antagonism may not be always 
available. Stimulants, artificial respiration, the alternate cold and hot douche, with cold 
to the head, and Ergotin or Atropine subcutaneously, are the best means to be used in 
cases Of poisoning by the Nitrites. 

Therapeutics. 

The inhalation of Amyl Nitrite is a useful palliative in angina pectoris, 
epilepsy, tetanus, and many of the respiratory neuroses, as spasmodic 
asthma, whooping-cough, laryngismus stridulus, etc. It is also indicated 
in migraine of the pale-face form, and in the cold stage of intermittents 
and pernicious remittents, to prevent internal congestion, — also in con- 
vulsions of various kinds, including the puerperal form. It has been 
sometimes used in threatened death from chloroform anesthesia, and in 
poisoning by strychnine. 

Nitroglycerin is employed with benefit in neuralgic dysmenorrhea and 
sea-sickness ; also in chronic interstitial nephritis, by redistributing to 
the kidneys their blood-supply cut off by degeneration of the renal gan- 
glionic centres. It promptly relieves hiccough, also migraine of spas- 
modic character, and has afforded immediate relief in neuralgia of the 
fifth and in sciatica. Its administration in angina pectoris, though not 
producing such prompt results as that of Amyl Nitrite, gives excellent 
and much more lasting effects. It is useful in the weak heart of the aged, 
or that from fatty degeneration, or when, as in Bright's disease, the 
arterial tension is above normal ; also in irritable and overacting heart, 
which it relieves by rapidly dilating the arterioles and thereby lowering 
arterial tension. 

Sodium Nitrite has been successfully used in angina pectoris, in hemi- 
crania, and in asthma of purely bronchial and neurotic origin. It has 
also proved decidedly beneficial in the abnormally high arterial tension 
of chronic desquamative nephritis, especially when complicated with a 
weakened and dilated heart. Disagreeable symptoms caused by it may 
be prevented by prescribing it with spirit of chloroform or ammonia 
water and small doses of morphine. 



152 AMYLUM. 

AMYLUM, Starch, C 6 H 10 O 5) — is the fecula of the seed of Zea Mays, 
the Maize or Indian Corn, a plant of the nat. ord. Graminese. Though 
corn-starch is the only official kind, any other might be properly used, as 
the starch occurring in wheat, barley, oats, arrow-root, sago and tapioca, 
all of which were official in the U. S. P. of 1870. The last three are 
almost entirely composed of starch ; wheat contains about 70 per cent., 
and rice nearly 90 per cent. The B. P. recognizes the starches from 
Maize {Zea Mays), Wheat {Triticum sativu?ti) and Rice (Oryza sativd) ; 
the Ph. Ger. recognizes that from wheat alone. 

Starch occurs in distinct grains (granules) which form irregular, angular masses, white, 
odorless and tasteless, of neutral reaction, easily pulverized and insoluble in alcohol, ether, 
and cold water. In boiling water they swell, burst and form a mucilage which gelatin- 
izes on cooling and gives a deep blue color on the addition of Iodine, the color disap- 
pearing on warming and returning on cooling. Under the microscope the granules are 
seen to be lenticular in form and differing somewhat in size and shape according to the 
plant from which they are derived. Those from wheat are large and small mixed and 
show concentric striae formed around a nearly central spot (hilum). Those from maize 
are smaller, have a hilum but no striae. Those from rice are very minute, polygonal in 
shape, with a small hilum but no striae. 

Starch is converted into grape-sugar (glucose) by the action of diastase, 
ptyalin and pancreatin, also by boiling it with a dilute mineral acid, 
Dextrin being formed as an intermediate product. [See the article en- 
titled Pepsinum.] By hot, concentrated nitric acid it is converted into 
oxalic acid, but cold, fuming nitric acid dissolves it, forming an explosive 
compound. By the action of ferments it is finally converted into alcohol 
and carbon dioxide. C 6 H 10 O 5 — 2C 2 H 5 OH -}- 2C0 2 . 

Glyceritum Amyli, Glycerite of Starch, — has of Starch 10 parts, Water 10, Gly- 
cerin 80, triturated and heated to a transparent jelly. A vehicle for external applica- 
tions. 

Cetraria, Iceland Moss, — is the lichen Cetraria islandica found in northern latitudes, 
and contains Lichenin or lichen starch, which forms as a jelly when the plant is boiled 
in water ; also Cetraric Acid. 

Decoctum Cetrariae, Decoction of Cetraria, — 5 per cent, strength. Dose, §ij-iv. 

Unofficial Derivatives and Analogues. 

Dextrin, — is produced by the action of dilute acids on starch, and is an intermediate 
product in the conversion of starch into glucose. It is a transparent, brittle solid, soluble 
in water and dilute alcohol, is not fermentable, and is not colored by Iodine. 

Maltum, Malt, — is the seed of Hordeum distickum, Barley (nat. ord. Gramineae), 
caused to enter the incipient stage of germination by artificial means and dried. The 
germination is allowed to go far enough to develop the maximum amount of Diastase, 
the peculiar ferment by which the starch of the grain is converted into glucose. Malt is 
the source of beer, ale and whiskey, and is composed of the germinated, dead grains 
with their acrospires and radicles. It should be fresh, not darker in color than a pale 
amber, and of agreeable odor and sweet taste. 

Extractum Malti, Extract of Malt, — is a liquid of the consistence of thick honey, 
containing all the soluble principles of malt in permanent form. It consists chiefly of 
diastase and glucose. Dose, ,^j-iv. 



AMYLUM. 153 

Horlick's Food, — is, like Mellin's and many other foods for children, a granulated 
Extract of Malt. Hoff's Malt Extract \% another such preparation, containing alcohol, 
and corresponding to a concentrated beer. 

Cellulose, C 6 H 10 O 5 , — forms the basis of all vegetable fibre, and is isomeric with 
starch. It exists almost pure in cotton and in Swedish filter paper. Pyroxylin, Gun- 
cotton, is dinitro-cellulose. 

Glycogen, Animal Starch, — closely resembles starch in its properties, being con- 
verted into glucose by the same agents which so act on starch. It exists in the liver of 
all animals. 



Physiological Action. 

Starch and its derivative grape-sugar are the chief members of the non- 
nitrogenous group of alimentary principles designated hydrates of carbon 
or carbo-hydrates, so called because in them the constituent elements H 
and O exist in multiples of the same proportions as in water. Starch is 
met with only in the vegetable kingdom, occurring in the form of gran- 
ules in many seeds, roots, stems, and in some fruits. It is formed by 
plants from inorganic material under the influence of light, and is stored 
up in their seeds as food for the young seedlings. In order to be ab- 
sorbed by the animal organism starch must undergo digestion by the 
action of the secretions of the pancreas and intestinal glands, which con- 
vert it first into soluble dextrin and then into grape-sugar, in which form 
it passes into the blood. 

Food is required by the animal organism for two purposes, (1) to gen- 
erate heat and other forms of force, (2) to repair the waste of the tissues. 
Both are essential to continued life, but the first is even more important 
than the second, for though the body may live a long time while wasting, 
it dies rapidly when the source of heat is removed or greatly lessened. 
The doctrine taught by Liebig — that the nitrogenous principles (albu- 
minoids) are exclusively concerned in tissue repair, and the non-nitrog- 
enous (starches, sugars and fats) in heat-production, — though not strictly 
accurate, still holds good as describing the leading office of each 
group. 

The carbo-hydrates (starches, sugars, etc.) represent in vegetable food 
the same office which the hydrocarbons (fats) represent in animal food, 
namely — the maintenance of heat-production and other forms of force. 
The glycogen in the liver and the muscles is a store of insoluble fuel for 
emergencies, and is given up in the form of soluble grape-sugar as 
required. Any surplusage of carbo-hydrates goes to form fat, the adipose 
tissue of the body, another reserve of body-fuel. Being devoid of 
nitrogen the carbo-hydrates cannot enter into the actual structure of the 
tissues, the instruments of energy, but their oxidation supplies the motive 
power, they being the fuel of the body. When they are entirely burnt 
up and no more supplied the organism perishes of exhaustion. The 
adult human body of average size and weight requires according to its 



I 



154 AMYLUM. 

activity from 12 to 18 ounces of water- free carbo-hydrate material daily 
in some form of food. 

Starch and sugar occur in vegetable foods in from three to five times 
greater amount than proteid material. The latter exists in greater pro- 
portion in the leguminous vegetables (peas, beans, lentils) than in meat, 
but in other vegetables the proteid is much less. Cereal grains are by far 
the most important vegetable foods, and among them Wheat is the one 
most generally used. Its constituents correspond with the requirements 
of the human organism more closely than those of any other grain ; in fact 
both life and health can be maintained on wheat alone for a very long 
period. As ordinarily used, however, it is deprived of much of its nutri- 
tive value, white bread being made from wheaten flour from which not 
only the indigestible cellulose has been removed but part of the starch 
and sugar and a large proportion of the gluten, which is the proteid mate- 
rial of the grain. Brown or Graham bread contains nearly all the 
nutritive elements of wheat and is much more nutritious than white bread. 
Rye is a valuable grain, containing nearly the same proportions of starch, 
sugar, fat and proteid as wheat. Rice contains more starch than the 
others and its starch is very digestible, but it has practically no fat and 
only the smallest quantity of proteid. Its nutritive value is small, and it 
requires an oil and some albuminoid to be taken with it in order to make 
it a suitable diet. Maize is more nutritious than rice, but is less digestible. 
It contains much starch and some fat, but is deficient in proteid material 
(gluten). Oats are rich in fat but contain less starch than the other 
grains and require prolonged cooking to render them digestible. Barley 
ranks about as wheat, contains rather more proteid and is rich in 
phosphates and iron. It is highly nutritious and was the principal diet 
on which the Grecian athletes were trained. The Potato contains nearly 
24 per cent, of a very digestible starch, is rich in salts and its juice is 
highly acid. It is an excellent antiscorbutic and is extensively used for 
food. Arrow-root, Sago and l^apioca consist almost entirely of starch, 
without fat or proteid, and are readily digested. Peas and Beans contain 
about 50 per cent, of starch and sugar, also 22 per cent, of legumin or 
vegetable casein, albumin, etc. — a very large proportion of proteid 
material, more in fact than exists in any kind of meat. They are rich 
also in fat and salts, and form the best vegetable substitute for animal 
food. They are somewhat indigestible and require prolonged cooking 
before being eaten ; but they are an excellent food, alone nourishing 
both men and beasts for a long time. 

The excessive consumption of starchy food delays tissue-metamorphosis, 
produces a superabundance of adipose tissue, and often causes acidity and 
flatulence. Undigested starch passes into the feces and the urine becomes 
saccharine in many cases. Profound disease does not necessarily follow, 



AMYLUM. 155 

but if decided corpulence is produced the muscular fibres of the heart and 
many voluntary muscles decrease in size, the cardiac action becomes 
enfeebled and the usual results thereof are manifested. The deprivation 
of starch can be borne well for a long time if fat is taken with the food, 
but if both starch and fat are excluded and nitrogenous material is alone 
supplied, illness results in a few days. [See the article entitled Albumin, 
ante, page 120.] 

Therapeutics. 

The principal affections in which the carbo-hydrates are imperatively 
required are gastric disorders, diarrhea, dysentery, excessive secretion of 
bile and other hepatic disorders, Bright's disease, alcoholism, gout and 
rheumatism. In acute and continued fevers there is often an almost com- 
plete inability to take and digest any kind of food. This may last for 
weeks, the result being that the patient dies from so-called exhaustion, 
in reality starvation due to want of fuel-food, the human fire going out in 
the absence of material to feed it. In such cases the need of soluble 
carbo-hydrate food must be supplied. Well-baked flour which contains 
much soluble dextrin, also milk-sugar or grape-sugar, should be added to 
the beef-teas which are so much used in the sick-room. Grape-sugar is 
digested starch and a very soluble carbo-hydrate; it may therefore be 
administered in lemonade or any other drink which the patient fancies. 
In gastric disorders accompanied by much acidity an uncrystallizable 
sugar like grape-sugar is preferable to cane-sugar or beet-sugar, the latter 
being crystallizable sugars and readily undergoing the acetous fermenta- 
tion. In diarrheal conditions the proper food is milk with some digestible 
carbo-hydrate, as arrow-root, sago or tapioca. Rice-water makes an 
excellent drink in diarrhea and dysentery, and has often arrested these 
conditions without medicinal aid. In the treatment of Bright's disease and 
chronic alcoholism a diet of carbo-hydrates should be inculcated and 
animal food reduced to a very small quantity. The same rule is impera- 
tive in the management of gout, especially when this disease occurs in 
persons of sedentary habits. In acute rheumatism the diet should be 
wholly non-nitrogenous, except for broken-down and debilitated subjects, 
or where serious nervous or cardiac complications exist. 

Starch is medicinally inert. It is employed as a vehicle for medicated 
enemata, as an antidote in poisoning by Iodine or Bromine, and as a pro- 
tective and absorbent powder applied by dusting over the skin. Mixed 
with glue it makes an excellent stiff bandage for surgical purposes. 

Malt Extract, containing good food elements, is directly nutritive, and indirectly so 
from the presence of the ferment Diastase, which converts the starch of bread or other 
farinas into sugar. It is usefully employed in wasting diseases, and mixed with milk or 
oleaginous foods it aids their digestion and assimilation. It may be used to form a syrupy 
mixture with preparations of Iron or Cinchona. 



I56 ANIMAL EXTRACTS. 

Cetraria is nutrient, demulcent and feebly tonic. It has a popular reputation in pul- 
monary affections, and is of value in chronic catarrhs, chronic bronchitis, purulent dis- 
charges from mucous surfaces generally, also in chronic diarrhea and dysentery. 



ANIMAL EXTRACTS (Unofficial).— The organs, tissues and 
secretions of animals were extensively employed as medicinal agents in 
ancient times, and many of them were official in the pharmacopoeias of 
the last century. At present the only ones so recognized are the di- 
gestive ferments (pepsin and pancreatin), ox-gall (fel bovis), and the 
secretion of the preputial follicles of the beaver (castoreum) and of the 
musk-ox (moschus). The first definite attempt in recent regular practice 
to apply animal tissues to the cure of disease was made in 1852 by Dr. 
Jackson of Philadelphia, who used as a tonic the blood of bullocks care- 
fully dried in vacuo, giving 5 to 10 grains thereof at a dose. Since then 
the drinking of fresh bullocks' blood has become a common practice in 
certain diseases. Raw meat was administered as a remedy for diabetes at 
St. Bartholomew's Hospital in London in 1874. The powdered Russian 
cockroach (Blatta orientalis) is still used as an efficient diuretic in drop- 
sies, and preparations of the bodies of various spiders and toads, also bee 
and serpent venoms, are recognized remedies in homeopathic practice. 

The use of glandular extracts as remedies in disease is very old. It 
was revived in 1889 by Brown-Sequard's advocacy of orchitic (testicular) 
extract for impotence and several nervous affections, and was profoundly 
stimulated by the results of Dr. Murray's suggestion in 1891 of thyroid 
extract for the cure of myxedema. 

Testicle Extract is fully noticed in the " Seplasutm or the Drug-gist's Shop Opened," 
by W. Salmon, published about 1685. ^ n tn i s book the author describes the testicles 
taken from man or beast as consisting of " a Flegm, Spirit, Sulphur and Volatile Salt 
joined with some Earthy Particles ; the chief used are from Bull, Horse, Goat, Ram, 
Boar and Buck," which were cut out, carefully dried, and used to make a tincture, a 
spirit, an oil and a volatile salt. Salmon further says that "their virtues are very great, 
for they refocillate the Spirits, — Natural, Vital and Animal, — comfort the Head, Brain 
and Nerves, and resist- all Diseases afflicting them, .... they restore in Con- 
sumptions, .... are also good against the Collick, and particularly strengthen 
the Instruments of Generation and provoke Lust." The same extract was also recom- 
mended by T. F r - Leaulte, who wrote in 1717. According to Pliny the ancient Greeks 
and Romans ate the testicle of the ass for the purpose of curing impotence. 

According to the theory promulgated by Brown-Sequard, all glands, in 
addition to their ordinary secretions, elaborate certain materials of un- 
known chemical composition, which pass into the blood and perform 
therein definite functions of some kind. We now know that such is the 
case with the thyroid gland, we suspect that it is equally true of the 
thymus, the spleen and the adrenals, and we have reason to believe it 
highly probable that the other glands of the body exert influences here- 
tofore unsuspected over distant parts of the organism. 



ANIMAL EXTRACTS. I 57 

The effect of the entire removal of the thyroid, the pancreas or the adrenal glands is 
to produce the symptoms of characteristic and fatal disorders ; but if a portion of either 
gland be left behind these toxic symptoms do not develop, and the same is true of the 
thyroid and pancreas if, after their entire ablation, a portion be engrafted upon the peri- 
toneum. It is evident therefore that the disorders so produced are of auto-toxic origin, 
the result of chemical poisons in the blood which were previously neutralized, destroyed 
or eliminated by the removed gland or some of its secretions. It has also been shown 
that the subcutaneous injection of an aqueous extract of the dead gland will dispel the 
toxic phenomena which follow the removal of that gland, proving that the active principle 
thereof is a chemical substance existing in the gland itself, and that the previous immu- 
nity was not due to any action of its living cells other than that required to produce the 
active agent. The discovery that ablation of the testicles causes retrogression of the 
hypertrophied prostate, and that removal of the ovaries will cure osteomalacia, as also the 
long-known facts that castrated individuals usually grow very obese and develop massive 
skeletons, while giants are generally endowed with atrophied testicles, — clearly point to 
the same conclusion. 

The animal extracts form a group of active medicinal agents which are 
proving worthy of careful investigation both physiologically and clin- 
ically. The study already given to them has yielded much new knowl- 
edge, and has shown indubitably that their employment as therapeutic 
agents rests on a scientific basis ; but most of them are as yet on trial, 
and the limits of their utility in medicine are by no means defined. They 
contain leucomaines, extractives and other chemical substances, all of 
which possess physiological powers, many proving distinctly poisonous 
when their excretion is prevented. Excepting thyroid extract and per- 
haps some others, the animal extracts are active medicinally only when 
injected subcutaneously or by the rectum, as most of them when given by 
the mouth are destroyed or altered in the stomach, or prevented by the 
liver from entering the general circulation. Physiological chemists are 
endeavoring to separate their active principles, a line of research which 
promises more accurate and positive results. It is already demonstrated 
that some of their principles are the most powerful of all alteratives, and 
that others possess the most energetic action upon the muscular fibres in 
the walls of the arterioles. 

The initial doses of many animal extracts should be very small, in 
order to avoid the possible systemic disturbance which has been fre- 
quently noticed by clinical observers as following on their administration. 

Sodium Phosphate in solution, administered hypodermically, is considered by Luton 
and Crocq, of Rheims, to be equally effective in reconstructive power with the animal 
extracts. (See under the title Phosphorus.) 

Thyroid Extract is the most efficient member of the group of animal 
extracts. Its administration has been eminently successful in the treat- 
ment of myxedema, which a few years ago was classed among the incurable 
diseases, but is now considered curable by thyroid feeding, or by the use 
of an extract of the thyroid gland of the sheep. Myxedema is a com- 
bination of symptoms due to thyroid absence or inadequacy, and occurs 
as a result of the removal of the gland or of disease impairing its func- 



I58 ANIMAL EXTRACTS. 

tional activity. It is characterized by imperfect oxygenation of the 
blood, lowered body-temperature, impairment of intellect, memory and 
speech, also increase of the fibrous tissue and subsequent mucoid degen- 
eration thereof, with thickening of the skin, drying of the surface and 
shedding of the epithelial structures. When caused by ablation of the 
thyroid the disease is fatal to cats and dogs in a very few days, but their 
life has been saved by engrafting a portion of the removed gland in 
other situations, and also by intravenous injections of thyroid extract. 
This treatment of the idiopathic form of myxedema was suggested and 
commenced by Professor George R. Murray, of the University of Dur- 
ham, in 1 89 1, and has since proved remarkably successful. At first the 
remedy was administered hypodermically, but it was soon found that the 
raw gland fed to the patient was equally efficient, or that a dry extract 
may be used. The latter represents the entire thyroid, divested only of 
its water, is easily administered and proves very efficient, improvement 
being usually noticed within a very few days, and going on steadily to 
apparent perfect recovery if the remedy is continued. The thickening 
of the skin disappears, the normal body heat returns, and speech, memory 
and intelligence are restored. In mild cases recovery is effected in a few 
weeks, but in severe ones several months of treatment are necessary ; and 
in most cases the symptoms of the disease return when the thyroid treat- 
ment is stopped, disappearing again when it is resumed. It is probable 
that the subjects of this disease will require to take a certain quantity of 
the remedy regularly and continuously for many years, perhaps for life. 

A large dose of thyroid extract gives rise to marked constitutional 
symptoms, and several cases are recorded in which it has caused death. 
Nausea, vomiting, neuralgic pains in the back and limbs, and cardiac 
irritability and weakness even to syncope, are the principal symptoms 
observed during its excessive use. It produces a distinct fall of the 
blood-pressure, even though the cardiac rate and force may remain unaf- 
fected, this effect being evidently due to its increasing the calibre of the 
vessels (Schafer and Oliver). In one case all the symptoms of diabetes 
developed under its continuous administration for psoriasis (James). In 
another instance a typical attack of gout came on, but subsided when the 
extract was stopped, and reappeared when it was again administered 
(Harris). 

Thyroid extract has produced great amelioration in cretinism (congeni- 
tal myxedema) which is a thyroid disease, and the improvement has been 
steady and progressive in many cases while the remedy was used, but 
ceased as soon as it was discontinued. In psoriasis, eczema, ichthy- 
osis, pityriasis rubra, lupus, universal alopecia and some other skin affec- 
tions, it has been employed as a stimulant of the cutaneous functional 
activity with most satisfactory results ; several cases of psoriasis treated 



ANIMAL EXTRACTS. I 59 

with this remedy alone recovering completely in the course of a few weeks 
(Bramwell). In exophthalmic goitre thyroid extract has been beneficial, 
and though some observers report ill effects from its use in this disease, 
others show that they were due to a primary aggravation of symptoms 
which subsides when the dose is largely reduced, and is then followed by 
distinct improvement under the administration of a very small quantity 
of the remedy (Bruns, etc.). Complete disappearance of the goitre has 
however rarely been observed (Kinnicut). In the insanity of the ado- 
lescent, climacteric and puerperal periods, the thyroid treatment has 
seemed to be especially beneficial (Bruce) ; but in several cases of insan- 
ity where there was parenchymatous (not cystic) enlargement of the thy- 
roid, the extract was used without result upon the mental affection though 
it diminished the size of the goitre and caused a marked loss of weight 
(Reinhold). In many cases its continued administration has produced 
emaciation, which fact suggested its employment for the reduction of 
obesity, and it has been successfully used for this purpose in many cases 
(Guttmann). A loss of weight at the rate of from 2 to 11 pounds per 
week is produced in some cases ; but after a time a limit is reached, 
beyond which further loss does not occur. Thyroid extract has given 
satisfaction in several other affections, including tetanus, ozena, uterine 
fibroma and carcinoma, and some forms of syphilis. It has been success- 
fully used to promote consolidation in obstinate fractures, having well- 
recognized effects in disordered nutrition of osseous tissue (Gauthier). 
It has seemed to act as an efficient galactagogue in some cases, increasing 
both the flow and the quality of the milk (Stawell). 

The chemical constituents of thyroid extract include lodothyrin, which 
seems to be the active principle. It exists in combination with the pro- 
teids (albumin and globulin) which are found in the colloid secretion of 
the follicles of the gland. lodothyrin contains Iodine in varying amount 
and a large proportion of nitrogen, also sulphur and phosphorus. So far 
as studied it appears to represent the therapeutic power of the extract, 
and is administered in tablet form and in doses of gr. -fa gradually 
increased. 

Liquid Thyroid Extract is prepared from the fresh thyroids of the sheep, by macerat- 
ing them in equal parts of glycerin and water for 24 hours, and then squeezing through 
fine calico. For hypodermic use the water employed in the menstruum should contain 
0.5 per cent, of carbolic acid. A dry extract, three times stronger than the liquid one, 
is made by expressing the juice from the glands, mixing it with sugar of milk, and drying 
it on glass plates at a temperature of 90 F. The dose of this product is from 2.]/ 2 to 5 
grains at first, thrice daily by mouth ; which dose may be gradually increased as long as 
it causes no systemic disturbance. The Thyreoidin prepared by Parke, Davis & Co. of 
Detroit, is a dry powder, each grain of which represents 10 grains of the fresh gland or 
1.6 grain of desiccated thyroid. The dose of this preparation is ]/ z grain two or three 
times a day, to be increased at the discretion of the physician. 

Thyreo-Antitoxin is a substance obtained by Dr. Frankel from the thyroid gland, 
to which he has given the above name and assigned the formula C 6 H n N 3 5 . It is in- 



l6o ANIMAL EXTRACTS. 

odorous and tasteless, and produces rapid emaciation. It is improperly named an anti- 
toxin. 

Thymus Extract. The thymus gland is active only during the developmental period 
of life, and becomes atrophied about the age of two years. The suggestion has been 
made that an extract thereof may prove useful in diseases characterized by defective de- 
velopment, as rachitis and pseudo-hypertrophic paralysis. It has been used with reported 
benefit in leucocythemia, chlorosis, idiopathic and pernicious anemia, and in Paltauf 's 
so-called " status thymicus. " It appears to be useless in exophthalmic goitre, but bene- 
ficial in the other form. Of 30 cases of goitre treated with it 20 were improved but only 
2 were cured (Kinnicut). The mode of preparation and dose are similar to those of 
thyroid extract. 

Bone Marrow Extract. — Red bone marrow has been long known 
as one of the sources of the red blood corpuscles, and it is thought prob- 
able that it contains chemical ingredients which may stimulate the 
production of blood cells by other blood-forming organs in which such 
natural stimulus may be lacking. In pernicious anemia the marrow of 
the long bones shows characteristic changes, which fact suggested the 
administration of red bone marrow as a remedy for that disease. This 
treatment has proved remarkably successful even in cases which were 
apparently hopeless. It was first suggested by Dr. Dixon Mann, who ad- 
ministered a glycerin extract thereof in cases of hemophilia, chlorosis, 
profuse hematemesis and other anemic affections, with good results. Its 
employment is indicated in disorders characterized by hyperfluidity of 
the blood, from whatever cause ; and it may render good service in any 
debilitating or blood-impoverishing affection, and in convalescence after 
severe osteitis. The raw marrow, freed from spicules of bone, may be 
administered to the amount of about 3 ounces daily in divided doses ; or 
it may be given as a paste made with wine, glycerin and gelatin. Tab- 
lets, containing from ij^ to 5 grains each of the dried marrow, are on 
the market and may be used if preferred. Carnogen is a proprietary 
preparation containing red bone marrow and hemoglobin. 

One of the most striking cases recorded is that of the gardener patient of Professor 
Fraser of Edinburgh. Under the use of raw bone marrow by the stomach his blood cor- 
puscles increased in number from less than 900,000 to over 4 millions per c.c, the pro- 
portion of hemoglobin- rose from 18 to 35 per cent., and the man became well enough to 
resume his occupation. 

Nuclein is a proteid substance, possessing a large proportion of Phos- 
phorus in the form of Nucleinic Acid, which is combined with a highly 
complex base, the latter being different in the various tissues. Nucleins 
are the chief chemical constituent of cell nuclei, and their number is 
limited only by the varieties of the cells. They are found in both animal 
and vegetable tissues ; wherever there is a nucleus we find a nuclein. 
They are generally insoluble in dilute acids, but are soluble in dilute 
alkalies, and resist peptic digestion. Their functions in the organism 
are supposed to be (1) that of a natural antiseptic, to destroy toxic prod- 
ucts which may accumulate through faulty elimination, and (2) that of 



ANIMAL EXTRACTS. l6l 

a natural bactericide, to resist microbic invasion. Two nucleins only 
have been clinically studied in this country, that obtained from yeast- 
cells and that from the thyroid and thymus glands. 

Nuclein is harmless, causing no functional derangement when admin- 
istered by the stomach or subcutaneously, even in very large doses. 
When injected hypodermically its principal effect is to produce a very 
marked increase of leucocytic activity (an artificial leucocytosis), both in 
healthy and in tuberculous subjects. The increase is observed to affect 
chiefly the polynuclear leucocytes ; it varies in degree with the indi- 
vidual, appears within three hours after administration of the nuclein, 
and disappears after forty-eight hours or thereabouts (Huber). The effect 
is to energize any existing inflammation, or to awaken such when com- 
paratively quiescent, as in latent tuberculosis (See). 

Nuclein was introduced into medicine by Professor Vaughn of the 
University of Michigan. Its employment as a therapeutic agent is based 
on the assumption that for immunity against and the cure of bacillary 
diseases we should look to non-toxic germicides of cellular origin, and to 
substances which stimulate the activity of those organs whose function 
it is to protect the body against such invasion. As the nucleins appar- 
ently fulfil these requirements they have excited considerable attention 
among the advocates of animal extracts. Nuclein has been successfully 
used in diphtheria, suppurative tonsillitis and other suppurative disorders, 
also in chronic rheumatism and malaria, chronic bronchial catarrh and 
neurasthenia, and has been employed in tuberculosis with encouraging 
results (Vaughn). In one case an ulcer of twenty years' standing was 
cured in four months by the local application of nuclein. A physician 
reports his own case, one of genito-urinary tuberculosis, as apparently 
cured by nuclein injections. In simple anemia, chlorosis, typhoid fever, 
debility from any cause, and convalescence from acute diseases, such as 
pneumonia and influenza, the beneficial results of nuclein medication are 
prompt and permanent (Aulde). As bactericides the nucleins may prove 
useful by reason of their harmlessness to the human subject. 

Nucleins are prepared from separate animal tissues and glands, as the 
thyroid, thymus, liver, spleen, etc. {animal nucleins) ; also from all the 
tissues and glands combined (protonucleiri), and from yeast-cells (vege- 
table nuclein). Vaughn uses a solution of yeast nuclein, containing i per 
cent, of nucleinic acid, prepared by Parke, Davis & Co. The dose of 
this solution is 30 minims, administered hypodermically, and increased 
daily as long as no unfavorable symptoms appear. Tablets of nuclein 
are on the market, for administration by the mouth, the dose being 1 
grain or more, as may be deemed advisable. 

Protonuclein is the trade-name of an extensively advertised product, which is said 
to be a combination of nucleins obtained from all the available lymphoid structures of 



1 62 ANIMAL EXTRACTS. 

bullocks and pigs, including the entire brain, the pancreas, liver, spleen, salivary glands, 
thyroid, thymus, gastric and intestinal glands, etc. The manufacturer claims that it is 
" the true tissue-builder of the organism " and its " natural antitoxic agent," and pub- 
lishes the usual florid literature, which includes clinical reports of the therapeutic efficacy 
of protonuclein in some forty-five different affections. It is sold in tablets and powder ; 
also in a special powder containing no milk-sugar, and intended for inhalations and in- 
jections. The dose is 3 grains every 3 or 4 hours. 

Orchitic Extract {Didymin, Testicular Juice), — was the subject of a 
communication to the Societe de Biologie at Paris, in 1889, from Pro- 
fessor Brown-Sequard, in which the aged and distinguished writer declared 
that he himself had experienced a wonderful degree of rejuvenescence 
after its use, and recommended it as a general tonic for the aged and for 
subjects of impotence or a debilitated nervous system. In subsequent 
communications made to the Academie des Sciences by Brown-Sequard 
and his assistant D'Arsonval, it was claimed that general paralysis, loco- 
motor ataxia, contractures, and certain forms of insanity, also affections 
due to organic lesions of the nervous system or impairment of its func- 
tions, are cured or ameliorated by injections of testicular juice ; and that 
organic or constitutional diseases due to defective nutrition of the organs, 
as anemia, glycosuria and tuberculosis, may be arrested by this procedure. 
Its remedial effects they held to be due to the action of a ferment or 
diastase contained in the fluid, which replaces the natural ferments pro- 
duced by normal testes and other glandular organs of the body. Although 
Brown-Sequard's claims for this agent were undoubtedly extravagant, and 
his assertions as to the results obtained therefrom were exaggerated, sub- 
sequent experience has confirmed his general statement regarding its 
effects, and the restorative power of testicular juice when injected sub- 
cutaneously is now admitted. 

Testicular extract injected into the human subject produces a steady 
increase of oxyhemoglobin in the blood, the cardiac force is strengthened, 
the vascular tone is exalted, and the oxygenation of waste products is 
promoted, as shown by the increased excretion of urea and the lessened 
amount of phosphoric acid in the urine. Intestinal peristalsis is slightly 
stimulated, the mind becomes clearer and more active, and the body 
temperature is usually raised but may remain unaffected. The crude ex- 
tract is said to be mildly bactericidal. These effects closely coincide with 
those produced by Spermine (see p. 164), and this substance is believed by 
Poehl to be the active principle of the juice, but it does not possess the 
powerful reconstructive properties of the latter, and cannot be efficiently 
substituted therefor. 

This extract has been employed by many competent physicians in 
several diseases, often with most beneficial results. It is a powerful 
tonic, especially in the decrepit subject of old age or exhaustion from 
wasting disease, as it stimulates the tissues and organs to renewed activity 



ANIMAL EXTRACTS. 163 

and endows the body with greater strength and with a feeling of increased 
well-being. It has been used in general adynamia, anemia, atonic gastro- 
intestinal affections, scurvy, malaria, epilepsy, cancer, nymphomania, 
perverted sexual habits, impotence, neurasthenia, hysteria, melancholia, 
diabetes, tuberculosis, hemiplegia, paralysis agitans and locomotor ataxia. 
In the last-named disease this remedy has shown the best results obtained 
therewith ; and under its administration the characteristic pains have 
ceased, steadiness and accuracy of motion have increased, and in some 
cases the ataxia has wholly disappeared. In diabetes it has been more 
satisfactory than pancreatic or any other organic extract. Under its 
administration in anemia one physician observed the hemoglobin to in- 
crease from 3 to 14 per cent, every three weeks; and in tuberculosis it 
has caused the temperature to recede to normal, the cough to lessen, the 
appetite and weight to increase, and the general condition to improve in 
every way. In sexual neurasthenia it has frequently proved to be of great 
benefit. No specific action is claimed for it in any of these affections, 
but all observers agree that it acts by stimulating functional activity. 
Many of the results observed have been ascribed to mental suggestion, 
but after the application of check experiments in similar cases the weight 
of evidence was found to be in favor of the remedy. 

D'Arsonval prepares this extract or emulsion in the following manner. The testicles 
of bulls, enveloped in their membranes, are washed in a 10 per cent, solution of subli- 
mate, and again with sterilized water, are each divided into five or six parts, placed in 
aseptic glycerin (a pint to the pound of testicle) and allowed to macerate therein for 24 
hours. An equal quantity of a 5 per cent, solution of common salt in boiled water is 
then added, the mixture is filtered and sterilized by being subjected to a pressure of 30 
atmospheres of carbon dioxide. The dose is 10 to 20 minims, hypodermically once daily 
or every other day, with strict aseptic precautions as to the syringe used and the site of 
injection ; the latter should be washed with a I to 1000 sublimate solution or a 2 per 
cent, solution of carbolic acid. The extract seems to have little or no effect when given 
by the mouth, but is efficient when used by the rectum. Some observers believe that it 
is dangerous by hypodermic administration, on account of its proneness to decomposition 
when prepared by the above method ; and one experimenter has made an extract from the 
crude juice for administration by the mouth, which he claims to have used in a thousand 
cases. 

The composition of the emulsion prepared by the above process is very 
complex, but it is supposed to include at least four active principles, viz. — 
P ho sphorized Albumins, in large quantity, Lecithin, known as phosphorized 
fat, Spermine, and Nuclein. The first two have undoubted value as nerve 
foods, the third is believed to increase the oxygen-carrying power of the 
blood corpuscles, and the last possesses bactericidal properties. The com- 
bination should prove of value as a remedy in many morbid conditions. 

Phospho-Albumen. Under this trade-name and the sub-title Syrup of Di-Oleyl- 
Lecithin, an animal extract is prepared in Chicago, which is said to be derived solely 
from the testes, spinal cords and brains of bulls. The juice is sterilized by D' Arsonval's 
carbon* dioxide process, and is mixed with simple syrup as a preservative menstruum and 
some flavoring material. It is supposed to contain lecithins, spermine, nuclein and 
phosphorized albumins, and is apparently a favorite tonic with many prominent physi- 



164 ANIMAL EXTRACTS. 

cians of Chicago. It is not patented, copyrighted or advertised, is sold only on physicians' 
prescriptions, and its manufacturers assure the profession that so far as their methods of 
promotion are concerned it will remain practically inaccessible to the laity. 

Spermine has been found in the form of a phosphate in the thyroid and thymus 
glands, the spleen, the ovaries and the blood, as well as in the testes. Dr. Poehl believes 
it to be an alkaloidal product of the retrogressive metamorphosis of albumins (a leuco- 
maine), and a most powerful intraorganic restorative of the oxidizing properties of the 
blood. He states that it should not be regarded as a specific for any particular malady, 
but should be used as a means of promoting oxidation in the body. It has been em- 
ployed with decided benefit in ataxy and delirious epilepsy (Poehl), as a tonic in tuber- 
culosis (Upenski), also in senile marasmus and the nervous affections, of the aged 
(Victoroff ). The Hydrochlorate is used hypodermically, in doses of y% grain twice 
daily, in the morning and at noon, avoiding evening administration as it may cause in- 
somnia. No reaction follows its injection. 

Brain Extract (Cerebrinin) is obtained from the gray matter of the 
sheep's brain by digestion in 5 times its weight of pure glycerin and then 
adding an equal quantity of a 12 per cent, solution of common salt. Its 
effects are almost identical with those of orchitic extract, the most notice- 
able being increased strength and a feeling of well-being, regulation of 
the organic functions and increase of the cardiac force. It has been em- 
ployed with benefit in locomotor ataxia, neurasthenia and allied affections, 
nymphomania, perverted sexual habits of cerebral origin, hysteria, melan- 
cholia, insomnia, the general debility of malaria, chlorosis and even more 
profound anemias (C. Paul) ; also in cases of defective development of 
the spinal apparatus, as Freidrich's ataxia. Mental derangement is not 
helped by it, or at most but temporarily. The dose is 16 minims (1 cc.) 
once daily or every other day, administered subcutaneousiy. 

Cerebrine is an extract of the entire brain of the ox, prepared by Dr. Hammond of 
Washington, by digestion for six months in a mixture of glycerin, alcohol, and a satur- 
ated solution of boric acid, and filtration through porous stone. The dose is 5 minims 
diluted with an equal quantity of distilled water at the time of administration by hypo- 
dermic injection. Dr. Hammond prepared similar extracts of the spinal cord (medullitie), 
the heart [cardine], the pancreas [pancreatine), etc. , and advocated their use medicinally 
on the organopathic theory that they are curative of depressed conditions of the corre- 
sponding human organs. 

Pineal Extract. — The pineal gland is present during the entire life of the individual, 
and its removal has been followed in animals by structural changes in the central nervous 
system. It is thought that the substance of this gland may act remedially in organic and 
functional affections of the brain attended with failure of cerebral nutrition, as chronic 
softening, chronic mania and dementia. 

Pituitary Extract. — The complete removal of the pituitary body (or gland) gives rise 
to symptoms which occur in a definite order, beginning with lowered temperature and 
loss of appetite, then twitchings, tremors and nervous phenomena, and finally dyspnea 
and death. Many of these symptoms have abated considerably after the administration 
of pituitary gland substance or an extract thereof. This organ has been found enlarged 
in cases of myxedema in which the thyroid was functionally absent, and other observa- 
tions point to some connection between it and the disease known as acromegaly. Inter- 
nally administered it causes increase of the cardiac force and rate, and a rapid rise of 
the blood-pressure due to direct contraction of the vessels. It is administered with the 
view of reestablishing perverted brain nutrition and function, and also with the object 
of supplying tone and structural growth to the entire nervous and muscular systems, on 
which its secretion seems to act as an alterative. Of 13 cases of acromegaly treated with 
pituitary preparations 7 showed varying degrees of improvement, 5 none, and I became 



ANIMAL EXTRACTS. 1 65 

worse. In 2 cases the violent headache and neuralgic pains in the limbs were diminished, 
and in one case decrease of the affected extremities occurred (Kinnicut). 

Adrenal Extract. The ablation of the suprarenal glands in guinea- 
pigs and frogs is followed by serious nervous disturbances, shown by low- 
ering of the body-temperature and progressive paralysis, and culminating 
in convulsions and death. Brown-Sequard made these observations in 
1856, and later showed that the subcutaneous injection of extracts of the 
healthy glands in such cases restored the animals to almost a normal state 
for a time. As Neurin has been found in the blood of animals suffering 
from Addison's disease, it has been suggested that it is the toxic substance 
which is neutralized by these organs in health ; but the recent researches 
of Schafer and Oliver have demonstrated that the function of these glands 
is not a defensive one, but that their secretions possess most positive and 
remarkable physiological properties, strongly contracting the muscular 
system in general, but especially the skeletal, the vaso-motor and the 
cardiac muscle. No other drug produces so great a rise of the blood- 
pressure as adrenal extract causes ; this effect being due to its extraor- 
dinary contractile power over the muscular fibres in the walls of the 
arterioles, probably by centric stimulation of the vagi (Wood). In this 
respect its action is directly opposed to that of thyroid extract. Another 
remarkable property of this extract is the smallness of its active dose, 
the y^th of a grain of the dried gland producing a maximal effect upon 
the heart and arteries in a twenty-pound dog. From this the conclusion 
is formed that its active principle is capable of producing a well-marked 
physiological effect in the dose of -g^-g-th of a grain for an adult man. 
This is probably the smallest active dose on record for any article in the 
materia medica. 

The medulla of the suprarenal gland contains a dialyzable organic principle which is 
soluble in water. It is not eliminated by the gland itself or by the kidneys ; and is not 
oxidized or destroyed by the blood, inasmuch as it retains its full power after having been 
in contact with blood for 24 hours. It is probably stored in the organism and rendered 
harmless by some of the other glandular organs after it has performed its proper func- 
tion. Though produced in very small quantity it doubtless preserves the normal action 
of muscular tissue, especially of that in the blood-vessels, and its absence gives rise to a 
series of symptoms which terminate in prostration, inanition and death. 

Adrenal Extract has been employed in a few cases of anemia and 
diabetes with some benefit, but the improvement usually ceased with the 
discontinuance of the remedy. Of 48 cases of Addison's disease treated 
with this extract 6 were reported cured, 22 improved, 18 unimproved and 
2 aggravated (Kinnicut). It may be tried in muscular disorders, espe- 
cially those which involve loss of tone or changes of degenerative type. 
The dose of the dry extract is from 3 to 5 grains (Wood). 

Renal Extract. — An extract of the kidney substance is suggested as being possibly 
beneficial in affections arising from impairment or failure of nitrogenous metabolism, the 



1 66 ANIMAL EXTRACTS. 

promotion of which is one of the functions of that organ, according to the new physiology. 
There are no reliable data on which to base any opinion as to the merits of this agent as 
a remedy. 

Splenic Extract. — Excision of the spleen, or the serious impair- 
ment of its functions by disease, is usually followed by marked tissue 
changes and great susceptibility to alterations of temperature, especially 
in malarial subjects. The substance of this organ has been used medi- 
cinally in various disorders of the blood, with the idea of supplying to 
that tissue some material which may be necessary to its health. The 
possession of bactericidal power by some secretion of the spleen is 
strongly indicated by certain facts, among which are the evident incom- 
patibility of tuberculosis and malaria and the enlargement of the spleen 
in acute infectious diseases, as though working against the germs 
thereof. It has therefore been suggested that the splenic substance of 
animals naturally immune against certain of these diseases be employed 
as a remedy therein, — for example, in tuberculosis, malaria and typhoid 
fever. By this treatment it is hoped that some light may be thrown on 
the functions of this organ, as has so recently been done in the case of 
the thyroid gland. Dr. H. C. Wood has reported excellent results from 
splenic extract in the treatment of exophthalmos. The improvement in 
some of his cases began soon after the commencement of the hypodermic 
administration of the remedy, and continued until the thyroid enlarge- 
ment had entirely disappeared. The general nervousness vanished and 
the extrusion of the eyeball lessened, but while the cardiac action was 
greatly reduced the heart remained irritable on excitement. 

Lymphatic Extract. — An extract prepared from the lymphatic glands of animals has 
been employed in exophthalmic goitre, lymphadenoma, and other glandular swellings, 
but there are no trustworthy reports as to the results. 

Pancreatic Extract. — In many cases of diabetes decided structural changes have 
been observed in the pancreas after death, and the ablation of this gland in animals is 
followed by emaciation and glycosuria ; but these symptoms will not occur if a portion 
of the pancreas is left, or if a part of it be engrafted on the peritoneum after its removal 
from its proper location. These facts have suggested the probability of the possession 
by the pancreas of power over carbohydrate metamorphosis, through the action of some 
substance elaborated by the peculiar, vascular epithelioid tissue which occurs in isolated 
patches throughout its substance, and which is not found in any other duct-bearing gland 
in the body. Upon this theory the pancreas, both in substance and extract, has been 
administered as a remedy for diabetes, but the results have been negative in nearly all the 
cases. A few instances are recorded in which its use was followed by some temporary 
amelioration of the symptoms of the disease. 

Parotid Extract. — An extract of the parotid gland has been employed, by Dr. Robert 
Bell, of Glasgow, with good results in ovarian disorders, particularly enlarged and tender 
ovaries associated with dysmenorrhea, metrorrhagia, chronic endometritis and subinvolu- 
tion of the womb. 

Ovarian Extract. — The substance of the ovaries has been administered with some 
benefit in the nervous manifestations and pathological conditions which occur when the 
ovarian functions are partially or wholly arrested, as in cirrhosis or malignant disease 
thereof, or after the operation of ovariotomy. It is said to be a serviceable remedy in 
cases of depression or other mental disturbance coincident with the climacteric. 



ANISUM ANTIMONIUM. 1 67 

Uterine Extract. — The substance of the uterus has been employed as a remedy in 
those disorders and cachexiae which seem to be consequent on the removal of this organ 
and its appendages. The available data are not, however, sufficient to enable any con- 
clusions to be formed as to its efficacy. 

Mammary Gland Extract has given satisfaction in fibroma and carcinoma of the 
uterus, also in menorrhagia, dysmenorrhea and enlarged and sensitive womb (Bell). 

ANISUM, Anise, — is the fruit of Pimpinella Anisum, a European 
plant of the nat. ord. Umbelliferae. It occurs in ovate bodies, y§ inch 
long, hairy, of grayish color, aromatic odor, and sweet, spicy taste, re- 
sembling conium fruit in appearance. Dose, gr. x-xx. 

Oleum Anisi, Oil of Anise, — is a volatile oil distilled from Anise, and represents the 
medicinal qualities of the plant. It contains Anethol (C 10 H 12 O) or Anise-camphor, con- 
geals at 50 to 59 F. , is soluble in an equal part of alcohol, and is an ingredient of 
Tinctura Opii Camphorata, Trochisci Glycyrrhizas et Opii, and of the two following 
preparations. Dose, TflJ-v. 

Aqua Anisi, Anise Water, — has in 500 parts I of Oil of Anise triturated with Calcium 
Phosphate, and mixed with distilled water. Dose, indefinite. 

Spiritus Anisi, Spirit of Anise, — is a 10 per cent, solution of the oil in alcohol. 
Dose, 3J-ij. 

The Volatile Oil is the active constituent of Anise. It has a slightly 
stimulant action on the heart and the digestive organs, and liquefies the 
bronchial secretion, being probably excreted in part by the bronchial 
mucous membrane. It is a favorite flavoring ingredient of cough-mix- 
tures, and relieves slight intestinal colic and flatulence in children. In 
full doses it has weak narcotic power. 

ANTHEMIS, Chamomile, — the flower heads of Anthemis nobilis, a European 
perennial of the nat. ord. Compositae, collected from cultivated plants. They contain a 
volatile oil, a camphor and a bitter principle, but no alkaloid. There are no official 
preparations. An infusion (3 iv to Oj) may be given in doses of ^j-ij. 

Oleum Anthemidis, Chamomile Oil (Unofficial), — the volatile oil, is of a dark blue 
or green color, and is composed of various ethers, the Angelates and Valerianates of 
Butyl predominating. Dose, TTLij-x, on sugar. 

Chamomile is a stomachic tonic. It improves the appetite and aids digestion by in- 
creasing the vascularity of the gastric mucous membrane. In large doses the warm 
infusion is emetic, and perhaps diaphoretic, though the latter action is chiefly due to the 
hot water. The oil is remarkably efficient in reducing reflex excitability in frogs, even 
after its excitation by Strychnine or Brucine. 

Chamomile is popular in domestic practice. An infusion is used internally for many 
infantile complaints, and externally as a fomentation to relieve pain, as in colic, etc. The 
oil is very efficient in reflex cough, pulmonary catarrh, acute dyspepsia, diarrhea of chil- 
dren, spasmodic asthma, whooping-cough, colic, and the spasmodic and pseudo-neuralgic 
affections of hysterical women. It should prove extremely useful in poisoning by 
Strychnine, from its power over reflex excitability. 

The Chamomilla of the homeopaths is the Matricaria Chamomilla, or German Cham- 
omile, official in the U. S. Pharmacopoeia as Matricaria, which see. 



ANTIMONIUM, Antimony, Sb.— Metallic Antimony is not offi- 
cial, and is not used in medicine. It is represented, however, by "the 
following official salts and preparations, viz. — 



l68 ANTIMONIUM. 

Compounds of Antimony and their Preparations. 

Antimonii et Potassii Tartras, Antimony and Potassium Tartrate, Tartar Emetic, 
2KSbOC i H 4 6 .H 2 0, — small white crystals or a granular powder of sweet, disagreeable 
metallic taste, soluble in 17 of water at 59 F., and in 3 of boiling water, insoluble in 
alcohol. Dose, gr. j 1 ^-^, but after tolerance is established as high as gr. ij may be given. 
It is an ingredient of the first two following, viz. — 

Vinum Antimonii, Wine of Antimony, — has of Tartar Emetic 4, Boiling Distilled 
Water 65, Alcohol 150, White Wine to 1000. Contains about 2 grains of Tartar Emetic 
to the ^ , and is an ingredient of Mistura Glycyrrhizse Composita. Dose, TT\,v-xv. 

Syrupus Scillae Compositus, Compound Syrup of Squill, Cox's Hive Mixture, 
Hive Syrup (See under Scilla), — contains about I grain of Tartar Emetic to the Jj , 
with Squill, Senega, etc. Dose, TT^j-^j, cautiously in children. 

Antimonii Oxidum, Antimony Oxide, Sb 2 3 , — a heavy, gray powder, insoluble in 
water or alcohol, but readily and wholly soluble in Hydrochloric or Tartaric Acid solu- 
tions. Dose, gr. j-iij. It constitutes ^d of — 

Pulvis Antimonialis, Antimonial {or James') Powder, — consists of the Oxide of 
Antimony 33 parts, with 67 of Calcium Phosphate. Dose, gr. iij-viij, every 3 hours as 
a diaphoretic, larger doses for emetic and cathartic effects. 

Antimonii Sulphidum, Antimony Sulphide, Sb 2 S 3 , — is the native sulphide, purified 
by fusion, and as nearly free from Arsenic as possible ; steel-gray masses, or a black, lus- 
treless powder, insoluble in water or alcohol. Dose, gr. %- j. 

Antimonii Sulphidum Purificatum, Purified Antimony Sulphide, Sb 2 S 3 , — is puri- 
fied by maceration in Aq. Ammoniae, washing and drying. Dose, gr. }(.-). 

Antimonium Sulphuratum, Sulphurated Antimony, Hermes Mineral, — is chiefly 
Sb 2 S 3 , with a very small amount of Sb 2 O s . A reddish-brown, tasteless powder, insoluble 
in water or alcohol, and a constituent of Pil. Antimonii Composite. Dose, gr. j-v. 

Pilulae Antimonii Compositse, Plummets Pills, — each pill contains about gr. j4. 
each of Calomel and Sulphurated Antimony, with Guaiac and Castor Oil. 

Physiological Action. 
Tartar Emetic in its action represents the other official antimonial 
preparations, being a cardiac, arterial and general depressant, a proto- 
plasmic poison, a systemic and local emetic, a specific gastro-intestinal 
irritant, an expectorant and a diaphoretic. Like Aconite, Arsenic, Hy- 
drocyanic Acid and Potassium, it is destructive to protoplasm, destroy- 
ing function in all nitrogenous tissue, and paralyzing the spinal cord, the 
motor nerves, the muscles and the sensory nerve terminations. It is espe- 
cially depressant to the heart-muscle and the cardiac motor ganglia ; it 
combines with the red blood-corpuscles, lessening their oxidizing power, 
lowering the blood-pressure and reducing the body-temperature. Its 
taste is styptic and one of its earliest effects is the production of constric- 
tion of the fauces. It promotes waste and rapid excretion of waste 
products, carbonic acid and urea being especially increased. Being 
eliminated by all the excretory organs, including the skin, it excites fol- 
licular inflammation at the points of elimination ; resulting in an eruption 
which is papular at first, then becomes vesicular, and finally pustular, the 
pustules being umbilicated like those of variola. This same eruption is 
also produced by the application of the drug to the skin with friction. 
Aphthous ulcerations, extending from the mouth to the stomach, with 
salivation and painful deglutition, may also result from its continued use. 



ANTIMONIUM. 169 

In small doses Tartar Emetic stimulates secretion in the bronchial and 
salivary glands, the stomach, intestinal canal, liver and pancreas. In 
larger doses it excites nausea, vomiting and purging, with evacuations 
like the "rice-water discharges" of cholera, and great prostration of the 
vital powers. Toxic doses produce similar symptoms, besides epigastric 
pain, cyanosis, delirium, cramps, motor and sensory paralysis, suppression 
of urine and collapse, — the same phenomena as in Asiatic cholera. 

The Sulphide occurs native, and is the source from which the other 
compounds are prepared. It seems to be inert medicinally. Sulphurated 
Antimony owes its efficacy to the small quantity of the oxide contained 
in it, and as this is variable, the action of the preparation is uncertain. 
The Oxide has similar action to that of Tartar Emetic, but being insoluble 
in water, it is of much less certain activity. 

Antidotes, Antagonists and Incompatibles. 
Tannic Acid, or any substance containing it, is the antidote, forming the insoluble 
tannate. Opium, Alcohol, Ether, and other antispasmodics are physiological antago- 
nists. Demulcent drinks should be freely administered to protect the mucous mem- 
branes. Alkalies and Salts of Lead decompose Tartar Emetic. 

Therapeutics. 
Tartar Emetic was formerly much employed as an antiphlogistic on 
account of its power to cut short acute inflammations of sthenic type, but 
its use was greatly abused, so that it has now gone out of fashion as a 
remedy. The contra-stimulant treatment of pneumonia and other inflam- 
matory diseases, by large doses of this salt after tolerance was established, 
is only worthy of reference as an historical fact. The same may be said 
of its external use as a counter-irritant as well as of its employment as an 
emetic, in both of which capacities it is too severe, while its emesis is too 
tardy in action to be of any value in poisoning. It is, however, a very 
efficient agent in many grave affections, if used in small doses (gr. -gV'To) > 
being highly efficacious in acute inflammatory affections of the respiratory 
tract, especially pneumonia, broncho-pneumonia, acute edema of the 
lungs, feverish and catarrhal colds, bronchitis, laryngitis and tonsillitis. 
In many respects it acts like Aconite in these and kindred affections, 
producing copious diaphoresis, slowing the pulse and allaying restlessness. 
It is considered a good remedy in puerperal peritonitis, mammitis, and 
orchitis, in lumbago and other muscular rheumatisms, also in photophobia 
and in gastric indigestion after beer-drinking. In still smaller doses 
(gr. yl-g- hourly) it is particularly efficient in catarrhal inflammations of 
the respiratory mucous membrane in children, accompanied by rattling 
breathing and much mucus, which is expelled with difficulty. Such cases 
often simulate asthma, the attacks being marked by cough, wheezing, and 
difficult respiration, with sibilant rales in the chest, and usually follow on 
severe colds or on measles. The Compound Syrup of Squill is commonly 



I70 ANTIPYRINUM. 

used as an expectorant and nauseant in the treatment of bronchitis and 
croup. The quantity of Tartar Emetic in it (gr. j to the J) should be 
remembered when administering it to children. (See under Scilla.) 

The Oxide is chiefly employed in the form of James' Powder (Pulvis 
Antimonialis) for its mild diaphoretic qualities. The Sulphide is not 
used in medicine. Sulphurated Antimony is very uncertain in action 
and is but little used. The Compound Pill of Antimony (Plummer's 
Pill) was devised to obtain mercurial results without writing Hydrargyrum 
on a prescription. 

ANTIPYRINUM, Antipyrin, Phenyl-dimethyl-pyrazolon, C 20 H 18 - 
N 4 2 , — unofficial in the United States, but official in the Br. Ph. under 
the name Phenazonum, Phenazone, — is a crystalline substance obtainable 
from phenyl-hydrazine, and prepared by a patented and complicated pro- 
cess. It is a synthetical base, forming salts which are analogous to those 
of Ammonium ; and occurs as colorless and inodorous scaly crystals, with 
a bitter taste, freely soluble in water, alcohol and chloroform, less soluble 
in ether. It gives a deep red color with ferric chloride, a deep green 
with nitrous acid, and with nitric acid a yellow color which deepens to 
crimson on warming. It is not irritant to the stomach or the tissues and 
may be administered hypodermically. 

Dose and Administration. 

The Br. Ph. states the dose at from gr.iij to gr. xx. An average adult dose may be 
placed at gr. x. For children the dose is gr. % per year of age between 2 and 5 years, 
gr. ]/2 per year from 5 to 10, not exceeding gr. v at a dose for any child under 15 years. 

Antipyrin has but little flavor, is not unpleasant, and is therefore readily taken by 
children, in which respect*it is greatly superior to Quinine. It may be administered in 
compressed tablets, each having from I to 5 grains ; — or in Aromatic Elixir, — say 
gr. lxxx in ^iv, of which solution each 3 contains gr. ijss. If vomiting result, the same 
dose may be dissolved in half its weight of hot water, and injected hypodermically while 
warm. 

In compatibles . 

Antipyrin may be decomposed when brought into contact with Nitrous compounds, a 
new and poisonous substance being supposed to be formed, of uncertain composition, but 
resembling the Anilin greens. The mixture of this drug with Spiritus yEtheris Nitrosi is 
therefore highly dangerous if this supposed reaction is at all likely to occur. 

It is more or less decomposed or thrown out of solution by a large number of chemical 
compounds and other preparations, of which the following are the most important, viz.: — 

Acid, Hydrocyanic, Dilute. Arsenic and Mercury, Solution of the 

Acid, Tannic. Iodides of. 

Butyl-chloral Hydrate. Mercuric Chloride. 

Chloral Hydrate. Naphtol /3 (solid). 

Cinchona, Decoction. Nitrites in solution (acid). 

Cinchona, Fluid Extract. Sodium Bicarbonate. 

Catechu, Infusion (cone). Sodium Salicylate (solid). 

Ferrum, Sulphate. Tinctures containing Tannin, Iron, or 

Ferric Salts in Solution. Quinine. 

Hamamelis, Tincture. Rose, Infusion. 

Iodine, Tincture. Uva Ursi, Infusion. 
Antipyrin and Phenyl-urethan liquefy when rubbed together. 



ANTIPYRINUM. IJl 

Unofficial Preparations and Derivatives. 

Salipyrin, Antipyrin Salicylate, — is formed by combining Salicylic Acid 57.7, and 
Antipyrin 42.3 parts; and is the only salt of the base which has any therapeutic impor- 
tance. Described under Salix. 

Hypnal, — is a combination of Antipyrin and Chloral, heated together, which is 
credited with hypnotic and analgesic power. It is described under Chloral. 

Migranin, — is a double Citrate of Antipyrin and Caffein, lately brought forward in 
Germany as a specific for sick headache and neuralgia. A report is published that the 
police authorities of Hamburg have issued a notice forbidding its free sale in the local 
pharmacies, and warning the public against using it except under a physician's direction 
(Squibb). The dose is placed at about gr. xv. 

Phenopyrin, — is prepared from equal parts of crystalline Phenol and Antipyrin. It 
is an oily liquid, colorless and odorless, insoluble in cold and sparingly soluble in hot 
water. It has as yet no medicinal importance. 

Pyramidon, Dimethyl-amido-antipyrin, — is a derivative of Antipyrin by a substitution 
process, and is highly praised as an antipyretic and analgesic. It occurs as a yellowish- 
white, crystalline powder, soluble in 10 parts of water. Its applications are the same as 
those of Antipyrin, but it is less soluble, slower in action, more lasting in effect, and the 
same results may be produced by it with about one-third the dose. Dose, gr. iv-viij, 
thrice daily. 

Physiological Action. 

Antipyrin is a powerful antipyretic, a local anesthetic, and a general 
analgesic, also possessing diaphoretic, mydriatic, antiseptic, disinfectant, 
hemostatic and slight hypnotic powers. After the ingestion of a full 
medicinal dose (gr. xx), there is a stimulant stage of short duration, in 
which the heart's action is increased, and a subjective sense of heat is 
experienced, with flushing of the face. This is soon followed by profuse 
sweating, coldness of the surface, slowed pulse, considerable depression, 
and if fever be present by lowered temperature ; the latter coming on 
within half an hour after taking the drug and its degree being in direct 
ratio to the quantity administered, as also its continuance, — the former 
being usually from 3 to 5 degrees, and the latter from 1 to 10 hours, a 
fair average being about 2 hours. In one case a fall of 12 F. was ob- 
served. When given with Kairin, the mixture of the two drugs has been 
found to produce a much greater fall of temperature, with longer continu- 
ance down, than that produced by an equal quantity of either drug given 
alone. After the antipyretic effect of the dose has passed off, the tem- 
perature (in fever) commences to rise again, — the onset being usually 
preceded by a chill, which is of slight degree when compared with the 
severe rigors and dangerous depression occurring under the action of 
Kairin, Chinolin and other members of the group. 

In health the administration of a full dose gives rise to slight nausea, 
singing in the ears, and a reduction of the body-temperature of scarcely 
any extent, about -fa° F. It slightly raises the arterial tension and blood- 
pressure ; sometimes induces vomiting, and may cause such a degree of 
depression as to almost amount to collapse. It has little or no effect 
upon, the respiration, but acts as a sedative upon the cerebrum, leaving 



172 ANTIPYRINUM. 

behind a somewhat depressant influence on the brain. It dilates the 
pupils and is rapidly eliminated by the kidneys, appearing in the urine 
within half an hour after its ingestion. The profuse sweating which it 
causes may be prevented by giving in advance a small dose of Atropine 
or Agaricine. In some persons a single dose of ten grains produces an 
urticarial eruption on the skin, and this is occasionally accompanied by 
swelling and irritation of the mucous membrane of the respiratory tract, 
the subject feeling as if the nose and throat were swollen so that breath- 
ing became difficult. 

In toxic dose Antipyrin probably acts as a primary stimulant and a sec- 
ondary depressant of the spinal cord, paralyzes both the motor and sen- 
sory nerve trunks, decreases the arterial pressure, and exerts a poisonous 
influence on the blood, altering the shape of the red corpuscles, separat- 
ing the hematin, and causing decomposition of that tissue. A peculiar 
livid discoloration of the surface is one of the most characteristic symp- 
toms of antipyrin poisoning, and is probably due to the formation in the 
blood of methemoglobin or some similar compound. 

As an antipyretic, Antipyrin, like Alcohol, acts by a double mode of 
operation, — (1) by diminishing oxidation, and (2) by promoting heat- 
loss. The latter is attained by dilating the cutaneous vessels, allowing 
free radiation from the surface, and by the refrigerant action due to evap- 
oration of the sweat. 

As an analgesic, Antipyrin has a very considerable degree of power, in 
common with all the Chinolin derivatives; but its property in this 
respect is found to act almost entirely upon pain due to manifestations of 
the rheumatic diathesis. In general anodyne action, it is not to be com- 
pared with the derivatives of Opium. Its hemostatic power is claimed 
to be superior to that of Ergotin. 

Therapeutics. 
One of the most popular of the modern antipyretics, Antipyrin de- 
serves high rank in professional esteem, being an excellent analgesic and 
one of the most certain and most powerful depressants of temperature, 
though somewhat dangerous, and devoid of any other influence upon the 
course of any febrile disorder. Its principal applications are as follows : 
(1) As an antipyretic it has been employed in all diseases with high tem- 
perature, and it may be used in asthenic fevers, as it has little effect upon 
the circulation. It has held a high place for several years in the treatment 
of acute rheumatism, and affords valuable aid in the pyrexia of intermit- 
tent fever, a stage in which the slow action of quinine prevents that drug 
being available for immediate relief. (2) As an analgesic it is highly 
efficient except when the pain is dependent upon a local inflammation, in 
which case it is of no value for this purpose. It is often remarkably effi- 



ANTIPYRINUM. 173 

cient in migraine and other headaches, in the fulgurant pains or the pain- 
crises of locomotor ataxia, and in other paroxysms of suffering dependent 
on disease of the nerve centres, or having the character of nerve storms. It 
is very serviceable in neuralgia, neuritis and other painful affections, espe- 
cially when of rheumatic origin, as lumbago, sciatica, hemicrania, supra- 
orbital neuralgia, etc., in which ten-grain doses are generally sufficient 
and may be given hypodermically. It often relieves dysmenorrhea, also 
the painful affections of hysteria, pain from cerebral tumors, and that due 
to cardiac disease. In acute gout, a preliminary dose of 25 grains, fol- 
lowed by 10-grain doses every two hours, promptly relieved the pain and 
shortened the duration of the paroxysms in one very carefully observed 
and thoroughly reported case. In chronic gout, very remarkable results 
are reported as due to it, indicating a specific and curative influence on 
that disease. For the relief of pain, the conjoint administration of Anti- 
pyrin and Morphine is said to be much more efficient than the use of 
either agent alone, (3) To allay nervous irritation; — thus it has been 
used with extraordinary success in nervous urticaria, and is often employed 
with benefit in the restlessness of hysterical subjects. In the urticaria- 
like eruptions of children its action has been so promptly efficient as to 
indicate for it a direct influence upon the vascular nerves; and as a 
symptomatic remedy against itching it is equally efficient in nervous 
pruritus, true prurigo, urticaria, erythema, pemphigus vulgaris and lichen 
ruber. (4) To antagonize excitability of the motor nerve centres, as in 
laryngismus stridulus, whooping-cough, tetanus, epilepsy and chorea. In 
the latter disease Antipyrin is held in high esteem as a curative remedy, 
and although it often fails entirely in epilepsy, it sometimes acts therein 
with extraordinary power, especially when given in combination with 
ammonium bromide. (5) To affect secretion, as in infantile diarrhea, in 
which it has rendered signal service, administered in doses of ^ to \]/ 2 
grain ; and as an antigalactagogue, when it is desired to arrest the secre- 
tion of milk, doses of gr. iv every two hours will prove efficient. It has 
also been employed with benefit in both forms of diabetes, and has been 
found to be remarkably effective in promoting the absorption of pleuritic 
effusions. (6) As a local anesthetic it is equal if not superior to cocaine, 
if applied to the mucous membranes in a 30 to 50 per cent, solution 
(St. Hilaire). (7) As a local hemostatic, it is highly efficient in 15 per 
cent, solution as a spray for epistaxis, and hemorrhages of almost any kind 
are checked by the application of stronger solutions. It has the advan- 
tage of constricting the small vessels without causing any external clot 
which may break down. (8) As an antiseptic it possesses properties 
which compare favorably with most of the anilin and coal-tar derivatives. 
Antipyrin has rendered good service in bronchial asthma, in sea-sick- 
ness, in cerebro-spinal meningitis, and in croupous pneumonia. In the 



174 ANTITOXINS. 

latter affection it has been employed in combination with camphor and 
small doses of morphine with excellent results. In erysipelas it is thought 
to be contraindicated, as when administered in that disease it has usually 
caused anuria and a profound fall of temperature (Spanoudis). 

ANTITOXINS (Unofficial). The remarkable reports which have 

been published during the last few years upon the antitoxin treatment of 
diphtheria and tetanus have excited fresh interest in bacterio-therapy, 
and seem likely to dispel the cloud which has rested thereon ever since 
the failure of Koch's tuberculin. After the discovery of the bacillus 
tuberculosis in 1882 several other micro-organisms were found to be con- 
stantly associated with certain acute infectious diseases, notably tetanus, 
diphtheria, cholera, pneumonia, erysipelas and typhoid fever. The spe- 
cific microbes of these affections were at first believed to be the immediate 
cause of their respective disorders, but later researches have shown that 
such diseases are due to the action of chemical poisons (toxins and tox- 
albumins) produced by their specific bacteria growing on suitable soils 
either within the animal organism or outside it. [Compare the article 
entitled Toxins.] 

It was shown by Von Fodor in 1887 and subsequently by Nuttall that 
the blood serum of healthy animals is naturally bactericidal, that it 
possesses this quality in varying degrees of efficiency, and that it may be 
sufficiently powerful in this respect to prevent certain pathogenic bacteria 
from gaining lodgment on the organism, thereby conferring natural 
immunity against a particular disease upon the individual so protected, 
and in some cases even upon the species. Further study and experiment 
established the fact that temporary artificial immunity against certain dis- 
eases may be imparted to an individual animal naturally susceptible by 
repeated inoculations of the specific bacteria or their toxic products in 
gradually increasing degrees of virulence (Behring, Kitasato, Roux). 
The crowning discovery that the blood serum of such an immunized 
animal may be successfully employed for curative as well as prophylactic 
purposes against its particular disease upon other animals of the same or 
different species, was made by Professor Emil Behring of Berlin, in 1891. 
This was no chance discovery, but was the legitimate result of logical 
reasoning and hard work, and is formulated under the title Behring 1 s 
Law, as follows : That the blood serum of an animal which has been arti- 
ficially rendered immune against a certain infectious disease, when injected 
into the body of another animal, has power to protect the latter individual 
against the same disease and to cure the disease after infection has occurred. 

An Antitoxic Serum or Antitoxin is a blood serum possessed of 
these immunizing and curative properties. The term Antitoxin is also 



ANTITOXINS. 175 

applied, and more correctly, to the suppositious defensive proteids, which 
are chemical substances assumed to be contained in the antitoxin serum, 
and believed to be produced by the blood or tissue cells for the defence 
of the organism against the foreign bacterial toxins. Alexins are similar 
substances, natural antitoxins, which are supposed to exist in the blood 
of naturally immune animals. 

Ehrlich has shown that Behring's law is valid also for the chemical poisons, Ricin 
and Abrin, the respective toxalbumins of the ricinus palm and the jequirity bean. The 
blood of animals slowly immunized by increasing doses of these toxins contains antitoxic 
substances named Antiricin and Antiabrin, which, if added to their respective poisons, 
will attenuate and even neutralize the latter. These facts are advanced as proof that the 
slowly increasing artificial immunity is not a simple tolerance acquired by the organism, 
as Sternberg taught, but is due to the production of new antagonistic and defensive sub- 
stances by the living cells of the organism. 

Theories deduced from the observed facts are as follows : (1) That, as 
the various pathogenic bacteria produce the causative toxins of their re- 
spective diseases, so the organic cells of the body, reacting under the 
stimulus of the poisons thus introduced, immediately proceed to elaborate 
defensive antitoxins, which if produced in sufficient quantity will neutral- 
ize the effects of the toxins. (2) That residual antitoxins remaining in 
the blood after recovery render the animal immune for a time against the 
disease. (3) That the immunizing and curative effects obtained by the 
injection of the blood serum of an immunized animal into the circulation 
of another animal are due — either to direct chemical neutralization of the 
toxins themselves by the antitoxins so introduced (Behring, Kitasato), 
or to a particular influence exerted by the antitoxins upon the living cells 
of the organism, which, being affected in two opposite directions, remain 
neutral to the disease (Buchner). 

Specific action is a characteristic of the antitoxins with perhaps a few 
exceptions ; which means that the serum from an animal inoculated with 
the toxin of the diphtheria bacillus is effective only against diphtheria, 
and the tetanus antitoxin only against tetanus. A dose of an antitoxin 
followed by a dose of the corresponding toxin produces no effect from 
either, the action of the one being rendered ineffective by that of the 
other. The corresponding toxin and antitoxin may be mixed together 
outside the body and then injected with like result, though of course there 
must be a certain amount of antitoxin present to counteract a given dose 
of toxin. The immunizing or vaccine property of the antitoxins, though 
transient, is probably destined to be of considerable importance. In- 
stances are already recorded in which epidemics of diphtheria in schools 
were apparently stopped by vaccinating all the children therein with 
diphtheria antitoxin. 

An Antitoxic Serum is prepared as follows. Either a highly virulent culture of the ' 
specific micro-organism of the particular disease, or still better, a strong toxin of tested 



I76 ANTITOXINS. 

strength prepared therefrom, is injected into the cellular tissue of a suitable animal, gen- 
erally a horse, at first in very small quantity. The effect is soon shown by the onset of 
fever and other symptoms of acute disease, which are known as the " reaction." After 
an interval of time sufficient for recovery from these symptoms, the injection is repeated 
with a stronger toxin or with a culture of greater virulence, or with a larger quantity of 
the original toxin. With proper care the amount injected may be gradually increased, 
until ultimately a dose many hundred times greater than one which would have been 
fatal at first can be given with impunity. This process is continued for several months, 
or until the animal no longer "reacts" to the poison, and then sufficient antitoxin is 
presumed to exist in its blood to render it immune to the toxin and to the disease. After 
each inoculation the animal's blood serum is tested as to its value by experiment on 
guinea-pigs of definite weights. When the desired degree of immunity is reached the 
animal is bled from the jugular vein under strict aseptic conditions, from 6 to 12 pints 
being taken from a horse, according to his size and general condition. The blood is 
received in sterilized flasks, which are carefully stoppered and stored on ice until the 
clot has separated from the serum. The latter is tested to determine its value in anti- 
toxin, has carbolic acid added to it in the proportion of 0.5 per cent., and is bottled in 
vials which contain in each the dose for one patient. The vials are labeled with a state- 
ment of the number of normal antitoxin units per cc. of the contents, expressed in mul- 
tiples of a standard normal serum. The effective antitoxin value of a serum intended for 
protective purposes is much less than that of one intended for curative action, and the 
earlier in the course of the disease that the latter serum is employed the smaller will be the 
quantity capable of producing a certain remedial effect. 

Serum-therapy properly means the prophylactic and curative treat- 
ment of certain acute infectious diseases by the subcutaneous injection of 
a blood serum containing an antitoxin specific to the particular disease. 
As generally used, however, this term includes the treatment of the same 
disorders by the toxins produced by attenuated cultures of their respective 
microbes ; but these toxins, though sometimes grown on blood serum, 
may be cultivated on other media, and are never administered in a serum 
as the antitoxins invariably are. The antitoxins at present employed in 
serum-therapy are those of diphtheria, tetanus, tuberculosis, erysipelas, 
pneumonia, cholera, syphilis, plague, and typhoid fever, but only the 
first three have come into anything like general use. Toxin treatment 
is described under the title Toxins. 

Diphtheria Antitoxin, though not the first antitoxin discovered, is 
by far the first in practical importance. The bacillus of diphtheria was 
discovered by Loeffler and Klebs in 1884, its toxic products were isolated 
by Roux, and the antidote to them was found by Behring, who established 
the preventive and curative properties of this antitoxin. In the meantime 
Sidney Martin had proved the chemical identity of the laboratory toxins 
discovered by Roux with those produced in the body by the bacillus. 
The clinical results obtained in Paris by the use of Behring's diphtheria 
antitoxic serum were announced by Roux at the Buda-Pesth Congress of 
Hygiene in 1894, and attracted universal attention. Since then the sta- 
tistics of diphtheria serum-therapy have grown voluminous, have included 
a large number of reports from official and private sources of the highest 
professional authority, and the weight of evidence has steadily grown 
more and more favorable to this treatment. 



ANTITOXINS. 177 

The statistics first presented by Roux covered 300 cases of true diphtheria, treated at 
the Hopital des Enfants Malades in Paris, with a mortality under the serum treatment 
of 26 per cent., against a mortality of 51.7 per cent, in the same hospital during the 
previous four years in 3971 cases, and a mortality of 60 per cent, in 520 cases during the 
six months immediately preceding. Professor Virchow stated, at a. fite of the Empress 
Frederick Hospital in Berlin, that from April to November, 1895, out of 335 diphtheria 
cases treated therein with the serum 305 were cured ; and that the diphtheria mortality 
in that hospital, formerly 43 percent., had declined to 0) l / z per cent, under the antitoxin 
treatment. Professor Welch of Baltimore has collected and analyzed the statistics avail- 
able in July, 1895, covering 7,166 cases from 80 different sources, and showing a gen- 
eral mortality under the antitoxin treatment of 17.3 per cent., against a previous general 
mortality of 42 per cent. Tabulating the results according to the time at which the treat- 
ment was commenced, he shows for 814 cases treated on the first and second days of the 
disease a mortality of 5^ per cent.; for 531 cases treated on the third and fourth days 
15.2 per cent., and for 286 cases treated after the fourth day 31.8 per cent. A collective 
investigation of 5794 cases treated with antitoxin in private houses, made by the Ameri- 
can Pediatric Society in 1896, showed a mortality for the whole of 12.3 per cent.; ex- 
cluding moribund cases and those which died within 24 hours after injection, a mortality 
of 8.8 per cent.; for those treated within the first three days of the disease, a mortality 
of 7.3 per cent.; and excluding the moribund cases from the latter, a mortality of 4.8 
per cent, in 4013 cases. 

The clinical history of the disease under the antitoxin treatment, as 
recorded by its observers, is equally favorable and shows an extraordinary 
decrease in the severity of the symptoms. The membrane loosens and 
clears off rapidly, high temperature is lowered, and the pulse slows and 
gains in force (Washbourn). Evident signs of distress vanished within 
24 hours, and apparent strength and good-humor took the place of a pre- 
viously low mental and physical condition (Kossel). In no case did the 
larynx become involved after the use of the serum if not so previously, 
and many cases showing laryngeal symptoms recovered without tracheot- 
omy. Even in the fatal cases life was prolonged (Caiger). 

While diphtheria antitoxin properly prepared and used under aseptic 
precautions is generally conceded to be harmless, some ill effects are 
recorded as caused by it. An urticarial eruption on the skin, also pains in 
and swellings about the joints, occur in about 5 per cent, of the cases, but 
these symptoms are usually transient and without serious consequences. 
Abscess at the site of the injection has occurred, but rarely forms if proper 
aseptic measures are used. Welch states that in over 100,000 injections 
given the serious mishaps directly attributable to the serum can be counted 
on the fingers. Two deaths are reported, one in Berlin and one in 
-Oregon, as having occurred within a few minutes after the injection of the 
antitoxin in healthy children. 

The following seem to be established facts as to the use of antitoxin in 
diphtheria : The immunized serum is far more efficient as a curative agent 
than any remedy heretofore employed, the general mortality of the dis- 
ease having been reduced by its use to about 17 per cent, from a previous 
rate of about 42 per cent. A marked improvement in both the local and 
general symptoms is usually noticed within 24 to 48 hours after the injec- 
tion of the serum. The remedy has decided power to prevent the spread- 



I78 ANTITOXINS. 

ing of the false membrane into the larynx and trachea. It is powerless 
to repair damage already done to the tissues by the diphtheria toxins, 
hence the earlier the serum is administered the better are its results. It 
is decidedly more efficient in the fibrinous form of the disease than in the 
septic form, and in cases of simple infection than in those of double or 
mixed infection. The liability to paralysis and albuminuria is not les- 
sened but is perhaps somewhat increased by this treatment, though genu- 
ine nephritis is less frequently seen under its use than in cases treated by 
other methods. The serum may cause certain untoward symptoms, as 
cutaneous eruptions, swellings, etc., but these are not serious and are 
not attended with danger to life. Its injection is very rarely followed by 
serious local disturbances, as abscess, and probably would never be com- 
plicated thereby if the serum were always pure and used with strict aseptic 
precautions. Recent improvements in the methods of preparation and 
more definite knowledge as to the dose and manner of employment have 
made the later reports even more favorable than the earlier ones. At the 
1895 meeting of the British Medical Association, Professor Klein made 
the statement that " the scientific basis for the application of antitoxic 
serum is as firmly founded and as thoroughly established as the use and 
application of any known drug." 

Local antiseptic treatment of the throat is still insisted on in connec- 
tion with the serum injection in every case of the disease. If thoroughly 
carried out in the incipiency it may destroy the dangerous streptococci 
and other microbes, thereby preventing the mixed infection which proves 
so virulent ; if continued throughout the case and during convalescence 
it will minimize the danger of infecting other persons. In some instances 
bacilli were found as long as two months after recovery. 

Behring's Diphtheria Antitoxin is standardized in comparison with a " normal 
therapeutic serum " of which one-tenth of a gramme will neutralize one gramme of 
diphtheria toxin, and I cc. of which is termed equivalent to one "normal " or " immu- 
nizing unit." As distributed the serum contains at least 100 such normal units in each 
cc. , the label on every vial showing the potential strength of its contents, thus : " This 
phial contains 6 cc. of 1 00 times normal strength == 600 normal units." Four different 
potentials are furnished, — one with a yellow label, possessing 200 units, and intended 
only for prophylaxis, and three for therapeutic employment, viz: (1) that with a. green 
label, containing 600 units, for use only in fresh cases on the first or second day; (2) 
that with a white label, possessing 1,000 units, to be used in more serious cases on the 
first or second day, or in less serious cases of longer standing ; (3) that with a red label, 
possessing 1,500 units, and meant for adults or for very severe cases in' children. 

A Concentrated Serum is recommended by the committee of the American Pedi- 
atric Society, in order to obtain the requisite number of antitoxic units in as small a bulk 
as possible. Parke, Davis & Co. furnish high-potency serums in hermetically-sealed 
glass bulbs, containing as many as 1,750 units per cc. These very concentrated prepara- 
tions are not so stable as those of lower potency and must be used while fresh, as they 
rapidly lose their antitoxic value. 

The Dose for Prophylaxis is 500 units, to be repeated after two or three 
weeks if the case is still exposed to infection. The immunity is only 



ANTITOXINS. I79 

temporary, its duration depends on the quantity of antitoxin injected, 
and it gradually decreases as the latter is eliminated, but can be main- 
tained for a long time by the repeated use of smaller doses at short 
intervals. 

The Dose for Curative Purposes should be rather large than small, in 
order to guard against a virulent infection, 500 units for a light or sus- 
pected case, 1,000 to 1,500 for a severe or advanced one; to be repeated 
on the next or even on the same day if the case seems grave, until 2,000 
or even 3,000 units have been given. The maximum quantity decided on 
may be administered in one dose, and then will not usually require to be 
repeated. The necessary amount for any case can be determined only 
by comparative estimation of the quantity of toxin present as indicated 
by the symptoms; remembering that this quantity increases rapidly with 
every day after infection. The prognosis is unfavorable if the case is so 
far advanced before treatment that the toxin has had time to accumulate 
and to exert its paralyzing influence on the nervous apparatus of the heart. 

Diphtheria Antitoxin is now prepared in all European countries and in the labora- 
tories of several boards of health, manufacturing druggists and others in this country. 
The serum on the English market differs somewhat in strength, Aronson's being a highly 
concentrated form obtained by precipitating the greater part of the inert constituents, 
while Klein's is prepared by injecting both the toxins and the bacilli into the animal to 
be immunized. In Germany the preparation of the serum is conducted by a private firm, 
under the supervision of Professors Behring and Ehrlich, and is tested by official experts 
before its distribution is permitted by the government authorities entrusted with the con- 
trol of its manufacture. In this country the favorite serums are Parke, Davis & Co.'s, 
Mulford's, and that furnished by the New York Board of Health. 

Double Diphtheria Antitoxin is a serum obtained from a horse which has been im- 
munized against streptococcus virus after having been previously rendered immune 
against the diphtheria bacillus. It is supposed to contain both the diphtheria and strep- 
tococcus antitoxins, and is intended for the virulent cases due to a mixed infection with 
these two poisons, but it may be used in any case of diphtheria. 

Tetanus Antitoxin. Tetanus was one of the first diseases to be 
studied successfully by the bacteriologists, and its antitoxin was the first 
one prepared. Breiger (1880) showed that a crystalline substance of high 
toxicity could be obtained from tetanic fluids, and that it would repro- 
duce the symptoms of tetanus when injected into healthy animals. 
Rosenbach found the tetanus bacillus in human cases of the disease, and 
Nicolaier demonstrated its existence in soils. Kitasato soon afterwards 
obtained pure cultures of the bacillus, and demonstrated the immunizing 
power of the serum of animals inoculated with its toxin. As human 
tetanus is a comparatively infrequent disease there are but few available 
statistics of its treatment with antitoxic serum, but its previous mortality, 
as shown by the two largest sets of statistics, covering 2,789 cases, was 
88 per cent., which has been reduced to 20 per cent, under the serum 
treatment (Kreiger). Dr. Marson has reported a series of 38 cases so 
treated by various physicians, with 25 recoveries, a mortality of 34.2 per 



. 



l80 ANTITOXINS. 

cent. Kanthack quotes the total statistics of treatment as giving 68 cases 
with 26 deaths, a mortality of 38.2 per cent. 

In spite of its failure in many instances, the antitoxic serum is unques- 
tionably the most efficient remedy known for this disease. As tetanus is 
recognizable only by symptoms due to nerve lesions, which symptoms 
are not manifested until the nervous system has been damaged by the 
toxin, an early diagnosis is impossible; and when first seen by the physi- 
cian the disease has usually advanced too far for the curative action of the 
remedy to be available. For this reason, and as the immunizing proper- 
ties of this antitoxin are very potent, it is advised that a preventive 
inoculation thereof should be given in all cases where infection is possible, 
such as lacerated wounds soiled with earth or rust, especially when occur- 
ring in those tropical countries where the disease is most common. For 
this purpose a dose of 10 cc. would suffice, if repeated at intervals of two 
or three weeks. For curative purposes the serum should be injected as 
soon as possible, the quantity being determined according to its stated 
strength, the gravity of the symptoms, the patient's age and the time 
since infection. The shorter the time of incubation or the more serious 
the symptoms, the larger should be the initial dose. As a rule one injec- 
tion should be given every other day, using a smaller quantity at each 
repetition, so as to maintain sufficient immunity and prevent relapse. 
Along with the serum treatment the usual remedial measures should be 
employed, namely : excision of the part or the actual cautery if the wound 
is recent, chloroform anesthesia, chloral, etc. The actual cautery, or the 
application of a strong solution of corrosive sublimate with tartaric acid, 
are the most efficacious means of neutralizing the tetanus germs in the 
wound. 

Tetanus Antitoxin prepared at the New York Pasteur Institute is dispensed in dry 
form only, may be transported any distance without injury by heat or frost, and is said to 
preserve its qualities for an indefinite time if kept in a dark and dry place. It represents 
as many antitoxic units as are contained in about 12 times the weight of liquid serum. 
The powder is put up in 25 cc. bottles, each containing 3 grammes, to be filled with ster- 
ilized water when required for use, and shaken thoroughly until the powder is dissolved. 
Each bottle then contains two doses of antitoxic solution, and this amount is to be admin- 
istered daily for four or five days, beginning on the very first appearance of symptoms of 
the disease. For prophylactic use I or 2 cc. of the solution should be injected immedi- 
ately after the infliction of a suspicious wound. 

Tuberculosis Antitoxin has superseded Koch's tuberculin, which 
was a toxin treatment, in the serum-therapy of tuberculous disease. 
Boinet immunized goats with injections of tuberculin, and claims to have 
used the resulting serum in eight cases of tuberculosis with marked bene- 
fit. Professor Maragliano, of Genoa, has treated a large number of cases 
with serum obtained in a similar manner from the dog, the ass and the 
horse. His published statistics cover 445 cases observed in his own prac- 
tice and in that of his colleagues and other practitioners. He concludes 



ANTITOXINS. l8l 

that cases of unmixed infection, with circumscribed foci of disease, slight 
surrounding consolidation, and but little fever, are distinctly benefited 
by the treatment and some are even cured thereby ; but that those with 
much broncho-pneumonic consolidation or with cavities do not show any 
great improvement. The local signs of the disease disappeared in 27 per 
cent, of the cases, the weight increased in 57 per cent., and the bacilli 
disappeared in 43 per cent. 

Dr. Maragliano administers in apyretic cases or those with slight fever I cc. of the 
serum every second day for the first ten days, then a similar dose every day for another 
ten days, then two similar injections daily for the next ten days. If there is high fever 
10 cc. should be given at once, and after three days a daily injection of I to 2 cc. if the 
fever does not rise again, but if it persists a second dose of 10 cc. is given eight days after 
the first one. Improvement is noticeable often within two weeks but sometimes not until 
after two months have elapsed. Even when a cure seems complete the injections should 
be continued for at least a month and even for a year. General hygienic measures must 
not be neglected, and the efficiency of the digestion must be especially attended to. 

Dr. Paul Paquin of St. Louis reported in 1895 upon 22 serious cases of 
this disease, treated by him in the city hospital with a serum obtained 
from horses immunized by injection of the toxins of the bacillus tuber- 
culosis. He stated that a large percentage of these cases increased in 
weight from 5 to 16 pounds each during 6 to 8 weeks, and at the same 
time showed other evidences of general improvement, without the use of 
tonics or any special diet, only the regular fare of the city hospital or 
poor-house being available for them. After the lapse of six months the 
entire 22 were alive, all having improved and more than one-half the 
number having been discharged from the hospital as well enough to work. 
In 1897 Dr. Paquin read a report before the American Medical Associa- 
tion in which he dealt with the results obtained in 393 cases of tubercu- 
lous disease, and claimed 93 complete recoveries, or 23^/3 per cent, of all 
the cases. Numerous reports from other observers testify to good results 
obtained with Paquin's serum in the worst cases, e. g., knee-joint tuber- 
culosis (Cale), laryngeal tuberculosis (Loeb), and acute pulmonary tuber- 
culosis (Lemen). The effects observed after injecting Paquin's serum 
include erythema, urticaria, local swellings, pain, swelling and stiffness 
of joints, numbness, pain in the spine, in the head and in the stomach. 
The most serious complication is a sudden disturbance of the circulation, 
caused by the injection entering a vein or the muscular tissues, which 
requires the prompt administration of cardiac stimulants, as alcohol, 
nitroglycerin, etc. 

Paquin administers a beginning dose of 10 minims, with strict aseptic precautions, 
hypodermatically into the subcutaneous tissue of the back, avoiding vessels and muscular 
tissue. He repeats the injection once daily, increasing the dose by 5 minims so long as 
it does not raise the temperature more than 1° F. above the normal. A dose of 25 
minims is usually sufficient as a maximum. He advocates the use at the same time of a 
continuously acting vaporizer containing creosote and other antiseptics ; also the in- 
halation of the vapor of the essential oils of peppermint, eucalyptus and cinnamon from 



1 82 ANTITOXINS. 

a " lip-trough inhaler " worn under the nose, and repeated disinfection of the mouth and 
throat by an antiseptic gargle. He states that a fever rising above ioi F. usually indi- 
cates a mixed infection, in which the serum treatment is not indicated ; the cases amen- 
able to it being the incipient ones and those in the first and second stages of the disease. 

Dr. Carl Fisch of St. Louis immunizes selected horses by injections of 
Koch's new tuberculin. (See under the title Toxins.) The injections 
are given in gradually increasing quantity, during a period of four 
months, until the enormous dose of 50 cc. of tuberculin-R is reached. 
The resulting serum is claimed to be " a really antitoxic and bactericidal 
antiphthisic serum," by which "it is possible to immunize and cure 
guinea-pigs with perfect certainty." This preparation is named Anti- 
phthisic Serum T. R., and is put up in vials containing 10 cc. each by 
Jno. T. Milliken & Co. of St. Louis. It has been used in some 20 cases 
of human tuberculosis with results which are stated to be "exceedingly 
gratifying." 

Niemann has obtained good results in the treatment of tuberculosis of moderate 
severity with a serum obtained from young goats inoculated with increasing doses of a 
tuberculin prepared from a virulent culture of tubercle bacilli. The general condition 
of the patients showed marked improvement, the tubercle bacilli disappeared from the 
sputum, and the cough and expectoration considerably diminished. High elevation of 
the temperature rarely followed the injection of the serum, even in large doses, while 
albuminuria was never observed. 

Lemen has treated 31 cases of pulmonary tuberculosis with various serums, including 
Paquin's and Fisch's. He reports 8 apparent recoveries, of which 6 were in the first 
stage of the disease and 3 in the second. Of those in the third stage, that of cavity- 
formation, numbering 15, all died. 

Streptococcus Antitoxin has been employed successfully in erysip- 
elas, puerperal fever, and several forms of septicemia and pyemia due to 
streptococcus infection. The credit for the suggestion and preparation 
of this antitoxin is due to Dr. Marmorek, of the Pasteur Institute, Paris, 
who has treated therewith 411 cases of erysipelas with a mortality of 3.4 
per cent. He also treated 16 cases of puerperal fever with this serum ; 
seven of which, due to streptococcus infection, recovered ; one, due to 
bacterium coli, died ; and among eight of mixed infection with strepto- 
coccus, bacterium coli and staphylococcus, five died. Though puerperal 
infection may be set up by several other organisms, in the majority of 
cases it is due to the streptococcus pyogenes, and in such cases only will 
this serum be successful. Furthermore, as strepto-infection is at first 
essentially a local disease and later becomes a blood disorder, local 
treatment should be carried on from the commencement and in con- 
junction with the serum treatment. Several cases of puerperal fever, 
erysipelas, and other forms of streptococcus infection, are reported by 
Pozzi, Charrin, Roger and others, as having been treated successfully 
with this antitoxin, including 14 severe cases of puerperal septicemia 
with only 2 deaths (Williams). It has been used with benefit in scarlet 
fever (Josias), in phlegmon following infection during operations (Van 



ANTITOXINS. I83 

Schaick), and in acute hemorrhagic septicemia resulting from a wound 
received while making an autopsy on a case of suppurative peritonitis 
(Ballance). The treatment is not entirely free from risk, several French 
observers having reported deaths which were apparently due to the serum 
(Hirst). Many of the most virulent cases of diphtheria are due to a 
double infection with the diphtheria bacillus and the streptococcus, and 
for the treatment of such a combination antitoxin has been prepared by 
Marmorek and also by Gibier. (See under Diphtheria Antitoxin, ante 
page 179.) The treatment of sarcoma and carcinoma by injections of 
streptococcus antitoxin is noticed under the title Toxins, and the sub- 
title Erysipelas and Prodigiosus Toxins. 

Streptococcus Antitoxin is obtained from the horse immunized against streptococcus 
erysipelatis by inoculations with the toxins of cultures which have been rendered highly 
virulent by passage through a certain series of animals. The serum possesses great 
activity, and is dispensed in vials containing a quantity sufficient for four injections of 6 
cc. each, two of which may be given immediately and two on the following day. 

Syphilis Antitoxin. — A serum obtained from the blood of lambs and 
dogs has been used by Tommasoli and other Italian experimenters in the 
secondary and tertiary manifestations of syphilis, with encouraging results. 
It has been suggested that the natural insusceptibility shown by certain 
animals to this disease may be increased by injecting into them the blood 
serum from human subjects in the primary or active secondary stages of 
syphilis. This has been carried out by Triboulet and others, without 
prejudicial effect on the animals injected, and their serum was used in the 
treatment of extensive tertiary ulcerations, with the result that these lesions 
almost completely disappeared, although they had resisted a six months' 
course of the ordinary treatment. Hericourt records a striking improve- 
ment in a case of syphilitic tabes under the same method, and other simi- 
lar observations have been reported with equally favorable results. The 
doses employed were 2 cc. of the serum on successive or alternate days. 
The only complications observed were a transitory roseolar eruption, 
slight albuminuria, and a brief elevation of temperature. 

Antivenene is the name given to an antitoxin prepared by Fraser in 
consequence of Calmette's discovery that the serum of an animal immu- 
nized by the injection of increasing doses of serpent venom possesses 
antidotal and immunizing properties against the effects of the bites of 
poisonous snakes. The active principle of serpent venom is of albumi- 
nous nature and is analogous to the so-called toxalbumins, active ingredi- 
ents of the bacterial toxins. Antivenene does not seem to be specific, as 
are the antitoxins in general, for Fraser finds that when obtained by the 
inoculation of cobra-poison it is equally effective against the venom of 
several serpent species, including the cobra, the rattlesnake, etc. Cal- 
mette states that tetanus antitoxin antagonizes the effects of cobra venom 



I84 APIOLUM. 

to a certain extent, also that intra-venous injections of calcium hypochlo- 
rite produce a blood serum which possesses antitoxic properties against 
the effects of the cobra poison. 

Other Antitoxins have been prepared by inoculating the cultures or the toxins of 
Frankel' s pneumococcus, the typhoid bacillus, and the bacteria of cholera, erysipelas, 
anthrax, vaccinia and the plague. Even rabies has its so-called antitoxin, though its 
bacterial origin has never been demonstrated. The blood of lepers and cancer elements 
have been used as toxins for the inoculation of animals in order to obtain antitoxic serums 
for use in the treatment of these diseases. The results have so far been few and unim- 
portant. Typhoid Antitoxin is obtained by injecting sheep for three months with broth 
cultures of the typhoid bacillus. The resulting serum is found to be efficient in neutral- 
izing the effects of the typhoid toxins in guinea-pigs, and a few cases of human typhoid 
have been treated with it, apparently with good results. Vaccinia Antitoxin is supposed to 
exist in the serum of vaccinated heifers, and M. Beclere has treated a few cases of variola 
with such a serum, in one case using 1,560 cc, with the result that the patient recovered 
rapidly without suffering any inconvenience. In another case an infant 21 days old 
received injections of the serum to the amount of J^th of its weight, and was cured of a 
serious form of small-pox. Plague Antitoxin is prepared at the Pasteur Institute and 
was used by Dr. Yersin at Amoy in 23 cases, with only 2 deaths. As the previous mor- 
tality of this disease was about 80 per cent., this result of the serum treatment proves 
decidedly encouraging. 

APIOLUM, Apiol, (Unofficial), — is an oily liquid/of green color, 
acid reaction and pungent taste, soluble in alcohol, ether, chloroform, and 
in glacial acetic acid. It is extracted from the fruit of Petroselinum sativum 
(Parsley), a biennial plant of the nat. ord. Umbelliferae, which also con- 
tains a gelatinous substance named Apiin, and a Volatile Oil which is by 
some considered to be the true emmenagogue principle of the plant. 
Apiol is probably a mixture of several substances, and as found in com- 
merce is often an impure oleoresin. Dose, ttlhj-x in capsule two or three 
times a day; as an emmenagogue, tt^xv in one daily dose. 

A camphor, also named Apiol, C 12 H u 4 , is obtained from the same source, and occurs 
in white needles, of a feeble parsley odor, insoluble in water, but freely soluble in alco- 
hol or ether. Dose, gr. xv as an antiperiodic, gr. v-x against dysmenorrhea. 

In small doses (T^iij-v) Apiol is carminative, diuretic, diaphoretic, ex- 
pectorant and stimulant to the circulation. In full doses (fiixv) it is 
decidedly emmenagogue and feebly antiperiodic^ but produces headache, 
tinnitus aurium, intoxication, giddiness, etc., its action generally resem- 
bling that of Quinine. Large doses (rrLxxx-^j) are decidedly narcotic. 

Apiol has had some reputation in intermittents and in malarial neural- 
gia, but is most frequently employed in amenorrhea and dysmenorrhea, 
being of especial advantage in the amenorrhea of anemia, also when the 
menstrual discharge is fetid. It is becoming fashionable as a supposed 
abortifacient, but is useless for this purpose, and if freely used may pro- 
duce decided narcotism, especially if the preparation employed should 
happen to be an active one. The capsules of Apiol put up in France and 
sold in this country over the counters of drag-stores to any applicant are 
generally inert ; hence cases of poisoning by this drug are seldom 



APOCYNUM AQUA. I 85 

observed. They are, however, an important source of revenue to the 
retailers, as, being "imported" preparations, they command a high 
price, which is readily paid by gullible women who wish to " bring 
around " their " courses." 

APOCYNUM, Canadian Hemp, — is the root of Apocymwt cannabinum, an indi- 
genous perennial plant of the nat. ord. Apocynacese, and is inodorous, but of bitter, dis- 
agreeable taste. It contains a peculiar active principle, Apocynin, also tannic and gallic 
acids, resin, wax, caoutchouc, etc. Dose of the powdered root, gr. v-xxx. A decoction 
( ^ss to the pint) may be given in doses of jf-j-ij thrice daily. 

Extractum Apocyni Fluidum, Fluid Extract of Apocynum, — Dose, TT^ v-xxx. 

Apocynum is powerfully emetic and cathartic in full doses, also diaphoretic, expecto- 
rant and sometimes actively diuretic. It lowers the pulse-rate, produces much nausea, 
and induces drowsiness. It should not be confounded with the Indian and American 
Hemps (Cannabis sativa), which have entirely different qualities. 

The only condition in which Apocynum has proven of much value is dropsy, especially 
ascites and the anasarca of Bright's disease, in which 15-grain doses are indicated. The 
active principle, Apocynin , is a good expectorant, in doses of gr. ^ to gr. l / z . 



AQUA, 'Water, H 2 0, — is natural water, in its purest attainable 
state ; a colorless limpid liquid, devoid of odor or taste, and of neutral 
reaction. Besides entering into the composition of most of the official 
extracts, fluid extracts, and many other pharmaceutical preparations, from 
it are prepared the 17 official Waters (Aquae), and also the following: — 

Aqua Destillata, Distilled Water, H 2 0, — 1000 parts of water are distilled, the first 
100 parts obtained being thrown away, 800 parts are preserved. It is as near chemically 
pure water as can be obtained. 

Aqua Carbonata, Carbonated Water, Soda Water, — is described under Acidum 
Carbonicum, ante, page 91. 

Nomenclature of Water. 
Aqua Fluvialis, River-water. Aqua Destillata, Distilled Water. 

Aqua Pluvialis, Rain-water. * Aqua Bulliens, Boiling Water. 

Aqua Fontana, Spring or Well-water. Aqua Fervens, Hot Water. 

Aqua Marina, Sea-water. Aqua Communis, Common Water. 

Aqua Carbonata, Carbonated Water, Balneum Maris, Warm-water Bath. 

Soda Water. ■ Balneum Vaporis, Vapor Bath. 

Mineral Waters. 
Natural Water differs from distilled water in containing saline and 
other constituents in varying proportions, — from common water (Aqua 
Communis), in which they are so small in quantity as not to alter the 
taste, color, etc., up to the Sea-water, having 3^3 per cent., and that of 
the Dead Sea with 26^ per cent. Spring waters, impregnated with for- 
eign substances so as to have a decided taste and a marked action on the 
human system, are called Mineral Waters, which may be subdivided into 
various groups, according to their prevailing constituents, as Carbonated, 
Alkaline, Saline, Sulphuretted, Silicious, etc. Full analyses of all the 
principal mineral waters of Europe and America are given in 'Squire' 's 



1 86 AQUA. 

Companion to the British Pharmacopoeia also in the 15th edition of the 
United States Dispensatory, but a few of the most prominent will be men- 
tioned here. 

Alkaline Mineral Waters. 

Ems, Germany. Perry Spring, Ills. 

Salzbrunn, Germany. St. Louis Spring, Mich. 

Gleickenberg, Austria. Buffalo Lithia Spring, Va. 

Vichy, France. Hot Spring, Va. 

Vals, France. Warm Spring, Va. 

Bladon Spring, Ala. Berkeley Spring, Va. 

Congress Spring, Cal. Bethesda Spring, Wis. 

Seltzer Spring, Cal. Gettysburg Spring, Pa. 

These waters are generally cold, those of Vichy and Ems being warm. They contain 
a considerable amount of Sodium Carbonate, also Sodium Chloride and Sulphate, and 
various other Chlorides, Carbonates and Sulphates, with Carbonic Acid gas in varying 
quantity. Vichy and Vals waters depend for their efficacy almost wholly on the quantity 
of Sodium Carbonate contained in them, which is for Vichy from 26 to 50 grains and for 
Vals about 60 grains to the pint. 

Saline Mineral Waters. 

Friedrichshall, Germany. Cheltenham, England. 

Hunyadi Janos, Germany. Kissingen, Bavaria. 

Baden-Baden, Germany. Reichenhall, Bavaria. 

Wiesbaden, Germany. Adelheidsquelle, Bavaria. 

Carlsbad, Bohemia. Kreutznach, Prussia. 

Piillna, Bohemia. Saratoga Springs, N. Y. 

Seidlitz, Bohemia. Ballston, N. Y. 

Marienbad, Bohemia. Hot Springs, Arkansas. 
St. Catherine's, Ontario, Canada. 

These waters are of more complex composition, the various waters of Saratoga con- 
taining more than thirty constituent salts. Those usually present are the Sulphates and 
Carbonates of Sodium, Calcium, Magnesium, etc. [Magnesian waters) ; Chlorides of 
Sodium, Potassium and Lithium {Chlorinated waters) ; Ferrous salts {Chalybeate waters'), 
with Iodine, Bromine, Manganese salts, and Phosphates in some few. Carbonic Acid 
gas is present in all. Most of them are purgative, some are considered alterative, and 
many are warm (ioo°-i6o°). 

The most powerful member of the saline group is Hunyadi Janos, which contains 
about 150 grains each of Magnesium and Sodium Sulphates to the pint, and is, therefore, 
effectively purgative. Nearly as strong is Piillna water, with 124 grains of Sodium Sul- 
phate and 93 grains of Magnesium Sulphate to the pint. Friedrichshall is less powerful, 
but perhaps a better aperient water in doses of 6 to 10 fluid ounces. Marienbad contains 
no Magnesium Sulphate, but has 36 grains of Sodium Sulphate, 9 of Sodium Carbonate, 
II of Sodium Chloride, and a small quantity of Ferrous Carbonate to the pint; in trans- 
portation, however, it loses its Carbonic Acid and deposits the Iron. It is not aperient 
in ordinary doses. Carlsbad water contains 20 grains of Sodium Sulphate and 9 each of 
Sodium Carbonate and Chloride to the pint. The so-called " Carlsbad Salt" is simply 
Sodium Sulphate with a trace of the Carbonate. Hartnack gives the following formula 
for its artificial preparation : Sodium Sulphate 100 parts, Sodium Bicarb. 80, Sodium 
Chloride 40 ; a dessertspoonful in water as a mild saline purgative. These waters are 
imported into, and made in the United States in large quantities, and may be ordered 
through any druggist. 

Sulphurous Mi?ieral Waters. 

Aix-la-Chapelle, Prussia. Blue Lick Spring, Ky. 

Bareges, S. France. Sharon Spring, N. Y. 

Eux-Bonnes, S. France. Yellow Sulphur Spring, Va. 

Llandrindrod, Wales. White Sulphur Spring, W. Va. 

Harrowgate, England. Salt Lake Warm Springs, Utah. 



AQUA. 187 

These waters all contain Sulphuretted Hydrogen gas, also Carbonic Acid gas and Car- 
bonates, Chlorides and Sulphates of Sodium, Potassium, Magnesium and Calcium ; some- 
times Carbonate and Oxide of Iron, Iodide and Bromide of Sodium. 

Carbonated Mineral Waters. 

These waters are cold, contain generally Carbonates of Calcium, Magnesium and 
Sodium (in some, Iron), which are held in solution by the excess of Carbonic Acid, also 
Chlorides of Sodium and Potassium, Sulphates, Phosphates, etc. They are described 
under Acidum Carbonicum, ante, page 91. 

Silicious Mineral Waters. 
Hot Springs, Iceland. Geysers of Yellowstone Park. 

The constituents of these waters are chiefly alkaline Silicates. 



Physiological Action of Water. 

Water is an essential constituent of all the tissues of the body, forming 
from 0.2 per cent, of the enamel of the teeth to 77 per cent, of the liga- 
ments. In the liquids of the organism it is contained in the proportions 
of 78 per cent, of the blood to 93 of the urine, and 99 of the tears. In 
moderate quantity it is necessary to digestion, but in large amount it 
weakens digestion by diluting the gastric juice. Ice-cold water, if freely 
used, suspends the action of pepsin, depresses the nerves of the stomach, 
and lowers its blood supply. The free use of water internally produces 
increased cutaneous and renal excretion, and promotes the elimination of 
some of the products of tissue-change, as urea, phosphoric acid, etc. In 
some subjects it favors the deposition of fat. 

Cold water applied externally, as by a bath (4o°-6o° F.), abstracts a 
portion of the body-heat, lowering the surface temperature and depressing 
the cutaneous nerves, producing spasmodic breathing and a quickened 
pulse. If the temperature of the water is not too low and the bodily vigor 
is good, reaction soon occurs, and the general effect is tonic to the mus- 
cular power, to the circulation and the respiration. If this does not take 
place a secondary chill occurs, and serious depression may result. 

Warm water (95°-ioo° F.) applied to the surface of the body, as by 
baths of water or steam, packing, etc., acts in the opposite manner at 
first, increasing the circulation in the skin, the rapidity of the pulse and 
respiration and the body-temperature. Rapid tissue-change occurs, the 
waste products being eliminated chiefly by the skin and the pulmonary 
mucous membrane. If long continued, precordial oppression, giddiness 
and muscular debility are experienced. 

Hot water (iio°-ii2° F.) at first dilates the vessels of the part to 
which it is applied, and soon afterwards contracts them. It is a valuable 
means of relieving congestion and inflammation, and is a most effective 
hemostatic when the bleeding is from small vessels or of capillary char- 



1 88 AQUA. 

acter. Whether generally or locally applied it is one of the most reliable 
means of relieving spasm. Hot vapor applied to the surface accelerates 
the circulation and produces profuse sweating. Its general action is sim- 
ilar to that of warm water. 

Mineral waters taken internally act chiefly by virtue of the water, partly 
in accordance with the effects of their various constituents. As baths, 
their action is doubtless entirely due to their temperature. 

Pathogenic Microbes of several diseases, notably those of cholera and typhoid 
fever, are conveyed to the human system in drinking water contaminated therewith. But 
these organisms are destroyed by a temperature of 144 F. in the absence of their spores, 
while a temperature of 212 F. , that of boiling water, maintained for five minutes, 
destroys the spores of all pathogenic organisms which have been tested (Sternberg). 
This fact is of the highest practical importance, as it shows that no germs of disease need 
ever gain entrance to our bodies through our drinking water, if only we will boil it. Many 
years ago an English physician's report was quoted in Braithwaite's Retrospect, in refer- 
ence to the immunity of the Chinese from typhoid fever, though he said that in Pekin 
there was no system of sewerage, but that all excreta were thrown on the ground to 
find their way into the watercourses by which the city was supplied, to soak into wells, 
etc. Yet, the author said, that contrary to all experience elsewhere, typhoid fever was 
unknown in Pekin. The reason is to be found in the fact that the Chinese boil all the 
water they drink. Those who know them best say that they never drink cold water, but 
always tea, i. e., boiled water. There must be some reason for their remarkable health 
under adverse hygienic surroundings. 

Therapeutics of Water. 

Cold water (or ice) has many external applications of value in the treat- 
ment of disease. As a wet pack it is used in tonsillitis, diphtheria and 
croup. Cold baths are the most effective antipyretic in the high temper- 
ature of fevers, and the cold wet pack is used for the same purpose. Ice 
or cold water is applied to the head in acute cerebral congestion, and to 
the spine in chorea, etc. ; also locally in hemorrhoids, bubo, orchitis, and 
to the uterus in post-partum hemorrhage. Cold affusion to the body is 
employed as a preventive of spasmodic croup, as well as to lessen suscep- 
tibility to taking cold. 

Hot water externally, as fomentations, hot wet packs, baths, etc., is most 
effective in reducing local congestion and setting up resolution of local 
inflammation. Hot fomentations to the renal region are useful in func- 
tional inactivity of the kidneys. The hot spinal douche is used in affec- 
tions of the spinal cord and meninges, and in the backache of women. 
The hot wet pack is highly esteemed in inflammation of the thoracic 
organs. The vaginal hot water douche is highly valued by gynecolo- 
gists for many morbid conditions of the uterus and its appendages, espe- 
cially catarrh of the vaginal and cervical mucous membrane, subinvolution 
of the uterus, also congestive, swollen and neuralgic conditions of the 
ovaries, tubes and adjacent tissues. The continuous hot water bath was 
highly commended in skin diseases by Hebra, who administered it in 
cases of extensive burns, psoriasis, pemphigus and variola. The contin- 



AQUA. 189 

uous immersion in very hot water of an indolent wound, ulcer or sore, is 
a method of great efficiency for the promotion of the healing process in 
cases which have resisted the ordinary stimulant applications. Hot water 
dressings for wounds are strongly favored by many high surgical authori- 
ties. Vapor and Turkish baths are used as diaphoretics in advanced kid- 
ney disease, in acute and chronic rheumatism, mineral poisoning, and 
syphilis. Warm baths, with cold applications to the head, are esteemed 
of value in infantile convulsions and chorea. 

Internally, water is chiefly of value as a diuretic, and if hot as a dia- 
phoretic. A glass of cold water before breakfast daily is often an effective 
means of overcoming constipation, while the drinking of hot water an 
hour before each meal has been of great value to many dyspeptics. The 
value of the popular teas in chronic diseases is almost entirely due to the 
diluent, diuretic and diaphoretic actions of the hot water used. 

Therapeutics of the Mineral Waters. 

An undue value is placed by the laity and interested proprietors on the 
medicinal value of mineral waters, causing the various localities of the 
best advertised springs to become resorts for invalids and idlers from every 
civilized country. The benefit derived is in most instances due to the 
change of climate and scene, freedom from home cares and business 
worry, regularity of life and diet, drinking of water in quantity, and in 
many cases the substitution of water for alcoholic beverages. In order 
to get the worth of their money, people will gladly submit to rigid 
hygienic and dietetic restrictions at a watering-place which they would 
totally ignore under treatment at home. The same may be said of the 
treatment at the so-called "hydropathic" or "water-cure" establish- 
ments. As a rule, those springs will prove of most value which are 
furthest removed from the patient's residence, — for "distance lends en- 
chantment " in these matters as well as in many others. Invalids whose 
homes are in the vicinity of some wonder-working spring will not usually 
derive much benefit from its water, but will by that of another spring, 
similar in constituents, but located several hundred miles away. 

The principal affections in which mineral waters are esteemed most 
highly are the following : dyspepsia, cirrhosis of the liver, gout, rheu- 
matism, lithiasis, diabetes of hepatic origin, constipation, strumous dis- 
orders, obesity, plethora of the pelvic organs, hypochondriasis, skin 
diseases, especially those dependent on gastric derangement, phthisis, 
constitutional syphilis, metallic poisoning, etc., in all of which the influ- 
ences above mentioned are especially efficacious, and are no doubt the 
chief factors in producing any benefit which may be attainable. Aperient 
and purgative waters are useful in many cases where a prejudice exists* 
against purgative medicine, but none against the same agents in a natural 



I9O ARGENTUM. 

water. The strong saline-aperient waters, as Carlsbad, Hunyadi, Fried- 
richshall, etc., have considerable repute in the treatment of the uric-acid 
diathesis and calculous affections, and the waters of St. Catherine's Wells 
are credited with decided influence upon local and chronic rheumatism. 

The special therapeutics of mineral waters are to be found in this volume under the 
heads of their principal constituents, as Acidum Carbonicum, Sodium Chloride, Sodium 
Sulphate, Magnesium Sulphate, etc. ; also in the therapeutical part of the book. 



ARGENTUM, Silver, Ag,— is represented by the following four 
official salts, viz. : — 

Silver Compounds and their Preparations. 

Argenti Nitras, Silver Nitrate, AgN0 3 , — occurs in colorless rhombic crystals, of 
bitter caustic taste and neutral reaction, soluble in 0.6 of water and in 26 of alcohol. Is 
best given in pill with Kaolin, or in distilled water ; never with tannin or a vegetable 
extract, lest an explosive compound result. Dose, gr. l /e—}4,, — if watched, up to gr. j 
may be given. When melted with 4 per cent, of Hydrochloric Acid, it makes — 

Argenti Nitras Fusus, Moulded Silver Nitrate, Lunar Caustic, — for local use as 
a mild caustic and astringent. Argenti Nitras Dilutus, Diluted Silver Nitrate, Miti- 
gated Caustic, — is the same salt melted with twice its weight of Potassium Nitrate. It is 
used locally by ophthalmologists. 

Argenti Cyanidum, Silver Cyanide, AgCN, — has no medicinal use except for the ex- 
temporaneous preparation of Hydrocyanic Acid. (See ante, p. 99. ) 

Argenti Iodidum, Silver Iodide, Agl, — a greenish yellow powder insoluble in water 
or alcohol. Is used instead of the nitrate internally, as it is supposed not to discolor the 
skin. Dose, gr. %-] in pill. 

Argenti Oxidum, Silver Oxide, Ag 2 0, — a brownish black powder, nearly insoluble 
in water and insoluble in alcohol. It is liable to decompose with violence when mixed 
or triturated with readily oxidizable or combustible substances, as creosote, phenol, potas- 
sium permanganate and many others. It should not be brought into contact with ammo- 
nia. Dose, gr. ^-ij in pill with Kaolin. It is not a dangerous internal remedy. 

All the silver salts should be protected from light in dark blue or amber-colored vials. 

Physiological Action. 
Metallic Silver is antiseptic, probably by forming a lactate with the 
lactic acid produced by microbes. In contact with colonies of germs it 
kills them without -exercising any inimical action on the animal tissues 
(Crede). Locally the silver salts are antiseptic, astringent, irritant and 
caustic, according to the strength of the applications. They are less irri- 
tant than the salts of mercury and more so than the salts of lead. The 
soluble salts of silver, taken internally in medicinal doses, are tonics to 
the nervous system, increase tissue change and promote the secretion of 
bile ; in larger doses they depress the heart, reduce the temperature and 
impair the respiration \ in overdoses they act upon the central nervous 
system, producing tetanic convulsions or paralysis. In mammals they 
affect the medullary centres particularly, at first stimulating and then de- 
pressing them, causing a primary rise of blood-pressure which afterwards 
falls, also slowing and embarrassing the respiration, which finally fails 



ARGENTUM. I9I 

from paralysis of the respiratory centre. The heart is but slightly affected 
and often continues to beat for some time after the breathing has stopped. 
The mucous membrane of the stomach and intestines shows congestion, 
ecchymoses and ulceration, the kidneys are irritated and edema of the 
lungs often occurs. None of these effects have been observed in man, 
but in him the prolonged use of the silver salts will produce chronic silver 
poisoning, known as Argyria. The first sign of this condition is a slate- 
colored line along the margin of the gums, with some inflammatory 
swelling. Subsequently grayish patches appear on various parts of the 
skin and mucous membranes, and extend over the whole integument 
which becomes slate-colored. No organ of the body, except the paren- 
chymatous cells and the epidermis, is exempt from this pigmentation, 
which is due to the deposit of silver, either in the metallic state or as an 
oxide or some organic compound, in the connective tissues. In the skin 
it is found in the corium, not in the epidermis. As a rule argyria does 
not produce any serious effect upon the health of the subject, though 
some authorities have ascribed to it gastro-intestinal catarrh, faulty assim- 
ilation, changes in the blood and fatty degeneration of the heart, liver 
and kidneys. It is probable that in most cases some degree of deranged 
nutrition is produced. A local argyria may be caused by the frequent 
topical application of a soluble silver salt for a long time. In a few 
cases general argyria has resulted from the local use of a silver salt, usu- 
ally in the mouth or throat; and it appears in workers in the manufac- 
ture of artificial pearls, who use silver as a pigment. Argyria is incura- 
ble, though many attempts have been made to remove the discoloration 
by the administration of iodides. The only solvent is Potassium Cyan- 
ide, which is inadmissible by reason of its violent toxicity. 

Silver salts unite with albumin to form albuminates, which are soluble 
in the digestive fluids, but it is not certain that silver is thus absorbed. 
According to some authorities the salts are reduced in the stomach and 
also in the intestinal canal, the tendency of such action being towards 
the separation of the metal, most of which passes through the alimentary 
canal unabsorbed, a very small portion finding its way through the lymph- 
atics to the tissues and remaining imbedded therein indefinitely. 

The Nitrate is the most soluble of the silver salts. It is antiseptic, 
astringent, hemostatic, irritant, and a limited escharotic, also antiphlo- 
gistic, antispasmodic and tonic. It has a strong affinity for albumin, 
with which it unites to form an albuminate. Locally applied in dilute 
solution it causes a marked contraction of the bloodvessels, but in 
stronger solutions it is irritant, dilating the vessels and acting as a super- 
ficial caustic by coagulating the albumin of the tissues to which it is 
applied and destroying their vitality. A dense layer is thus formed- 
which prevents the further penetration of the salt and so limits its 



192 ARGENTUM. 

escharotic action. This albuminous coating is at first white but soon 
turns black under the influence of light. The stains made by handling 
or applying it to the skin may be removed by washing with a strong solu- 
tion of Potassium Cyanide, and may in great part be prevented by 
immediately neutralizing the silver salt with a solution of common salt. 
Internally, in small doses, the Nitrate stimulates the heart, promotes nu- 
trition and acts as a nerve tonic. In large doses it produces violent gas- 
troenteritis, corrosion and ulceration of the gastro-intestinal mucous 
membrane, due to thrombosis of its veins. Burning pain is felt in the 
throat and stomach, followed by nausea, vomiting and often by purging. 
Central impairment of the nervous system may occur, with loss of co- 
ordination power and paralysis. Collapse follows, with weak pulse, 
pinched face, coldness of the surface and shallow respirations ; and this 
condition may be followed by coma, convulsions and finally death from 
paralysis of the respiratory centre. The lethal dose has not been deter- 
mined. 

Antagonists and Incompatibles. 

Common Salt freely used is the antidote, precipitating the silver as the insoluble chlo- 
ride and acting as an emetic. The Nitrate is exceedingly sensitive to organic material and 
to light, which readily decompose it. Incompatibles are Alkalies and their carbonates, 
Alkaloids, solutions of Arsenic and Tannin, most of the Mineral Acids and their salts, 
also all Bromides, Chlorides, Iodides and Phosphates. Distilled Water should be speci- 
fied when prescribing the Nitrate in aqueous solution. In spite of the most careful 
choice of an excipient it is doubtful if the Nitrate ever reaches the stomach in its own 
form, and if it does it is probably changed at once upon arrival. 

A course of silver medication should be regulated by suspending the remedy after 5 or 
6 weeks' use, then promoting elimination by purgatives, diuretics and baths. To pre- 
vent the general discoloration Potassium Iodide may be given conjointly with the silver, 
and baths of Sodium Hyposulphite used frequently. The dark line at the margin of the 
gums is removable by a course of the Acid Tartrate of Potassium. Argyria has been 
produced in three months and after the use of Sj ss-j of the nitrate. 

Therapeutics. 
The local uses of Silver Nitrate, which are the most important, depend 
on its antiseptic, hemostatic, astringent, caustic and stimulant properties. 
As an antisepticit has proved an efficient prophylactic against ophthalmia 
neonatorum, a drop of a 1 percent, solution being instilled into each eye 
of the new-born infant. In this disease, when the discharge is purulent, 
a similar solution should be applied to the conjunctiva daily, and when 
the discharge is very profuse a 2 per cent, solution is not too strong. A 
solution of the latter strength is commonly employed in the purulent con- 
junctivitis of adults, applied once daily to the everted lids by a brush, 
after cleansing and drying the surface; the excess being removed by 
washing with warm water or by neutralization with a solution of common 
salt. When the cornea is intact a solution of % to ji of one per cent, 
strength may be occasionally dropped into the conjunctival sac, but care 
must be taken that it does not come in contact with an inflamed or ulcer- 



ARGENTUM. I93 

ated cornea, as it is not well borne in such cases and may cause a perma- 
nent corneal opacity by the deposit of silver. 

In chronic purulent inflammation of the middle ear Silver Nitrate is one 
of the most valuable applications, in solutions varying from % of one per 
cent, to saturation, applied by a special syringe through the perforated 
tympanic membrane or by dropping them into the external meatus. Aural 
polypi have been successfully treated with solutions of from 6 to 20 per 
cent, strength. Weak solutions are useful in eczema of the ear and in 
external otitis, also for chronic inflammation of the lining membrane of 
the Eustachian tube, to abort aural furuncles and to relieve pruritus of the 
external auditory meatus. 

In the local treatment of the nose and throat Silver Nitrate is useful 
but should be employed with care. The stick of caustic is brittle and 
liable to break off while in use, hence it might be swallowed and produce 
acute poisoning. The danger of general argyria occurring from the pro- 
longed use of the salt in this situation should be remembered. For ulcers 
on the nasal septum, vascular granulations arising after operations on the 
nose, fissures of the tongue and lips, and mucous patches and ulcers of 
the mouth, the fused stick or a moderately strong solution is a good ap- 
plication. In subacute and chronic laryngitis a weak solution is some- 
times very effective, as it is also in ulcer of the larynx when not due to 
laryngeal tuberculosis. 

In genito-urinary surgery Silver Nitrate has many uses. In solutions 
of various strengths, 1 in 2000 to 1 in 500, it is an old remedy for gon- 
orrhea, applied to the urethra during the course of the disease. Stronger 
solutions, up to 5 per cent., have been employed in the early stage with 
the view of aborting the inflammation, but this procedure causes great 
pain and has many opponents as well as many advocates. If it fails to 
cut the disease short it will probably aggravate the inflammation consider- 
ably. The milder solutions are useful applications in chronic gleet, 
prostatorrhea, urethritis, vaginitis and chronic cystitis. In the form of 
gelatin bougies impregnated with the salt it may be applied to the urethral 
mucous membrane with more facility and with better results than by in- 
jection with a syringe. A 2 per cent, solution injected into the substance 
of buboes in their early stage has given satisfaction. Indolent sinuses 
from buboes or abscesses may be stimulated to healing by the application 
of lunar caustic lightly or a strong solution of the salt. It has been much 
used in the treatment of cervical endometritis and erosion of the os uteri. 

In diseases of the skin the Nitrate is employed to destroy parasitic 
fungi, to cause exfoliation of the epidermis and for a stimulant effect 
upon indolent ulcers and sores. Lunar caustic is used to destroy warts 
and other small growths, to arrest capillary hemorrhage and for other 
similar purposes. Solutions of various strengths are useful in some forms 
13 



194 ARGENTUM. 

of eczema, relieve the itching in prurigo and lichen, and are said to pre- 
vent pitting in variola. It is a very efficient application in pemphigus, 
if used in a 4 per cent, solution to the surface of the derma, after remov- 
ing the epidermis over the blebs and cleansing their bases of all secretion. 
Chilblains may be painted with a strong solution to relieve the irritation, 
and in lupus, psoriasis, erythema and ringworms solutions of this salt 
have been applied with satisfactory results. In erysipelas a concentrated 
solution, 20 grains to the drachm, was formerly applied on the inflamed 
surface and over the healthy skin beyond to the extent of two or three 
inches, after washing and drying the part, with the object of checking the 
spreading inflammation or at least rendering it less severe; but this pro- 
cedure has been superseded by other methods of treatment. For appli- 
cation to the skin a solution in Spirit of Nitrous Ether is recommended. 
This solution deposits a light-colored precipitate but itself does not turn 
black like the simple alcoholic solution. It blackens the skin however in 
a shorter time than any other solution. 

In general surgery the moulded stick (lunar caustic) is much employed 
to cut down exuberant granulations in suppurating wounds and to stimu- 
late the healing of indolent ulcers, sores and sinuses. Bedsores may 
often be prevented by painting the red but unbroken skin with a 2 to 4 
per cent, solution. Cysts and hydroceles may be cured by the injection 
of a strong solution into them after evacuating their contents, the result 
being the exciting of an adhesive inflammation which obliterates the sac. 
In chronic dysenteric ulcers a mild solution, 60 grains in 60 ounces of 
water, is used by enema after clearing away the contents of the lower 
bowel. 

The internal use of Silver Nitrate is almost wholly confined to the treat- 
ment of affections of the gastro-intestinal tract. Its astringent and tonic 
actions are sometimes very efficient in cases of weak and irritable stomach 
accompanied by great depression of spirits, morbid apprehensions and want 
of courage. It is employed in persistent vomiting, in chronic gastric 
catarrh, in hematemesis, and in gastric ulcer. When given for stomach 
affections it should be administered when the viscus is empty. Chronic 
gastritis has been treated with benefit by irrigating the stomach with solu- 
tions of various strengths, from 2 to 4 grains gradually increased to 20 
grains in 6 drachms of water, immediately followed by a 3 to 5 per cent. 
solution of common salt. The Nitrate has often proved of value in 
chronic inflammation of the large and small intestine, especially where 
there was ulceration of the intestinal mucous membrane. It has done 
good service in some epidemics of acute dysentery, has been praised in 
cholera infantum after the acute symptoms abated, and has given marked 
relief to the pain in catarrh of the biliary ducts. Its employment in spinal 
sclerosis, labio-glosso-laryngeal paralysis and similar affections has not 



ARGENTUM. I 95 

proved very successful, but it is said to be one of the few remedies which 
are of any service in locomotor ataxia. It was formerly used as a nerve 
tonic in epilepsy, but has been superseded by other agents which are less 
objectionable and more efficient. It has cured epilepsy where the bro- 
mides have failed, and it is well established that patients who have been 
subjected to a course of silver medication which has produced a deposit 
of the metal in the tissues secure a remarkable degree of immunity from 
various minor nervous ailments. It may be inferred that a remedy which 
is deposited in the tissues may interfere by its presence with the chemical 
activity of adjacent atoms, preventing their explosive union (Murray). 
The Oxide is the least irritant of the silver salts and does not discolor 
the skin so quickly as the nitrate, but eventually the same result follows 
its continued administration. It has been employed with more or less 
success in gastric neuralgia, irritable dyspepsia, pyrosis, gastric and pul- 
monary hemorrhages, dysmenorrhea, menorrhagia and other uterine 
affections, also to check profuse sweating, to relieve vomiting even in 
severe gastritis, and to control diarrhea depending on reflex nervous irri- 
tation. As an ointment, 5 to 10 grains to the drachm of lard, it is em- 
ployed for application to venereal sores and to the urethra in gonorrhea. 
The Iodide has been used in gastric affections, dysmenorrhea and epi- 
lepsy, but has no advantage over the other silver preparations. 

Unofficial Silver Compounds. 

As the Nitrate is precipitated by proteids and by chlorides its disinfectant action is 
more limited than that of many other antiseptics. To avoid this precipitation and ob- 
tain more penetrating action several new silver compounds have been introduced, many 
of which possess special trade names and all are highly vaunted for their efficiency in 
the treatment of gonorrhea. The following are the most important of these preparations. 

Actol, Silver Lactate, — is a white, inodorous and tasteless powder, which coagulates 
albumin and is soluble in 20 of water. It lessens putrefaction in the bowel and consti- 
pates to some extent. The compounds which it forms with the juices of the tissues or 
the secretions of wounds are soluble ones, which gradually permeate the tissues and ex- 
tend its action to some distance from the surface. Crede considers that this salt fulfils 
all the requirements of an efficient antiseptic better than any other silver compound. A 
solution of 1 in 1000 destroys all pathogenic microbes within five minutes. For gargles, 
mouth- washes, etc., solutions of I in 8000 to I in 4000 are used, though stronger ones 
do not irritate. In surgical affections it may be employed hypodermically. In erysipe- 
las the amount thus administered daily ranges from 7 to 20 grains, but the solution used 
must not be stronger than I in 200, lest coagula of the albumin form and prevent the 
remedy getting into the circulation. 

Argentamin, — is a patented preparation consisting of Silver Phosphate 10 per cent., 
dissolved in a 10 per cent, solution of Ethylene-diamine. It is an efficient antiseptic 
and astringent, but the alkaline diamine renders it somewhat irritant. Aqueous solutions 
of various strengths, from I in 5000 to I in 1000, are recommended as urethral injections 
in gonorrhea. 

Argentol, Silver Oxy-chinolin-sidphonate, — is a combination of Silver and Quina- 
septol, and occurs as a sparingly soluble yellowish powder which is used as a substitute 
for iodoform in wounds, skin diseases, syphilitic sores, etc., also as an injection for gon- 
orrhea. In ointment the usual strength is I or 2 per cent., for injections I to 3 in iooo._ 

Argonin, — is a patented combination of Silver (4 per cent), Casein and an alkali, 
occurring as a white powder which is soluble in hot water, non-irritant, not precipitated 



I96 ARNICA. 

by chlorides or albumin, and does not stain the hands or clothing. It is a weaker anti- 
septic than argentamin or silver nitrate, and has no effect on intestinal microbes. In 
the conjunctival sac its solutions are non-irritant, but it is said to give good results in 
catarrhal and purulent conjunctivitis. In gonorrhea a 2 per cent, aqueous solution is 
first used, the strength being gradually increased up to 10 per cent. Its solutions should 
be protected from the action of light. 

Itrol, Silver Citrate, — is a fine, light, inodorous and tasteless powder, soluble in 3800 
of water. Even in very weak solutions it is an energetic antiseptic, disinfectant and 
germicide, has a powerfully destructive action on gonococci, is readily borne by the 
urethral mucous membrane, has deep-reaching power but no injurious effect on the 
tissues, and therefore meets all the requirements of an efficient injection for gonorrhea 
(Werler). In that affection the solutions should be very weak at first, I in 8000, gradu- 
ally increased as the inflammation subsides until the full strength of I in 3800 is 
reached. It is very efficient in acute and chronic gonorrhea, in gonorrheal inflamma- 
tion of the vulvo-vaginal gland and in chronic cystitis. As an ointment for the treatment 
of wounds and skin diseases the strength is I in 100 or I in 50 of Lanolin. Solutions 
should be protected from light in amber-colored bottles. 

Largin, — is an albumin-silver compound, containing in the air-dried condition 1 1 per 
cent, of silver. It occurs as a gray powder, soluble in 10 of water, and is a powerful 
astringent and germicide, non-irritant and not precipitated by chlorides or albumin. It 
is used in gonorrhea, the solutions being of \ to 1^ per cent, strength, according to the 
stage of the affection. 

Protargol, — is a protein-silver compound, containing 8 per cent, of metallic silver, 
and occurring as a yellow powder, readily soluble in water. It is claimed to be absolutely 
non-irritant, either in the conjunctival sac or the urethra. It is highly praised by Neisser 
as an antiseptic and astringent application in \ to 2 per cent, solutions for affections of 
the conjunctiva, also for wounds and gonorrhea. 

Silver and Sodium Hyposulphite, — is very soluble in water, does not coagulate 
albumin, and may be given by the stomach or hypodermically. It has been used inter- 
nally for locomotor ataxia and is preferred to silver nitrate for local application to the 
throat, being more agreeable to the taste. It does not stain the skin or the clothing. 
Dose, by the mouth, gr. ss-iij ; hypodermically, gr. \—\ daily. 

ARNICA, — is the plant Arnica montana or Leopard's Bane, a peren- 
nial of the nat. ord. Composite, indigenous to the mountains of Northern 
Europe and Siberia, and said to have been found in the mountains about 
the headwaters of the Missouri and Columbia rivers. It has large orange- 
yellow flowers and a small, curved rhizome with several rootlets. Both 
the flowers and the roots are official. Its most important constituent is 
Trimethylamine, C 2 H 9 N, an ammoniacal alkaloidal principle, which is 
probably the active ingredient. It also contains Arnicin, Inulin, Capronic 
and Caprylic Acids, tannin, mucilage, resins, and two essential oils, one 
of which exists in the flowers, the other in the root. 

Arnicae Flores, Arnica Flowers, — the flower-heads of Arnica Mon- 
tana, large and yellow, of feebly aromatic odor and bitter, acrid taste. 

Arnicae Radix, Arnica Root, — the rhizome and rootlets of Arnica 
mo?itana, is externally brown and rough from leaf-scars, internally whitish, 
with a thick bark containing a circle of resin-cells and a large, spongy 
pith. Odor somewhat aromatic, taste pungent, aromatic and bitter. 
Resembles Valerian, which is distinguished by its smell ; Serpentaria, 
which has many contorted rootlets; and Veratrum Viride, which has 
thicker rootlets. Dose, gr. v-xx. 



ARNICA. I97 

Preparations of the Flowers. 

Tinctura Arnicae Florum, Tincture of Arnica Flowers, — strength 20 per cent. 
Dose, rt^v-xxx. 

Infusum Arnicae, Infusion of Arnica (Unofficial), — Arnica flowers 20, to 100 parts 
of water, is thought by many observers to be the best form for local use, .as it does not 
excite dermatitis, probably from containing none of the Volatile Oil, nor the insoluble 
principle Arnicin. 

Preparations of the Root. 
Extractum Arnicae Radicis, Extract of Arnica Root, — Dose, gr. j-iij. 
Extractum Arnicae Radicis Fluidum, Fl. Extr. of Arnica Root, — Dose, TTLv-xx. 
Tinctura Arnicae Radicis, Tincture of Arnica Root, — 10 per cent. Dose,TT\,v-xxx. 
Emplastrum Arnicae, Arnica Plaster, — contains Extract of Arnica Root 33 parts to 
67 of Lead Plaster. 

Derivative. 

Trimethylamina, Trimethylamine, C 3 H 9 N (Unofficial), — is a thin, colorless, strongly 
alkaline liquid, boiling at 49 F. , and at ordinary temperatures a colorless, inflammable 
gas. The Hydrochlorate is the most stable salt, crystallizing in white or colorless prisms, 
nearly odorless, of pungent taste, very deliquescent, freely soluble in water and in alco- 
hol. Dose, gr. ij-iij in syrup every 2 hours. 

Trimethylamine has been obtained from Arnica flowers and those of several other 
plants, from Ergot, Hops, Codeine, Cod-liver Oil, and decomposing albuminous sub- 
stances, such as human urine, herring-pickle, and the residue left in making sugar from 
beets. It is sometimes incorrectly named Propylamine, a term also applied to an impure 
trimethylamine, but in reality an allied and isomeric compound. 



Physiological Action and Therapeutics. 

Arnica is irritant, stimulant, depressant, antipyretic, diuretic and vul- 
nerary. It irritates the gastro-intestinal tract, and in some persons the 
local use of alcoholic preparations of the flowers will excite erysipela- 
tous inflammation of the skin, though those of the root have not been 
observed to do so. In small doses internally it increases the action of the 
heart, raises the arterial tension and stimulates the action of the skin and 
the kidneys. Large doses produce a transient excitement, followed by 
depression of the circulation, respiration, and nerve-centres ; headache, 
unconsciousness, and even convulsions being induced, the body-tempera- 
ture lowered, the pupils dilated, and muscular paresis produced. A toxic 
dose paralyzes the nervous systems of animal and organic life, causing 
collapse and death. 

Arnica is a popular remedy with those who patronize the so-called 
homeopathic school of practice, but like many other agents which the 
homeopathists claim to have given to medicine, it is a remedy much 
older than homeopathy, and was investigated originally by regular physi- 
cians, notably by Van der Kolk in the sphere of mental affections. Ex- 
ternally, the tincture in water has a popular reputation in sprains, bruises, 
etc., though an infusion is better for local use. Ecchymoses are rapidly 
dispersed by its administration internally as well as externally; and for 
internal bruises from shock or concussion its internal use has proven 



I90 ARSENUM. 

very efficacious. The aqueous preparation applied locally promotes the 
rapid union of cut surfaces. 

Internally, besides its value as previously noted, Arnica is undoubtedly 
employed effectively in typhus and typhoid fevers as a stimulant and 
antipyretic ; also in delirium tremens, rheumatism and rheumatic gout, 
hemorrhages, epistaxis, hemoptysis, amaurosis, concussion of the brain, 
chronic dysentery and paralysis of the bladder, it has rendered good ser- 
vice. In idiopathic mania, after the first excitement has diminished, 
Arnica, in aqueous preparation internally, has given great satisfaction. 
It has often checked an exhausting diarrhea after many other remedies 
have failed. 

Trimethylamine is an active escharotic and a gastrointestinal irritant. It lowers the 
rate and force of the heart, decreases the body-temperature, and diminishes (though 
sometimes increases) the excretion of urea. The Hydrochlorate is a powerful antipyretic 
in doses of gr. ij every 3 hours. It has been found useful in acute rheumatism and gout, 
relieving pain, reducing temperature, and diminishing the frequency of the pulse. In 
chronic rheumatism, as a liniment (i to 3 of Glycerin), it is said to give relief equal to 
that produced by any anodyne. It has been used with benefit in chorea, moderating 
the spasmodic movements when not suspending them entirely. 



ARSENUM, Arsenic, As. — The metal Arsenic is not used in 
medicine, but is represented by one of its Oxides, a salt of another Oxide, 
and the Iodide, which are official ; together with four preparations of 
these compounds, or of their salts, viz. : — 

Arsenic Compounds and their Preparations. 

Acidum Arsenosum, Arsenous Acid {Arsenic Trioxide, White Arsenic), As 2 3 , — is 
a heavy, white solid, occurring as an opaque powder, or in semi-transparent masses 
having usually a striated appearance, soluble in 30 to 80 of water at 59 F. , the solu- 
bility varying with its physical condition, also soluble in 15 of boiling water, in alkalies 
and their carbonates, in hydrochloric acid and in glycerin. It is volatilized at 424. 4 F. 
without melting, and when thrown on ignited charcoal it emits an alliaceous odor. 
Arsenous Acid is obtained by roasting native arsenides, and condensing the fumes in a 
long horizontal chimney. Dose, gr. ^ to -jL. 

Liquor Acidi Arsenosi, Solution of Arsenous Acid, — is a I per cent, solution in 
HC1 and Distilled Water. Dose, rryj-viij, thrice daily in water after meals. 

Liquor Potassii Arsenitis, Solution of Potassium Arsenite {Fowler's Solution), — is 
a I per cent, solution, prepared by boiling together Arsenous Acid I, Potassium Bicar- 
bonate 2, Comp. Tincture of Lavender 3, and Distilled Water to 100. Dose, TtTjj-viij, 
in water thrice daily after meals. 

Sodii Arsenas, Sodiztm Arsenate, Na 2 HAs0 4 + 7H 2 0, — is a salt of the second 
oxide, Arsenic Acid, As 2 5 . Occurs in colorless prismatic crystals, of feebly alkaline 
taste and a feebly alkaline reaction, soluble in 4 of water at 59 F., very soluble in 
boiling water, hardly soluble in alcohol. Dose, gr. y-g— §- ; of the dried salt, gr. 2i~iV 

Liquor Sodii Arsenatis, Solution of Sodium Arsenate {Pearson s Solution), — is a I 
per cent, solution of the dried Arsenate in Distilled Water. Dose, rt\,ij-viij, in water 
after meals. 

Arseni Iodidum, Arsenic Iodide, Asl 3 , — occurs in glossy, orange-red crystalline 
masses or scales, gradually losing iodine by exposure to the air. soluble in 7 of water and 
in 30 of alcohol at 59 F. ; is gradually decomposed by boiling water and by boiling 
alcohol, and is completely volatilized by heat. Dose, gr. -^-\. 



ARSENUM. I99 

Liquor Arseni et Hydrargyri Iodidi, Solution of Arsenic and Mercuric Iodide 
(Donovan's Solution), — has Arsenic Iodide and Mercuric Iodide, of each I part in 100 
of Distilled Water. Dose, n\jj-viij, in water after meals. 

Unofficial Arsenic Compounds. 

Cupri Arsenis, Cupric Arsenite, — occurs in the various cupro-arsenical pigments 
used for wall-paper coloring and as insect-poison, viz. — Scheele's green, Mineral green, 
Paris green, etc. Is highly poisonous. Dose, gr. j^-q- daily, in divided doses. 

Liquor Arseni Bromidi, Solution of Arsenic Bromide [Clemens 1 Solution), — so named 
by Dr. Clemens, who described it as a chemical union of Arsenic and Bromine, but the 
action of Bromine on Arsenous Acid results in the formation of Arsenic Acid and Hydro- 
bromic Acid, and the preparation is rather a Liquor Potassii Arsenatis et Bromidi. It 
contains Arsenic equal to I per cent, of Arsenous Acid ; and is prepared by boiling to- 
gether Potassium Carbonate and Arsenous Acid, pjj of each in ^ x of distilled water, 
until a clear solution is formed ; when cold ^ij of Bromine and 5j xij of water are added, 
and the mixture is allowed to stand until all color disappears, when it is ready for use. 
Dose, TT\J-v, thrice daily in water after meals. 

Solutions of the Bromides of Arsenic and Gold (Arsenauro), of Arsenic, Gold 
and Mercury (Mercauro), of Arsenic, Gold and Calcium (Calcauro), and of Arsenic, 
Gold and Manganese (Manganauro), are described under the title AuRUM. 

Physiological Action. 

Arsenous Acid, when applied to the skin denuded of its epidermis, acts 
as a painful escharotic, producing violent inflammation and resulting in a 
slough which forms a barrier to its absorption. If applied in dilute solu- 
tion over a large surface, it will be absorbed, and may produce the 
systemic effects to be described. 

In small doses it is a stomachic and general tonic, promoting the appe- 
tite and digestion, increasing the cardiac action, the respiratory power, 
and the intestinal secretions ; stimulating peristalsis, exalting mental 
activity and the sexual appetite, and producing a fair skin and a rotund 
form. When tolerance of the drug is established, large doses are used 
with impunity, as by the arsenic eaters of Styria, who can swallow at once 
as much as 5 grains with safety. They are careful, however, not to take 
any water into the stomach at the same time, so that the dose is slowly 
absorbed, and probably eliminated rapidly. Not all those who begin its 
use can acquire tolerance of it, but those who do so seem to continue it 
without injury, and live to an old age, undergoing great exertion without 
exhaustion, and being enabled to ascend steep mountains without diffi- 
culty of respiration. 

In full medicinal doses, continued for some time, it causes itching and 
edema of the eyelids, ptyalism, nausea and vomiting, diarrhea or dysen- 
tery, epigastric pain and soreness, feeble and irritable heart, dyspnea, 
disordered sensibility, herpes zoster, urticaria, eczema and other skin 
eruptions, jaundice and albuminuria. 

In large doses it is a powerful irritant to the gastro-intestinal and 
bronchial mucous membranes. Toxic doses may produce either symp- 
toms of gastro-enteritis, or those of profoundly narcotic character. In 



200 ARSENUM. 

the first and most usual form of acute arsenical poisoning, there is burning 
pain in the throat and stomach extending over the abdomen, vomiting, 
thirst, bloody stools, strangury, suppressed, albuminous or bloody urine, 
rapid and feeble heart, great anxiety, cold breath, finally exhaustion and 
collapse, — a group of symptoms much resembling cholera. The autopsy 
shows erosions, ecchymoses, and softening of the gastro-intestinal mucous 
membrane, congestion of the lungs and bronchi, and fatty degeneration 
of the liver, kidneys and cardiac muscle. The poison is found in the 
urine, saliva, tears, sweat, etc., and may be detected even in the paren- 
chymatous tissues. In the nervous form of poisoning by Arsenic, pro- 
found coma and insensibility come on suddenly without any gastro-intes- 
tinal symptoms. 

Arsenical preparations are generally classed as alteratives, but they are 
valuable tonics and antiseptics, and possess antiperiodic powers second 
only to those of Quinine. 

Chronic Arsenical Poisoning may occur from the inhalation of arsenical 
vapors or dust arising from wall-papers or other substances containing the 
poison. The quantity necessary to produce symptoms of poisoning when 
inhaled seems to be very small. The most prominent symptoms are, at 
first increased appetite, next colicky pains, mucous or dysenteric stools, 
irritation of the eyes, coryza, a short, dry cough, and a white and silvery 
tongue, all accompanied by great bodily prostration. 

The long-continued use of arsenic may induce peripheral neuritis, the 
chief symptoms of which when so caused are — severe darting pains in the 
limbs, paralysis of the muscles of the extremities, especially the extensors 
of the hands and feet, ataxic gait, herpes zoster, and rapid muscular 
atrophy. In several cases it has caused general brown pigmentation of 
the skin, and may give rise to the same pigmentation of psoriasis patches. 
After death from chronic poisoning, in addition to the gastro-intestinal 
and nervous lesions, there is found wide-spread fatty degeneration, affect- 
ing most of the organs, but particularly the liver, kidneys, stomach and 
muscles, including the heart. 

To avoid arsenical poisoning during a course of the drug, full doses 
(ir^x of Fowler's Solution) should be used at the commencement, and 
always taken on a full stomach. The dose should then be steadily re- 
duced. Susceptible persons often tolerate it better if a few drops of 
laudanum are administered with each dose. 

Antidotes and Incompatibles. 

Poisoning by Arsenic is treated by prompt evacuation of the stomach, and washing it 
by means of the stomach pump, then Magnesia, Chalk and Lime-water freely, or better 
still, the chemical antidote to Arsenic in solution, viz., the Hydrated Oxide of Iron, 
freshly precipitated and in a soft magma, in the proportion of gr. viij for each grain of the 
poison ingested. (See Ferri OxiDUM Hydratum for the preparation of this antidote.) 
Oil or mucilaginous drinks should be given to protect the mucous membranes, and dilu- 



ASAFGETIDA. 201 

ents, alkaline mineral waters or Iodide of Potassium to promote elimination. Dialyzed 
Iron has been shown to be quite efficient as an antidote, and is more easily obtained 
than the hydrated oxide. It has rendered good service in many cases of poisoning from 
inhalation of arsenical fumes. 

Incompatibles are salts of Iron, Magnesium and Calcium, also Astringents. 



Therapeutics. 

Externally, Arsenic has been employed in the form of paste as a depila- 
tory, and as an escharotic in cancers, but is excessively painful. Most of 
the secret "cancer cures" have arsenous acid for their basis. Internally, 
it is used as a tonic and astringent to the intestinal canal, as a tonic and 
antispasmodic in nervous diseases, and for its action on tissue change. 
It is of especial value in irritative dyspepsia, gastralgia, pyrosis, gastric 
ulcer or cancer, regurgitation of food without nausea, diarrhea coming 
on immediately after taking food, vomiting of drunkards and chronic 
alcoholism. It has proven of signal service in the commencement of 
phthisis, also in catarrhal pneumonia, probably by causing fatty degen- 
eration of the exudation in the alveolar cavities, thus breaking it up and 
quickening its absorption. It is often very serviceable in chronic bron- 
chitis with copious expectoration, in acute catarrh, hay fever, whooping- 
cough, asthma, chorea, epilepsy, angina pectoris and other spasmodic 
nervous disorders. In many forms of neuralgia it frequently gives prompt 
and permanent relief, especially in cases due to malarial poisoning. As 
an antiperiodic, it has high rank, being, however, of particular value in 
chronic malarial poisoning, and as an adjunct to Quinine in the intervals 
between the paroxysms of intermittents. Anemia and chlorosis are re- 
markably benefited by it, and in rheumatic arthritis and chronic rheuma- 
tism it is sometimes of great service. In chronic scaly and papular skin 
diseases its value is very great, but it is not serviceable in acute forms, and 
the more chronic the cutaneous affection the more likely it is to be 
amenable to Arsenic. Epithelioma may be retarded by small doses long 
continued, and it has certainly been useful in delaying the progress of 
other cancers, particularly scirrhus of the stomach and uterine carcinoma. 
Hypodermically its solutions have been extremely efficient in histrionic 
spasm, local chorea of the head and neck, obstinate cases of general 
chorea, and in lymphadenoma. 

The so-called Bromide of Arsenic, in the form of Clemens' Solution, 
has rendered good service as a remedy for diabetes mellitus of hepatic 
origin. Cupric Arsenite is highly recommended in typhoid fever. 



ASAFQETID A, Asafetida, — a gum-resin obtained by incision from 
the living root of Ferula fxtida, a perennial herb of the nat. ord. Urn- 
belliferse, native of Persia and Afghanistan. It occurs in whitish tears 



202 ASAFCETIDA. 

embedded in a grayish sticky mass, of alliaceous odor and taste, soluble 
in alcohol to at least 60 per cent., and when triturated with water it yields 
a milk-white emulsion. Its principal constituent is a Sulphuretted Vola- 
tile Oil, consisting chiefly of Allyl Sulphide, C 6 H 10 S ; it also contains a 
gum and a resin, with ferulaic, malic, acetic, formic and valerianic acids. 
Dose, gr. v-xx. 

Preparations. 

Tinctura Asafcetidae, Tincture of Asafetida, — strength 20 per cent. Dose, gss-ij. 

Emulsum Asafcetidae, Emulsion of Asafetida, Milk of Asafelida, — strength 4 per 
cent, in water. Dose, j|ss-ij. 

Pilulae Asafcetidae, Pills of Asafetida, — each pill has gr. iij of Asafetida with gr. j 
of Soap. Dose, j-iv pills. 

Pilulae Aloes et Asafcetidae, Pills of Aloes and Asafetida, — each pill has gr. iy^ of 
each constituent named and the same quantity of Soap. Dose, j-iv pills. 

Mistura Magnesias et Asafcetidae, Mixture of Magnesia and Asafetida, Dewees' 1 
Carminative (Unofficial), has of Magnesium Carbonate 5, Tinct. Asafcetidae 7, Tinct. 
Opii I, Sugar 10, Aqua Dest. q. s. ad 1 00 parts. Dose, ^ss-^ss. 

Spiritus Ammoniae Fcetidus (Unofficial), — Asafetida 1^, Liquor Ammonias For- 
tior 2, Alcohol 20 parts. Dose, gss-j. 

Physiological Action and Therapeutics. 

Asafetida is a powerful antispasmodic, a stimulant to the brain and 
nervous system, a stimulating expectorant, also tonic, laxative, diuretic, 
diaphoretic, emmenagogue, aphrodisiac and anthelmintic in action. Its 
odor and taste are extremely nauseous and persistent. In small doses 
continued it causes impaired digestion, alliaceous eructations, acrid sen- 
sation in the fauces, gastralgia, flatulent distention, fetid flatulence, 
burning urination, diarrhea and tenesmus. Full doses produce various 
nervous or hysterical phenomena, with nausea, vomiting and purging. 
The Volatile Oil diffuses into the blood and tissues, and is excreted in the 
urine, sweat, breath, etc. By its action the circulation is stimulated, the 
arterial tension raised, the power of the cardiac motor ganglia is increased 
and the cardiac inhibition relaxed. Asafetida also stimulates the brain 
even to pleasant intoxication, and produces a subjective sensation of 
warmth without any rise of body-temperature. It stimulates the nervous 
system, the secretions and excretions, the menstrual flow and the sexual 
appetite. In Asia it is used as a condiment with food, and though at 
first it is extremely nauseous to most people, a taste for it may be readily 
acquired. 

The disgust which is generally felt for this remedy makes its use very 
restricted, though a valuable medicine. The Emulsion is extremely ser- 
viceable in the flatulent colic of infants, and as an enema in infantile con- 
vulsions. There is no better remedy in hysteria and hypochondriasis 
with indigestion and flatulence ; in constipation with amenorrhea of 
anemic subjects, due to ovarian and intestinal torpor; in bronchial 



ASCLEPIAS ASPIDIUM ASPIDOSPERMA. 203 

affections, cough of habit, chronic catarrhs, and flatulent indigestion. It 
has been highly praised in the treatment of habitual abortion. 

ASCLEPIAS, Pleurisy Root, — is the root of Asclepias titberosa, a plant of the nat. 
ord. Asclepiadaceae and a native of the Eastern and Southern States. Two other species 
of Asclepias are used in medicine and were formerly official. 

Extractum Asclepiadis Fluidum, Fluid Extract of Asclepias, — Dose, gss-j. 

An Infusion or Decoction may be made in the proportion of ^j of the powdered root 
to a quart of water, and given in teacupful doses every 2 or 3 hours. 

Asclepias contains two resins, a peculiar principle, tannic and gallic acids, albumin, 
pectin, gum, various salts and a volatile, odorous, fatty matter. It is emetic and cathar- 
tic in full doses, also diaphoretic and expectorant, as well as depressant to the action of 
the heart, and probably slightly sedative and astringent. It is a popular remedy in the 
Southern States for pleurisy (hence its common name), and has been used in medicine 
for catarrh, pneumonia, phthisis, diarrhea, dysentery, rheumatism, gastralgia, and to pro- 
mote the eruption in exanthematous fevers. It is undoubtedly a powerful diaphoretic. 



ASPIDIUM, — is the rhizome of Dryopteris Filix-mas (Male Fern) 
and of Dryopteris marginalis (Marginal Shield Fern), plants of the nat. 
ord. Filices, the former found in most parts of the world, the latter indi- 
genous to N. America. The active principle is Filicic Acid, C u H 18 5 , 
which is extracted in the oleoresin. It also contains a green, fatty oil, 
a volatile oil, resin, tannin, etc. Dose, 3SS-3JSS in a single dose fasting, 
or in divided doses at short intervals, followed by a purgative. 

-. Oleoresina Aspidii, Oleoresin of Aspidium, — is an ethereal extract and deposits 
Filicic Acid on standing. It should be well shaken before being used. Dose, gss-^j, 
in capsules, repeated every 3 hours for 2 or 3 doses. 

Aspidium is an efficient vermicide against tapeworm, particularly the 
unarmed variety (Bothriocephalus latus). The oleoresin is the best form 
in which to use it, the patient having fasted for the previous day, or used 
only a milk diet, gj may then be given in 4 doses ^ hour apart. This 
may be repeated the next morning and followed by three drops of croton 
oil in emulsion. This is one of many methods. Cusso may be com- 
bined with it advantageously. A formula for a mixed treatment by As- 
pidium, Pomegranate and Pumpkin-seed is given under the title Grana- 
tum. 



ASPIDOSPERMA, Aspidosperma, Quebracho— -is the bark of 
Aspidosperma Quebracho-bianco, a large evergreen tree of the nat. ord. 
Apocynacese, growing in Chili and the Argentine Republic. The name 
is one given in S. America to any very hard wood (quebrar hacho, to 
break the axe), and the particular tree above named is known as Quebra- 
cho -bianco, from the white color of its wood. It contains several alkaloids, 
no one of which represents the action of the bark itself; the most impor- 
tant being Aspidospermine, C 22 H 30 N 2 O 2 , and Quebrachine, C 21 H 26 N 2 3 . 



204 AURANTIUM. 

Several false Quebrachos are found on the market, that most frequently 
seen being the bark of Loxopterygium Lorentzii, or Quebracho Colorado, 
an Argentine tree of the order Terebinthaceae. 

Extractum Aspidospermatis Fluidum, Fluid Extract of Aspidosperma, — is the 
only official preparation. Dose, tt\v _ 3J- 

Tinctura Quebracho, Tincture of Quebracho (Unofficial), — strength 20 per cent. 
Dose, £j-iv. 

Vinum Quebracho, Wine of Quebracho (Unofficial). Dose, 3J-^j. 
Extractum Quebracho, Extract of Quebracho (Unofficial). Dose, gr. ij-x. 

Aspidosperma is a bitter tonic of disagreeable taste, increasing appe- 
tite and promoting digestion. It lowers the action of the heart, reduces 
arterial tension, and slows respiration, also decreasing the sensation of 
need of air after active exercise. In large doses it causes severe saliva- 
tion, nausea, vomiting, vertigo and headache. In animals it paralyzes the 
motor nervous system and lowers the reflexes, producing great dyspnea 
and finally death, apparently from asphyxia. 

This drug has long been used in Chili as an antiperiodic, a stomachic 
tonic, and a remedy for dyspnea. In the latter condition it is reported 
to be remarkably palliative, especially when due to emphysema, uremic 
and spasmodic asthma, spasmodic cough and chronic bronchitis. It is not 
efficient in dyspnea from organic diseases of the heart, or in that of aged 
subjects of atheroma. 

Aspidospermine is actively poisonous to the respiratory apparatus and 
circulation in both cold- and warm-blooded animals, in the former the 
respiration being chiefly affected, in the latter the motor ganglia of the 
heart. Lowered temperature, dyspnea, stupor and convulsions occur 
before death. It has been used as an antipyretic, also in cardiac neu- 
roses and in asthma. Its salts are freely soluble in water, but the alkaloid 
itself is soluble only in oils and fats, 6 to 8 parts being readily incorpo- 
rated with ioo of cod-liver oil by the aid of heat. The average dose is 
about gr. j-ij. 



AURANTIUM, Orange, — occurs in two official varieties of fruit 
and flowers, viz. — those of Citrus vulgaris, the Bitter Orange, and Citrus 
Aurantium, the Sweet or Portugal Orange, both trees of the nat. ord. 
Aurantiacese, cultivated in almost all warm countries. Other varieties are 
described under Limon. The official titles are — 

Aurantii Amari Cortex, Bitter Orange Peel, — the rind of the fruit 
of Citrus vulgaris, characteristics well known. Contains a Volatile Oil 
isomeric with Oil of Turpentine, C 10 H 16 , and a bitter, crystalline prin- 
ciple, Hesperidin or Aurantiin. 



AURUM. 205 

Aurantii Dulcis Cortex, Sweet Orange Peel, — is the rind of the 
fresh fruit of Citrus Aurantium. It contains a Volatile Oil differing from 
that of the bitter orange, and less of the bitter principle. 

Preparations. 

Extractum Aurantii Amari Fluidum, Fluid Extract of Bitter Orange Peel. — 
Used as flavoring. Dose, gss-j. 

Tinctura Aurantii Amari, Tincture of Bitter Orange Peel, — strength 20 per cent. 
Dose, 3J-ij. A flavoring preparation. 

Tinctura Aurantii Dulcis, Tincture of Sweet Orange Peel, — strength 20 per cent. 
Dose, gj-ij. A flavoring preparation. 

Syrupus Aurantii, Syrup of Orange, — Sweet Orange Peel 5, Calcium Phosphate 
Precip. 5, Sugar 70, Alcohol and Water to 100. Dose, gj-ij. Used for flavoring. 

Syrupus Aurantii Florum, Syrup of Orange Flowers, — Sugar 85, Orange-flower 
Water to 100. Dose, gj-ij. A delicate flavoring agent, but having to some persons an 
extremely sickish taste. 

Spiritus Aurantii, Spirit of Orange, — Oil of Orange Peel 5, Deodorized Alcohol 
95. Dose, to be regulated by the quantity of alcohol desired. 

Spiritus Aurantii Compositus, Compound Spirit of Orange, — Oil of Orange Peel 
20, Oil of Lemon 5, Oil of Coriander 2, Oil of Anise y 2 , Deodorized Alcohol to 100. 
Dose, as for alcohol. 

Aqua Aurantii Florum Fortior, Stronger Orange-flozver Water, — is water saturated 
with the volatile oil of fresh orange flowers. Dose, indefinite, for flavoring. Used to 
prepare — 

Aqua Aurantii Florum, Orange-flower Water, — consists of equal volumes of the 
preceding and Distilled Water, mixed immediately before use. Dose, indefinite. 

Oleum Aurantii Corticis, Oil of Oraiige Peel, — a volatile oil, obtained by expres- 
sion from the fresh peel of either orange. Is soluble in about 4 times its volume of alco- 
hol, and is an ingredient of the two official Spirits of Orange and also of Spiritus Myrcise 
(Bay Rum). Dose, gtt. j-v. 

Oleum Aurantii Florum, Oil of Orange Flozvers {Oil of iVeroli), — a volatile oil, 
distilled from the fresh flowers of the bitter orange. Is the most important constituent 
of Cologne Water (Spiritus Odoratus), and is soluble in an equal volume of Alcohol. 
Dose, gtt. j-v. 

Elixir Aromaticum, Aromatic Elixir [Simple Elixir), — has of the Comp. Spt. of 
Orange 1.2, Precipitated Calcium Phosphate \]/ z , Syrup 37^, Deodorized Alcohol and 
Distilled Water to 100. A flavoring vehicle. Dose, 5J-3J, or more. 

Orange is aromatic and tonic, also more or less bitter, but has little 
action except a mild stimulant influence on the nervous system due to 
its volatile oil. Persons much exposed to its fumes are liable to cutaneous 
eruptions and various nervous disorders. The oil may produce violent 
colic and convulsions in children, one case being reported in which death 
resulted from eating the rind. Its use in medicine is confined to flavoring 
purposes, though the preparations of the Bitter Orange may be used as 
gentle tonics and stimulants to the digestion, but they are usually com- 
bined with more energetic agents. 



AURUM, Gold, Au, — is represented by only one official salt, the 
Gold and Sodium Chloride, but triturations of the metal itself may be' 
prepared, according to the general pharmacopceial formula for such prepa- 



206 AURUM. 

rations. The unofficial solution of Gold and Arsenic Bromide is a very- 
efficient preparation. Fine gold and a solution of the perchloride are in 
the Br. Ph., and powdered gold, also the oxide, chloride, sodio-chloride, 
iodide and cyanide, are official in the French Codex. 

Official Preparation. 

Auri et Sodii Chloridum, Gold and Sodium Chloride, — is a mixture composed of 
equal parts of dry Gold Chloride, AuCl 3 , and Sodium Chloride, NaCl ; and occurs as an 
orange-yellow powder, of saline and metallic taste, slightly deliquescent in damp air, 
very soluble in water, partly soluble in alcohol, and contains about 32 per cent, of pure 
gold. Its solutions are decomposed by organic substances, by light, and by almost all 
salts. Dose, gr. g 1 ^— \, once or twice a day. The Ph. Ger. gives the maximum single 
dose as gr. 3^", and the maximum daily dose as gr. iij, but these doses are too high. 



Unofficial Preparations. 

Auri Pulvis, Potvdered Gold, — may be obtained by triturating gold leaf with ten 
times its weight of sugar of milk or potassium sulphate until brilliant particles are no longer 
visible in it, and then washing the diluent away with boiling water. A T?'itziration of 
Gold may be prepared in the same manner, retaining the sugar of milk, as directed by 
the pharmacopoeia under the title Triturationes. Dose of powdered gold is gr. -|-gr. j, 
or a little of it may be applied by friction to the sides of the tongue. 

Auri Chloridum, Gold Chloride, — also called the perchloride or terchloride of gold 
(AuCl 3 ), the "potable gold" of the alchemists, — occurs in needle-shaped prisms of a 
deep orange color, very deliquescent and freely soluble in water, in alcohol and in ether. 
Dose, gr. ^q-JTp * n P^ or som tion, preferably the latter. The commercial salt so named, 
and much used by photographers, is not the pure chloride but a crystallized double salt 
of gold and sodium, containing 50 per cent, of metallic gold. 

Auri Bromidum, Gold Bromide, AuBr 3 , — occurs as a yellowish-gray, friable mass, 
which is insoluble in water but soluble in ether, and contains 55 per cent, of Bromine. 
Dose, gr. 2V - <b but a gai nst migraine the minimum quantity should be used twice daily 
an hour before meals. 

Auri et Sodii Bromidum, Gold and Sodium Bromide, AuBr 3 NaBr.2H 2 0, — may be 
used hypodermically in solution, 2 parts to 100 of distilled water, the dose of which is 
TT\viij increased to TTLxxxij, respectively representing \ to § of a grain. 

Liquor Auri et Arseni Bromidi, Solution of Gold and Arsenic Bromide (Barclay), — 
is marketed under the trade-name "Arsenauro" and contains gr. -gL of each salt in rt^x. 
Dose, TT\v-xv in water, thrice daily after meals, or hypodermically. 

This solution may be prepared as follows : (1) Take of Nitric Acid 3 j and of Hydro- 
chloric Acid g iij, mix them and dissolve in the mixture 21 grains of pure Gold, then 
evaporate to dryness in a water-bath. Dissolve the resulting Chloride of Gold in distilled 
water ^j, and add slowly a solution of 35 grains of Ammonium Bromide in giv of water. 
Shake with Squibb's ether until all the gold is taken out, separate in a separating funnel, 
and treat the ether solution with fused calcium chloride to remove all water. Distil off 
the ether, and dissolve the remaining Gold Bromide in ^ iv of water, to make Solution 
No. 1. (2) Dissolve 48^ grains of Arsenous Acid in ^ iv of distilled water by the aid 
of heat, and when cold add 3 j of Bromine and let the mixture stand for 24 hours. Then 
drive off the excess of bromine by boiling in a sand-bath until the solution is colorless, 
which gives Sohition A r o. 2. (3) Mix the two solutions and add sufficient water to make 
I quart 

Liquor Auri, Arseni et Hydrargyri Bromidi, Solution of Gold, Arsenic and Mer- 
cury Bro7nide (Barclay), — is marketed under the trade-name " Mercauro," and con- 
tains gr. g 1 ^ of each bromide in TT^x. Dose, rt\v-xv in water, thrice daily after meals, 
or hypodermically. 

Similar solutions of the bromides of gold, arsenic and calcium (" Calcauro ") and of 
the bromides of gold, arsenic and manganese (" Manganaiiro "), are on the market and 
may be used in like doses. 



AURUM. 207 



Physiological Action. 

The action of the salts of gold upon the human organism is analogous 
in many respects to that of mercury, causing local irritation and escha- 
rotic effects when applied in substance or in strong solution. In continued 
medicinal doses given internally they produce a condition of general 
erethism which closely resembles the mercurial fever, and is accompanied 
by salivation but without tenderness or ulceration of the gums. The 
Chloride is one of the most active salts, being, according to Chrestien, 
even more toxic than corrosive sublimate. Locally, it produces irritant 
and caustic effects, and imparts a yellow stain to the skin, which later on 
turns violet and even black, from reduction of the metal therein. In 
overdoses it causes gastric pain and inflammation, also ulceration of the 
gastro-intestinal mucous membrane, and otherwise acts as a corrosive 
poison ; toxic doses produce a violent gastro-enteritis with such nervous 
phenomena as convulsive tremor, cramps, priapism, insomnia and insen- 
sibility (Magendie). 

The salts of gold, administered in small medicinal doses, increase the 

appetite and the digestive power and stimulate the functional activity of 

the secreting organs, especially the skin and the kidneys. They also 

stimulate the generative apparatus, causing diaphoresis and diuresis, and 

exciting the menstrual flow in women and the sexual appetite in men. 

The observations of several competent physicians have established the 

power of these salts to excite the vascular and muscular systems and to 

produce fever, to increase the urine and the sweat, to cause salivation 

without stomatitis, a sense of heat in the stomach, headache and diarrhea, 

to promote menstruation, excite the genitalia, and profoundly affect the 

nervous system. In large or continued doses they cause dryness of the 

tongue, redness of the pharynx, gastric and intestinal colic, nausea and 

vomiting, and even erosion of the gastric mucous membrane. The 

Bromide, though containing only 55 per cent, of bromine,, is found to be 

many times more active, weight for weight, than the ordinary bromides. 

Administered in doses of from yi grain to 3 grains per kilogramme of 

body-weight, it depressed the cortical motor centres to such a degree that 

the strongest electrical stimulation thereof failed to produce an epileptic 

seizure (Shtcherbak). 

Antidotes and Antagonists. 

Poisoning by gold salts is treated like that by corrosive sublimate. The Antidote is 
Albumin in some form, followed by evacuation of the stomach, as the albuminate is not 
wholly inactive. The Antagonists are Bismuth, Tannin, Sodium Sulphite, and diluted 
Nitric Acid, in water, as gargles and mouth washes for the salivation ; Belladonna to 
lessen the salivary secretion, Hyoscyamine for the tremor and Morphine for shock. 



208 AURUM. 



Therapeutics. 

The literature of gold shows that it is one of the most ancient medi- 
cines. Pliny, in the first century, recorded its use as a recognized remedy 
for several conditions for which it is still employed, including lichenoid 
eruptions, fistula, hemorrhoids, warts, putrid ulcers, and sores emitting 
an offensive smell. In the finely divided metallic state it was employed 
as a panacea by the Arabian physicians and by the alchemists. During 
the 17th and 18th centuries it was highly esteemed as an antisyphilitic, 
also for leprosy, dropsies, epilepsy, the pest, fevers, amenorrhea, sterility 
and uterine diseases. During the first quarter of the present century it 
was in high repute among the Continental physicians as a remedy for 
syphilis and for scrofula. 

Mitchill (1818) administered gold salts for syphilis in the New York Hospital, with 
excellent results. In his opinion " the muriate of" gold will effect all that is achieved by 
the muriate of quicksilver, with incomparably less inconvenience to the patient, who gets 
well under the former without the hazard of a sore mouth or a salivation, and with very 
little wear and tear of constitution." Trousseau (1851) says that the happy results of 
gold in the treatment of venereal diseases are incontestable ; and von Schroff of Vienna 
(1868) gave it great praise for the restoration of a case of syphilis in which the strongest 
mercurials had failed to avert destruction of the nasal bones or the deep, spreading ulcers 
of the skin. Phillips (1894) says that its efficacy is best seen in the later developments 
of syphilis, such as ulceration of the nose and larynx, cutaneous syphilides, hard nodes, 
etc., also that it may especially be employed in long-standing cases with chronic peri- 
ostitis and when mercury has already been given to saturation. Still it has never obtained 
general professional favor in the United States or in England until recently. Professor 
Barton, of Jefferson Medical College, Philadelphia (1827), pronounced the following 
judgment upon it in his lectures on materia medica. " On the whole view of what has 
been said in favor of gold, I am not inclined to attach great importance to it as a remedy. 
It is well enough in its proper place and for its proper purposes, for which it is more use- 
ful than as a medicine. Plenty of it would doubtless cure many diseases of mind and 
body." Such has been the general opinion since the above words were printed, but of 
late years a number of compounds of gold with other elements (chlorine, bromine, iodine, 
arsenic and mercury) have been employed as medicines with considerable satisfaction. 

Dr. Piffard of New York finds that Gold is unquestionably useful in 
the later stages of syphilis, and says that its best effects are obtained with 
very small doses, gr. J- or less, which he rarely continues for more than 
one or two weeks at a time. Several other observers have given it great 
praise as a remedy in constitutions which are broken down by the com- 
bined influence of syphilis and mercury, for syphilis in strumous subjects, 
and for the various manifestations of scrofula. Under its use the auric 
fever may develop, and the local affections for which it is administered 
may assume an aggravated intensity, and even new ones appear; but 
these phenomena do not call for the suspension of the remedy, for the 
disease retrogrades rapidly in a few days after they appear (Trousseau) ; 
and on lessening the dose pyrexia subsides and good effects are more 
conspicuous (Phillips). 

Strumous affections have been frequently reported cured by the internal 



• AURUM. 209 

and local use of auric preparations, including scrofulous ulcers, lupus, 
ozena, enlarged and indurated cervical glands, and hypertrophy of the 
tongue with induration thereof. Gold has been credited with many 
cures of cancer of the uterus, mammae and tongue, but it is probable that 
such have really been cases of scrofulous ulceration. Squamous skin dis- 
eases, the "dartres " of the older writers, are, next to syphilis, the most 
successful field for the action of gold. In cutaneous diseases it is used 
locally as well as internally. Dropsy is one of the affections in which it 
was anciently recommended, and in which modern therapeutists have 
found it efficient, especially ascites due to chronic hepatic disease or to 
induration of the abdominal organs, also post-scarlatinal dropsy and 
ovarian dropsy. 

Many disorders of the female generative organs have proved amenable 
to gold when persistently employed. Amenorrhea due to ovarian torpor 
and chronic metritis witbi scanty menstruation are often benefited thereby, 
while sterility dependent on these states or due to coldness, is more 
certainly cured by the auric preparations than by any other merely 
medicinal means. The tendency to habitual abortion may be averted 
by the use of the Chloride, which is also beneficial for mental symptoms 
of hysterical character, especially when connected with uterine disease. 
Many competent clinicians have highly commended gold in suicidal 
melancholia, in hypochondriasis accompanying hepatic or testicular dis- 
ease, in decline of the sexual power in men, and as a tonic for low-spirited, 
pining boys with undeveloped testes. 

Sclerosis of the internal organs, especially the liver and kidneys, may 
be retarded by the persistent use of the Gold and Sodium Chloride, in 
doses of gr. 8 1 £ Q thrice daily. Nervous dyspepsia, characterized by a 
red and glazed tongue, epigastric pain increased by food, and relaxation 
of the bowels after eating, is greatly benefited by the same salt in equally 
small doses. Catarrh of the duodenum and bile-ducts, and jaundice 
therefrom, also vertigo and vertiginous sensations connected with gastric 
disorders or due to cerebral anemia, are often removed by a course of 
treatment with the salts of gold. The Bromide has been employed in 
doses of from gr. % to gr. y 2 with decided benefit in obstinate cases of 
hysteria and epilepsy. Goubert used it successfully for migraine, epilepsy, 
chorea and exophthalmic goitre, in daily doses of gr. ^ to y& t continued 
until its characteristic headache was produced. He claims for it greater 
efficacy in epilepsy than is possessed by the other bromides, and says that, 
as compared with them, it is better tolerated and does not induce depres- 
sion and emaciation or the other pronounced symptoms of bromism. 

A combination of Gold and Arsenic (Auri Arsenas) was introduced by 
Chrestien and extensively employed by Massart in cancer and phthisis,, 
with sufficient success to merit the approval of the medical societies of 
14 



210 AVENA SATIVA? 

Lyons and Toulouse. It is said to be particularly serviceable in scrofu- 
lous affections, especially lupus, and to exercise a highly beneficial influ- 
ence on anemia and chlorosis. A solution of the Bromides of Gold and 
Arsenic has been successfully employed for several years by Dr. Barclay 
and others in the various diseases of which sclerosis is the chief factor, 
such as cirrhosis of the liver and lungs, interstitial nephritis, atheroma 
and calcareous degeneration of the arteries, senile degenerative changes 
and neurotic disease, fibroid phthisis, locomotor ataxia, etc. ; also in 
cervical adenitis, arthritis deformans, syphilitic neuralgia and iritis, mili- 
ary tuberculosis, epilepsy, chronic neuritis, sciatica, chronic muscular 
rheumatism and neurasthenia. Arsenauro is the trade-name of this solu- 
tion, which has been the subject of extended reports from many compe- 
tent observers, many of whom claim to have obtained from the use of 
this combination results which neither of its constituents are capable of 
when administered alone. It is held to have marked alterative power 
upon the glandular system and uponjall non-malignant scleroses ; to be 
not only a blood-maker but a blood-builder, increasing the number of 
the corpuscles and improving their quality, and also increasing the amount 
of hemoglobin therein. It is eliminated by the kidneys and produces no 
irritation when administered either by the mouth or hypodermically. A 
similar solution of the Bromides of Gold, Arsenic, and Mercury, named 
Mercauro, is on the market, and is highly praised in the treatment of the 
late manifestations of syphilis, particularly those affecting the nervous 
system. 

A so-called li Bichloride-of-Gold Cure " for inebriety has become highly 
notorious through extensive advertising and other commercial methods, 
but from the most reliable information obtainable it is reasonably certain 
that the only preparation of gold which plays a prominent part therein is 
the gold coin which passes from the patient's pocket to that of the 
manager of the " institute." The physiological symptoms produced by 
the remedy employed are those of strychnine and atropine, the adminis- 
tration of which hypodermically several times daily for three or more 
weeks is decidedly dangerous. In many cases cardiac failure has occurred 
soon after the completion of the treatment, and in a large number of 
instances insanity or other serious psychoses have developed immediately 
after the subjects had been through one of these so-called "cures." 



AVENA SATIVA, — the common Oat, a plant of the nat. ord. Graminaceae, — was 
official in the U. S. P. 1870, as Avence Farina, or Oat-meal. A concentrated tincture 
or fluid extract has been extensively advertised by drug manufacturers as a nerve stimu- 
lant and tonic, especially efficacious in the treatment of chorea, epilepsy, insomnia, ner- 
vous exhaustion, alcoholism and the opium-habit. The seeds contain starch, gluten, 
gum, etc., and form a nutritious food, the meal being made into a porridge, or gruel. In 
the latter form it is a good demulcent for coughs. The pericarp contains an amorphous 
alkaloid, which has doubtless some stimulant and narcotic power ; but the claims 



BALSAMUM PERUVIANUM BALSAMUM TOLUTANUM. 211 

advanced for it, as a specific remedy for the cure of the opium-habit, have been strenu- 
ously denied by many competent observers. Dose of the concentrated tincture or fluid 
extract may be stated at TT\,x-gij. 

AZEDARACH (Unofficial), — is the bark of the root of Melia Azedarach, or Pride 
of China, a handsome tree of the nat. ord. Meliacese, indigenous to China and India, but 
naturalized in the Gulf States. A decoction of the fresh bark (^ij to Oj boiled to 
0)4) ma y be used in tablespoonful doses. 

This drug is known to produce symptoms of narcotic poisoning, as giddiness, dimness 
of sight, mental confusion, stertorous breathing, dilated pupils and stupor. Large doses 
are necessary to cause these effects, and some authorities question their occurrence. It 
is, however, a gastro-intestinal irritant, producing vomiting and purging, and also an 
anthelmintic against the round-worm. Its active principle has not been isolated. It is 
only employed as an anthelmintic against lumbricoid worms, and as the fresh 'bark is dif- 
ficult to obtain in any region where it does not grow, other agents are more generally 
used. It is given to horses affected with " bots." 



BALSAMUM PERUVIANUM, Balsam of Peru,— is a bal- 
sam obtained from Toluifera Pereirce, a Central American tree, of the 
nat. ord. Leguminosse. It occurs as a thick, brown-black liquid, its odor 
reminding of benzoin and vanilla, soluble in 5 of alcohol, almost insolu- 
ble in water, which extracts from it only some Cinnamic Acid and Cin- 
namein. It is not a true balsam, as it contains no volatile oil. Its com- 
position is : Cinnamein (Benzyl Cinnamate, C 16 H u 2 ) 60 per cent., Cin- 
namic Acid 6 per cent., Resins 30 per cent.; also Benzoic Acid and 
other bodies. Dose r^x-xxv, in emulsion. There are no official prepara- 
tions. 

The action of Balsam of Peru is that of its several constituents, namely, 
antiseptic, disinfectant, stimulant to the circulation, and sedative to the 
nervous system; acting chiefly on the mucous membrane, it is tonic and 
expectorant, diuretic and diaphoretic. In large doses, it causes gas- 
tralgia, nausea and vomiting, colic and diarrhea. It closely resembles in 
physiological action its congeners, Styrax and Benzoin. 

Balsam of Peru is used locally in chronic skin diseases of inflammatory 
type and sore nipples, to relieve itching, cleanse bed-sores, promote the 
healing of wounds and ulcers, and to kill the acarus scabiei, being con- 
sidered by some authorities the best of all applications in itch. Inter- 
nally, it is used as a stimulant and disinfectant expectorant in chronic 
bronchitis, asthma, etc., as well as in gonorrhea, gleet, leucorrhea, and 
other discharges from mucous membranes. Incorporated with Iodoform 
it partially covers the odor of that drug. 

BALSAMUM TOLUTANUM, Balsam of Tolu,— is a balsam obtained from 
Toluifera Balsamum, a tree of the nat. ord. Leguminosse, native in Venezuela and New 
Granada. Its composition and properties are similar to those of Balsamum Peruvianum, 
except that it is of lighter color, more agreeable odor, and contains a volatile oil, Tolene, 
in the proportion of about I per cent. 

Tinctura Tolutana, Tincture of Tolu, — contains 10 per cent, of the Balsam dis 
solved in alcohol. Dose, n\x-xxx. 



212 BAPTISIA BELLADONNA. 

Syrupus Tolutanus, Syrup of Tolu, — has of the Balsam I per cent., with Sugar 85, 
Alcohol 5, and Water to 100. It is much used in cough mixtures, and covers the taste 
of Chloral Hydrate well. Dose, gj-ij. 

Balsam of Tolu has similar action to that of Balsam of Peru, but being more agree- 
able in flavor it is more used internally than the latter. It is chiefly employed as a 
pleasant excipient in cough mixtures, and is a constituent of the Compound Tincture of 
Benzoin. 

BAPTISIA, Wild Indigo (Unofficial),— is the root bark of Bap- 
tisia tinctoria, a plant of the nat. ord. Leguminosse, native in North 
America, and contains an alkaloid and a resin, neither of which have been 
examined critically. The so-called Baptisin is an impure resinoid, ob- 
tained by precipitation from the alcoholic extract with water. 

Unofficial Preparations. 
Extractum Baptisise, Extract of Baptisia, — Dose, gr. j-x. 
Extractum Baptisiae Fluidum, Fluid Extract of Baptisia, — Dose, nyj-xx. 
Tinctura Baptisiae, Tincture of Baptisia, — Dose, Tt\v-xxx. 
Baptisin, — the resinoid. Dose, gr. j-v. 

Baptisia has a bitter and acrid taste ; in small doses it is laxative, in 
large ones violently emeto-cathartic, and may excite severe gastrointesti- 
nal inflammation. It is a decided stimulant of the liver, and increases 
the secretions of the glandular appendages of the gastro-intestinal mucous 
membrane. It has considerable power as an antiseptic. 

Baptisia has been used locally in decoction or cataplasm to obstinate 
and painful ulcers, in threatening or existing gangrene and gangrenous 
sores. Internally, it is a useful remedy in amenorrhea, typhoid and 
typhus fevers, variola, scarlatina, and epidemic dysentery. In the 
common continued fever, or in the first stage of typhoid, it will be 
found of great service in drop-doses of a fresh tincture, repeated every 
hour. 

BARII DIOXIDUM, Barium Dioxide, Barium Peroxide, Ba0 2 , — is the commer- 
cial anhydrous Barium Dioxide, a heavy, grayish-white, amorphous powder, odorless 
and tasteless : gradually decomposed by exposure to the air, from which it slowly takes 
up moisture and carbon dioxide. Used to prepare the Aqua Hydrogenii Dioxidi. 

Though almost insoluble in cold water, Barium Dioxide forms therewith a definite 
hydrate, and imparts thereto an alkaline reaction. It is decomposed by most of the 
mineral acids, producing the corresponding barium salts, and liberating Hydrogen 
Dioxide, H 2 2 , which remains in the solution for a considerable length of time, if the 
reaction has taken place in the cold, and if an excess of the acid is present. In this 
way is prepared the official Aqua Hydrogenii Dioxidi (Solution of Hydrogen Peroxide), 
for which see the title Oxygenium. 

BELLADONNA, Deadly Nightshade.— The Atropa Belladonna 
is an herbaceous, perennial plant, of the nat. ord. Solanaceae, having 
dark-purple, bell-shaped flowers, and glossy, purplish-black berries about 
the size of cherries. It is indigenous in the mountainous districts of 
Central and Southern Europe and Asia, and is cultivated in Europe and 



BELLADONNA. 2 I 3 

in the United States. It contains two alkaloids, — the official Atropine 
(see below), and Belladonnine, the latter being considered by many 
authorities as identical with Hyoscyamine, Daturine, and Duboisine. 
They exist in the plant in combination with Malic Acid. The plant also 
contains the usual vegetable constituents, as albumin, gums, etc., and a 
coloring principle named Atrosin. The official titles are as follows : — 

Belladonnse Folia, Belladonna Leaves, — ovate and tapering, brown- 
ish-green above, grayish-green below, of slight odor and bitter, disagree- 
able taste. Stramonium leaves are more wrinkled, Hyoscyamus leaves 
are more hairy. Dose, gr. j, gradually increased. 

Belladonnae Radix, Belladonna Root, — cylindrical, tapering, 
wrinkled pieces, ^ to i inch thick, nearly odorless, taste bitter and 
acrid. Dose, gr. j, cautiously increased. 

Preparations of the Leaves. 

Extractum Belladonnse Foliorum Alcoholicum, Alcoholic Extract of Belladonna 
Leaves. — Dose, gr. j 1 ^ to \. 

Tinctura Belladonnae Foliorum, Tincture of Belladonna Leaves, — 15 per cent. 
Dose, TT\j-xxx. 

Emplastrum Belladonnae, Belladonna Plaster, — has of the above extract 20 per 
cent., mixed with Resin and Soap Plasters, of each 40 per cent. It may produce the 
physiological action of the drug. 

Unguentum Belladonnae, Belladonna Ointment, — has of the above extract 10, 
Diluted Alcohol 5, Benzoinated Lard 85. 

Preparations of the Root. 

Extractum Belladonnae Radicis Fluidum, Fluid Extract of Belladonna Root. — 
Dose, n\j-v. 

Linimentum Belladonnae, Belladonna Liniment, — has of Camphor 5, dissolved in 
Fluid Extract of Belladonna Root to 100. 

Atropine and its Derivatives. 

Atropina, Atropine, C lt H 23 N0 3 , — white, acicular crystals, odorless, of bitter taste 
and alkaline reaction ; very soluble in alcohol and in chloroform, also in 130 of water at 
59 F. Is decomposed by prolonged contact with caustic alkalies and is resolvable into 
Tropin and Tropic Acid. 

Atropinae Sulphas, Atropine Sulphate, (C n H 23 N0 3 ) 2 H 2 S0 4 , — a white powder of 
bitter taste and neutral reaction, soluble in 0.4 of water and in 6.2 of alcohol at 59 F. 
Dose, gr. T |o-<nr- 

Homatropina, Homatropine, C 16 H 21 N0 3 (Unofficial), — is a derivative alkaloid, ob- 
tained by the action of dilute HC1 on Amygdalate of Tropin. The Hydrobromate is 
used by ophthalmologists as a mydriatic, its effects passing off much sooner than those of 
Atropine. Homatropine slows the heart, Atropine quickening it. 

Tropeius (Unofficial), — is a result of the action of a mineral acid on Tropin. 



Physiological Action. . 
Belladonna is an irritant narcotic, a mydriatic, an antispasmodic and 
an anodyne : in small doses a cardiac, respiratory and spinal stimulant ; 
in large doses a paralyzer of the cardiac and respiratory centres, the spinal 



214 BELLADONNA. 

cord, the motor nerves and the involuntary muscles. It produces conges- 
tion and dryness of the mucous membrane of the throat, mouth, nose, and 
larynx, and at first lessens the gastric and intestinal secretions, but soon 
reproduces these in large quantity. The heart rate is at first slowed, but 
soon becomes very rapid and vigorous, the pulse being doubled in rapid- 
ity ; the arterial tension being at the same time raised, the circulation is 
greatly increased. This is accomplished by stimulation of the cardiac 
sympathetic, and paralysis of the pneumogastric, thus stimulating the 
accelerator apparatus while lessening the inhibitory. [Digitalis increases 
both.] The vasomotor ganglia are stimulated all over the body, but are 
afterwards paralyzed by over-stimulation, the heart weakens, the vessels 
relax, and the blood-pressure becomes greatly reduced. Complete motor- 
paralysis follows, delirium, stupor, and finally death, which usually occurs 
by asphyxia. 

The pupils are dilated by either the local or systemic use of the drug, 
which stimulates the end-organs of the sympathetic and paralyzes those of 
the motor oculi, thus increasing the power of the radiating iris fibres and 
lessening the action of its circular ones. Atropine applied locally also 
paralyzes accommodation and increases the intraocular pressure. The 
least quantity of Atropine which will affect the pupil is stated at gr. 10 o 00 
(Wood), gr. 2 o^- (Roosa), gr. ^^ (Ely), gr. y-rsWo (Trousseau), 
g r - 46T000 ( Lorin g)> g r - TooiR) it (Bonders). 

The brain is congested by Belladonna, headache, vertigo, busy delirium, 
and hallucinations being produced, the latter from a selective action on 
the cells of the gray matter. The spinal cord is stimulated from the 3d 
cervical vertebra to the 10th dorsal, resulting in complete motor paraly- 
sis, central and peripheral, power being lost first in the lower extremities. 
Sensation is also impaired somewhat, but the muscular irritability is not. 
Respiration is increased and the body-temperature elevated. Metamor- 
phosis is greatly promoted by the increased activity of the circulation. A 
diffused eruption of scarlet color, closely resembling the eruption of scar- 
let fever, is often produced on the skin and fauces by Belladonna, with 
dysphagia and sore throat, and is sometimes followed by desquamation of 
the epidermis. It is due to capillary congestion caused by the greatly 
increased circulation. 

Belladonna is rapidly diffused and quickly eliminated, particularly by 
the kidneys. The urine of an animal under the action of the drug will 
dilate the pupil of another animal. Herbivorous animals and birds are 
scarcely susceptible to it, and pigeons are not affected by it at all. 

Atropine has the same actions as those above described, being the active 
principle of the plant. Belladonnine was long supposed to be inert, but 
has recently been shown to be identical with Hyoscyamine. It is a myd- 
riatic when given internally, but not when used locally. 



BELLADONNA. 2 I 5 

Antagonists, Antidotes , and Incompatibles. 

Opium is the physiological antagonist to the effects of Belladonna on the cerebrum, 
pupil, heart, respiration, arterial tension and kidneys. Physostigmine , Aconite, Pilocar- 
pine and Quinine are each antagonistic to some of its effects, Muscarine, to most of them. 
In poisoning by this drug, Tannic Acid and emetics should be used, then Morphine, 
Physostigmine or Pilocarpine for the nervous disturbance. Caustic alkalies decompose 
Atropine and are therefore incompatible with the preparations of Belladonna. 

Therapeutics. 

Belladonna is one of the most valuable drugs in the Materia Medica, 
ranking with Aconite, Arsenic and Opium in efficacy and wide range of 
use. It is especially efficient in the pain of inflammation, particularly 
that of rheumatism, gout, neuralgia due to peripheral disturbance, sciatica, 
cancer and pelvic affections. In cerebral and spinal hyperemia, conges- 
tive headaches, encephalitis, meningitis and myelitis it proves one of the 
very best remedies. In erysipelas of superficial and non-vesicular charac- 
ter and when cerebral, it is really curative when locally and internally 
administered. Inflammations of the lungs, iris, bladder kidneys and 
breasts are all amenable to it. In constipation from atony of the bowels 
it is remarkably effective, 'and in the enuresis of children it is equally so 
if used freely, 10 to 20 drops of the tincture thrice daily. In recent cys- 
titis from chill, spasm of the urethra, bladder and sphincter ani, typhus 
and typhoid fevers, acute nasal catarrh, sore throat with fever, inflamed 
and swollen tonsils, in many skin diseases, in asthma and whooping- 
cough, epileptic and puerperal convulsions, spermatorrhea and seminal 
losses, Belladonna is often a highly useful agent. Its local application is 
efficiently used in ulcers of the rectum, anal fissure, abscesses, boils, car- 
buncles and other superficial inflammations. In scarlet fever it relieves 
many of the symptoms, and is especially indicated in this disease when 
the rash is imperfect, the pulse feeble and the condition one of adynamia. 
Its prophylactic power against scarlet fever is believed in by many of our 
best practitioners, though questioned by many others. 

Atropine is used in poisoning by Opium, Physostigma, and Hydrocy- 
anic Acid ; in ptyalism from mercury, pregnancy, etc. ; in the sweats of 
phthisis, in sudden cardiac failure, and by eye-surgeons to paralyze 
accommodation, dilate the pupil, contract the vessels, lessen pain, and 
diminish (?) intra-ocular tension. In opium-poisoning it should be given 
in very small doses, and repeated for effect, as most of the unsuccessful 
cases of its use in this connection were due to overdosing with the antag- 
onist, superinducing belladonnarnarcosis upon the opium-narcosis. In 
cases of heart-failure from Chloroform or Ether inhalation, the hypoder- 
mic injection of Atropine has, in the writer's hands, saved several lives 
when all other methods of resuscitation had failed. It is highly efficient" 
in lead poisoning, if used in combination with Potassium Iodide ; and 



2 1 6 BENZINUM BENZOINUM. 

has given the most satisfactory results as a hemostatic in profuse metror- 
rhagia after abortion, in metrorrhagia of obscure origin, and in phthisical 
hemoptysis. 

BENZINUM, Benzin {Petroleum Ether}, — is a purified distillate from American 
petroleum, and consists of a mixture of hydrocarbons, chiefly of the marsh-gas series 
(C 5 H 12 .C 6 H U , and homologous compounds). It is a transparent, colorless liquid, very 
diffusive, highly inflammable, insoluble in water, soluble in alcohol, ether, chloroform, 
benzol and fixed and volatile oils. Its sp. gr. is 0.670 to 0.675, an d its boiling point 
122 to 140 F. It should be carefully kept in well-stoppered bottles or tin cans, in a 
cool place, remote from lights or fire. Dose, gtt. v-x, on sugar or in mucilage. 

Benzin taken internally in overdose is known to produce gastro-enteritis, and such a 
case is reported which terminated fatally. In the ordinary medicinal doses it does not 
produce either vomiting or diarrhea. Benzin-poisoning may be produced by its inhala- 
tion, which is becoming quite a practice among glove-cleaners, and alcoholics have been 
known to take to inhaling benzin in place of drinking spirits. It has been used with 
some success externally as a remedy for rheumatic pain, neuralgia, itch and prurigo ; 
and internally as a vermicide against tapeworm. In pharmacy it has many uses on 
account of its power as a solvent for oils, fats, resins, caoutchouc and some alkaloids. 
In the household it is used as a solvent application for removing grease from clothing. 

BENZOINUM, Benzoin, — is a balsamic resin obtained from 
Styrax Benzoin, a tree of the nat. ord. Styraceae, native in Sumatra and 
Siam, by incision of its bark. It occurs in agglutinated tears or a brown, 
mottled mass, is soluble in alcohol and solution of potassa, and is com- 
posed of Resins 80 per cent., Benzoic Acid 10 to 20 per cent., and a 
trace of Volatile Oil. Some varieties yield also Cinnamic Acid. 

Adeps Benzoinatus, Benzoinated Lard, — is prepared by suspending the powdered 
Benzoin, tied up in coarse muslin, in melted Lard, in the proportion of 2 parts to 100, 
for 2 hours, then removing the residual benzoin, and occasionally stirring the lard as it 
cools. When intended for use in warm weather 5 per cent, or more of the lard should 
be replaced by White Wax. 

Tinctura Benzoini, Tincture of Benzoin, — has of Benzoin 20 parts, Alcohol 100. 
Dose, gss-j. 

Tinctura Benzoini Composita, Compound Tincture of Benzoin (F)'iar'' s Balsam), — 
has of Benzoin 12, Aloes 2, Styrax 8, Balsam of Tolu 4, Alcohol to 100. Dose, 3 ss— ij . 

Benzoic Acid and its Salts. 

Acidum Benzoicum, Benzoic Acid, HC 7 H 5 2 , — occurs in light, feathery plates and 
needles, and is obtained from Benzoin by sublimation, or prepared artificially, chiefly 
from Toluol. It is soluble in 500 of water, and in 2 of alcohol at 59 F., but its solu- 
bility in water is aided by Borax, one part of each being soluble in 100 parts. It is a 
constituent of Tinctura Opii Camphorata. Dose, gr. x-xxv, in wafers. 

Ammonii Benzoas, A??imonium Benzoate, — is soluble in 5 parts of water and in 28 
of alcohol. Dose, gr. v-xxx. 

L-ithii Benzoas, Lithium Benzoate, — soluble in 4 parts of water and in 12 of alcohol. 
Dose, gr. v-xxx. 

Sodii Benzoas, Sodium Benzoate, — is efflorescent on exposure to air, soluble in about 
2 parts of water and in 45 of alcohol. Dose, gr. v-^j. 

Physiological Action and Therapeutics. 
Benzoin is decidedly antiseptic and disinfectant, and when used exter- 
nally is slightly stimulant to the vessels. Its action is due to its Ben- 



BENZOLUM. 2 I J 

zoic Acid, which taken internally produces slight epigastric heat, increases 
the pulse-rate, and stimulates the action of the skin, the salivary glands, 
and the bronchial mucous membrane. It is principally excreted by the 
kidneys, in part as hippuric acid by combination with glycocoll, and in 
part unchanged. It renders the urine acid and increases its quantity. 
It is irritant to the fauces, and the powder when inhaled excites sneez- 
ing and coughing. 

Benzoin is principally used as a stimulant expectorant, especially in the 
chronic bronchitis of the aged, and by atomization in laryngeal affec- 
tions. The compound tincture, 3J to gj in a pint of boiling water, is a 
useful sedative inhalation for the irritation and cough of subacute laryn- 
gitis and tracheitis. It has also been used beneficially in chlorosis and 
some uterine disorders. The compound tincture is a good local applica- 
tion (i part to 4 of glycerin and water) for sore nipples and chaps of the 
hands and lips. For use as a cosmetic, either tincture is mixed with 20 
parts of water, and employed to remove freckles and for other skin affec- 
tions, especially urticaria. The tinctures are excellent applications to 
foul-smelling wounds, and form the basis of all the proprietary pre- 
parations sold for that purpose. 

Benzoic Acid and its salts are the only certain means we possess, by 
which to neutralize morbid alkalinity of the urine. In cystitis, with 
phosphatic deposits and alkaline urine, they are extremely valuable, acid- 
ulating the secretion, and stimulating and disinfecting the mucous sur- 
faces involved. Phosphatic calculi are said to be dissolved by the long- 
continued use of Ammonium Benzoate. 

Sodium Benzoate has been largely used as a substitute for the salicy- 
lates in the septic diseases, being equally antiseptic and antipyretic. 
Though slower in action, its effects are more permanent, and it is capable 
of being used in larger doses (gij-iij daily). In diphtheria and scarlet 
fever it has been highly efficient, and in acute rheumatism, typhoid and 
the malarial fevers it has rendered good service. In phthisis, its use by 
inhalation to the extent of 10 i 06 of the body-weight daily has seemed to 
be of value. It has also proved very efficient in whooping-cough. 

Lithium Benzoate is intended for use in gout and the uric acid 
diathesis, with the object of forming the very soluble urate of lithium in 
the system, as also on the theory that, as benzoic acid is converted into 
hippuric acid at the expense of nitrogenous material which would other- 
wise become uric acid, the latter product will be lessened. 

BENZOLUM, Benzol {Benzene, Phenyl Hydride), C 6 H 6 (Unofficial),— is a con- 
stituent of coal-gas tar, obtained by distilling coal naphtha. It is a thin, colorless, 
oleaginous liquid, very inflammable, of agreeable odor, and sp. gr. 0.850. It is very 
diffusible, and the vapor, when inhaled, acts as an anesthetic. Dose, gtt. v-x, on sugar, 
in emulsion or capsules, up to gjss daily. 

Benzol is a reliable pulmonary antiseptic, and has been used successfully in the treat- 



2l8 BERBERIS — BERGAMOTT^ OLEUM BISMUTHUM. 

merit of whooping-cough, the vapor being diffused throughout the room, and proximity 
to a light or fire being carefully avoided. It has made quite a reputation in the treatment 
of influenza, and has been found effectual in destroying both head and body lice, for 
which purpose a single application is usually sufficient. It has also been given internally 
for the destruction of trichinae, followed by a brisk laxative ; and, mixed with lard, it 
is used externally in parasitic skin diseases, especially scabies, also in rheumatism and 
neuralgia. 

BERBERIS, Barberry (Unofficial), — is the root of several species of the nat. ord. 
Berberidacese, the one generally used being the Berberis aquifolium, or Oregon grape, 
which grows on the Pacific slope of the United States. Its value is probably due to its 
alkaloid, Berberine, C 20 H n NO 4 , a yellow, crystalline body, soluble in hot water and 
alcohol, but not in ether, which is found also in several other plants, as Hydrastis, Coptis, 
Podophyllum, Menispermum, Calumba, Xanthoxylum, etc. 

Extractum Berberidis Fluidum, Fl. Extr. of B. (Unofficial), — Dose, tt\v-xxx. 

Tinctura Berberidis, Tincture of Berberis (Unofficial), — I to 5. Dose, rt\x- gj. 

Berberina, Berberine (Unofficial), — Dose, gr. j-x. It usually occurs in commerce 
as Hydrastin, which is a Berberine Hydrochlorate prepared from Hydrastis. 

Berberis is an astringent bitter, a tonic and stomachic in small doses, but in large 
doses it is cathartic, producing watery diarrhea with abdominal pain. It is also believed 
to possess considerable alterative powers. It has been successfully used as a local appli- 
cation in conjunctivitis, and internally as a remedy for intermittent, remittent and typhoid 
fevers, diarrhea and dyspepsia. As an alterative and tonic it is useful in syphilitic and 
strumous affections, and in pain, soreness and burning sensations along the biliary or 
urinary tracts with a tendency to gravel or gall-stones it will be found a useful remedy. 

Berberine has some antiseptic and antiperiodic value, but in large doses is a gastro- 
intestinal irritant. The Hydrochlorate is a useful injection in gonorrhea, in which it acts 
by virtue of its antiseptic and astringent powers. 

BERGAMOTTiE OLEUM, Oil of Bergamot,— is a volatile oil, extracted from 
the rind of the fresh fruit of Citrus Bergamia, an orange-tree of the nat. ord. Aurantia- 
ceee, native in Southern Europe. It is of greenish color, faintly acid, and is soluble in 
alcohol, glacial acetic acid and liquor potassae. It contains several hydrocarbons of the 
formula C 10 H 16 , together with Bergaptene or Bergamot Camphor. It is an ingredient of 
Spiritus Odoratus, and is exclusively used as a perfume in the manufacture of toilet 
articles. 

BISMUTHUM, Bismuth, BL— This metal is represented in med- 
icine by four official salts and several unofficial ones, the most impor- 
tant of which are the following : — 

Official Salts of Bismuth. 

Bismuthi Citras, Bismuth Citrate, BiC 6 H 5 7 , — a white, amorphous powder, odor- 
less and tasteless, insoluble in water or alcohol, soluble in Water of Ammonia. Used 
only for pharmaceutical purposes. 

Bismuthi et Ammonii Citras, Bismuth and Ammonium Citrate, — is a combination 
of the citrate with aqua ammonise, and has no definite chemical composition. Small, 
pearly scales, very soluble in water, sparingly in alcohol. Dose, gr. j-v. 

Bismuthi Subcarbonas, Bismuth Subcarbonate, — a white or yellowish- white pow- 
der, of somewhat varying chemical composition, tasteless and odorless, insoluble in water 
or alcohol. Dose, gr. v-xxx, in powder or emulsion. 

Bismuthi Subnitras, Bismuth Subnitrate, — a heavy, white powder, of somewhat 
varying chemical composition, odorless and almost tasteless, of slightly acid reaction ; 
insoluble in alcohol, almost insoluble in water. Dose, gr. v-xxx, several times a day, in 
powder, pill, or milk ; often combined with opium, morphine or belladonna. 

Unofficial Salts of Bismuth. 
Bismuthi Salicylas, Bismuth Salicylate, — exists in two forms, the acid salt and the 
basic salt, the latter being the one used therapeutically. It contains 76 per cent, of the 



BISMUTHUM. 219 

oxide of bismuth, and 23 per cent, of salicylic acid ; and occurs as a white, crystalline 
salt, almost entirely insoluble in water, alcobol or glycerin. It should give no reaction 
with perchloride of iron. Dose, gr. v-xx. 

Bismuthi Subiodidum (Oxyiodidum), Bis?7iuth Stibiodide, — a brick-red, heavy, 
amorphous powder, insoluble in water, insoluble in any reagent without decomposition. 
Used locally as an antiseptic dusting powder, and internally in doses of gr. jss-iij. 

Bismuthi Subgallas, Bismuth Subgallate (Dermatol), — a fine, odorless, saffron- 
yellow powder, insoluble in all ordinary solvents. Dose, gr. v-xxx. 

Bismuthi Oleas, Bismuth Oleate, — a pearly-gray, soft, bland substance. [See under 
Acidum Oleicum, ante, p. 103.] 

Airol, Bismuth Oxy-iodo-gallate, — is a patented combination of Bismuth Subgallate 
and Iodine, occurring as a bulky, gray powder, odorless and tasteless, insoluble in water 
or alcohol. It is used as a dusting powder for ulcers and wounds, or mixed with Vaselin 
or Lanolin as an ointment. 

Eudoxin, Bismuth Tetra-iodo-phenol-phtalein, — is a bismuth salt of Nosophen and 
contains about 53 percent, of Iodine and 14 per cent, of Bismuth. It occurs as a red- 
dish-brown, odorless and tasteless powder, insoluble in water. It is said to be an effi- 
cient internal antiseptic for gastric and intestinal affections. Dose, for children, gr. j-iij ; 
for adults, gr. iij-viij. 

Orphol, Bismuth Beta-naphtolate, — contains from 50 to 70 per cent, of Bi 2 3 also 
Beta-naphtol , and is a reddish-brown powder, insoluble in water, and recommended as an 
intestinal antiseptic and astringent. Dose, gr. v-xx, up to a daily quantity of gr. xv for 
children and gr. xlv for adults, given with honey or milk. 

Xeroform, Bismuth Tri-brom-phenol, — is a patented preparation which contains 
about 50 per cent, of Bi 2 3 and occurs as a yellow, insoluble powder, having a faint 
odor of carbolic acid. It is almost non-toxic and unirritating to mucous surfaces. It is 
an excellent surgical and intestinal antiseptic, and has been used locally with benefit in 
chancroids, buboes, foul ulcers, infected wounds, burns, eczema and other skin diseases. 
It has been given internally with satisfactory results in cholera, intestinal catarrh and the 
summer diarrhea of children, also for chronic urticaria and certain forms of infantile 
eczema. Dose, gr. vij-xv, three times a day. 



Physiological Action. 
The action of the insoluble Bismuth salts is chiefly a local one, they 
being sedative to the end-organs of the nerves, though a minute quantity 
passes into the blood and acts as a tonic, promoting constructive meta- 
morphosis by increasing the appetite and digestion. They are also feebly 
astringent, and produce constipation after a time, coloring the stools and 
tongue a dark clay color, from their conversion in part into the sulphide. 
Toxic effects when occurring are ascribed to Arsenic, with which the 
commercial preparations were formerly contaminated* Lately, however, 
it has been shown that Bismuth salts possess toxic powers of their own, 
and that the symptoms of bismuth-poisoning may develop when these 
preparations are applied as a dressing to a large, denuded surface, or 
taken internally in large doses for a long period of time. A black line 
along the margins of the gums, headache, nausea, vomiting, pale face, 
elevated temperature, rapid pulse, edema of the lower extremities, 
diarrhea, and an odor of urine on the breath are some of the symptoms 
observed in such cases. Black and gangrenous sloughs may occur in the 
intestines, and the urine may contain albumin. 



220 bismuthum. 

Therapeutics. 

The insoluble Bismuth salts are used internally in many forms of dis- 
ordered digestion, gastralgia, vomiting and diarrhea, especially in chil- 
dren, but large doses are necessary for efficiency. The best vehicle for 
them is milk. Locally they are used with advantage in acne rosacea, 
stomatitis, nursing sore mouth, eczema, intertrigo, ulcers, conjunctivitis, 
coryza, gonorrhea, gleet and leucorrhea. The Subnitrate is regarded by 
many practitioners as almost a specific in cholera infantum, given in 
hourly doses of 3 to 6 grains : also in the diarrhea of phthisis, in dysen- 
tery and intestinal ulceration, it is highly efficient, in doses of 15 grains 
every hour or two. Externally, it is employed as a dusting powder, 
either pure or mixed with starch (1 to 5) ; as a drying application for the 
nasal, pharyngeal and laryngeal mucous membranes; in suspension as an 
injection in gonorrhea (4 to 10 per cent.) ; and with vaselin (10 to 15 
per cent.) as an ointment in eczema, also for burns and wounds. 

The Bismuth and Ammonium Citrate being soluble, is more rapid in 
action, but also more astringent and irritant than the other salts, though 
it is probably precipitated in the stomach by the hydrochloric acid of the 
gastric juice. It is serviceable in diarrhea without irritation of the intes- 
tinal mucous membrane, but rather with relaxation thereof. The Sali- 
cylate (basic salt) when pure is well borne by the stomach, and can be 
used for longer periods than the subnitrate. It has been especially 
serviceable in the diarrhea of phthisis, in that of typhoid fever, and in 
chronic gastric and intestinal disorders. It is highly praised as an internal 
antiseptic in dilatation of the stomach, also to prevent fermentation in 
the intestinal canal after operations. 

The Subgallate, also known as Dermatol, is one of the many proprietary 
substitutes for Iodoform, and has been patented in this country. It has 
great stability, as well as valuable drying and bactericidal qualities, and 
is an excellent vulnerary for wounds and burns. It has proven useful in 
the treatment of moist eczema, ulcers, and other affections of the eye, 
diseases of the middle ear and dental caries. It occasionally produces 
dermatitis, and Dr. Cantrell holds that it is decidedly irritating, is a 
stimulant rather than an astringent, does not check but rather increases 
discharge, and does not fulfil the claims made for it. Efforts are made 
to show value for it as an internal remedy in fermentative dyspepsia and 
gastric catarrh. It is efficiently employed internally for diarrhea in doses 
of 20 grains every two or three hours. 

The Oleate is credited with mildly astringent and emollient properties, 
having been used with- benefit in pustular affections of the skin and in 
acne. The Subiodide is an exceedingly valuable agent in the treatment 
of burns, wounds, ulcers, and similar affections as a substitute for Iodo- 
form. (See under Iodum.) 



BOLDUS BROMUM. 221 

BOLDUS, Boldo (Unofficial), — the leaves and stems of Peumus Boldtis, an ever- 
green shrub of the nat. ord. Monimiaceae, found in Chili. It contains a volatile oil and 
a bitter alkaloid, Boldine. A tincture is made (i to 5), of which the dose is ir^v-viij, 
gradually increased, but large doses have a somewhat narcotic effect, besides causing 
vomiting and purging. 

Boldo is used in anemia, rheumatism, dyspepsia and general debility, also in catarrhal 
affections of the urinary passages, and as a substitute for Quinine. In France it is em- 
ployed as a tonic, especially for cases with chronic torpor of the liver ; and in South 
America it is much used in gonorrhea and in chronic cystitis. 

BROMUM, Bromine, Br, — is a dark, brownish-red, volatile liquid, 
evolving an irritant vapor of peculiar and suffocating odor. It is soluble 
in 30 of water at 59 F., very soluble in alcohol, ether, chloroform and 
carbon disulphide ; is a non-metallic element found in sea-water and in 
the mother-liquid of certain salt-works, usually in combination. On ex- 
posure to air or heat it is completely volatilized. It destroys the color 
of solutions of litmus and indigo, and imparts a yellow color to solution 
of starch. It is used only by inhalation and locally as an escharotic. 

Bromides and their Preparations. 

Potassii Bromidum, Potassium Bromide, KBr, — colorless, cubical crystals, soluble 
in 1.6 of water and in 200 of alcohol. Dose, gr. ij-gj, well diluted. 

Sodii Bromidum, Sodium Bromide, NaBr, — colorless, monoclinic crystals, soluble 
in 1.2 of water and in 13 of alcohol. Dose, gr. ij-gj, well diluted. 

Lithii Bromidum, Lithium Bromide, LiBr, — a white, granular, deliquescent salt, 
very soluble in water and in alcohol. Dose, gr. ij-xx, well diluted. 

Ammonii Bromidum, Am?noniu?n Bromide, NH 4 Br, — colorless, prismatic crystals, 
soluble in 1 .5 of water and in 30 of alcohol. Dose, gr. ij-xx, well diluted. This Bromide 
is well borne by children in comparatively large doses if epileptic from reflex causes. A 
child one year old can tolerate gr. v every 4 hours (Barton). 

Calcii Bromidum, Calciu?n Bromide, CaBr 2 , — a white, granular, deliquescent salt, 
very soluble in water and in alcohol. Dose, gr. ij-£J, well diluted. 

Strontii Bromidum, Strontium Bromide, SrBr 2 (H 2 0) 6 , — colorless, hexagonal crys- 
tals, very deliquescent, very soluble in water and in alcohol ; insoluble in ether. Dose, 
gr. ij-xxx, well diluted. 

Zinci Bromidum, Zinc Bromide, ZnBr 2 , — a white, granular, deliquescent powder, 
very soluble in water and in alcohol. Dose, gr. y 2 — ij, well diluted. 

Syrupus Ferri Bromidi, Syrup of Iron Bromide (Unofficial), — is a syrupy liquid 
containing 10 per cent, of Ferrous Bromine, FeBr 2 , prepared by acting on Iron Wire 35 
parts with Bromine 75, adding Sugar 600 and Water up to 1000 parts. A translucent, 
pale-green, odorless liquid of sweet, ferruginous taste and neutral reaction. Dose, 3 ss-j. 

Bromoformum, Bromoform, Tri-bromo-methane, CHBr 3 , (Unofficial), — is prepared 
by the action of sodium hypobromite on acetone, or by the action of bromine upon a 
solution of equal parts of caustic potash and methyl alcohol. A clear and colorless 
liquid, of pleasant odor and sweet, agreeable taste ; slightly soluble in water, readily 
soluble in alcohol and in glycerin. Dose, TT\,v-xx. If it has color it should be rejected 
as unsafe by reason of decomposition. 

Acidum Hydrobromicum Dilutum, Diluted Hydrobromic Acid, — is composed of 
10 per cent, of absolute Hydrobromic Acid (HBr), and 90 per cent, of water. It is a 
clear, colorless, and odorless liquid, of a pungent acid taste, produced by decomposing 
Potassium Bromide by Sulphuric Acid and distilling. Dose, rr^xx-^ij. 

Arsenic Bromide is described on page 199, Aurum Bromide on page 206, Ethyl 
Bromide on pages 113 and 116, and Camphora Monobromata under Camphora. 



222 BROMUM. 

Physiological Action. 

Bromine is an active and very painful escharotic, a deodorant and an 
antiseptic, setting free ozone. Its vapor is highly irritant to the respira- 
tory mucous membrane and the eyes, producing cough, hoarseness and 
dyspnea. Internally, it is an active, corrosive poison, causing violent 
gastritis, depression and collapse. 

The Bromides are powerful depressants of the cerebral and spinal func- 
tions, also alterative, antispasmodic and hypnotic. The Potassium salt 
is a cardiac and muscular paralyzant. Bromides have a saline taste 
and are very diffusible, but slowly eliminated. They are decomposed 
in the blood, and re-formed at the points of elimination (fauces, bronchi, 
intestines, skin and kidneys), where they irritate the mucous mem- 
branes. Continued for some time, they produce severe gastric catarrh. 
They reduce the number of the respirations, and the heart's action 
and force; and though diminishing the calibre of the arterioles, they 
lower arterial tension. They lessen the activity of the brain cells, pro- 
ducing somnolence ; and diminish the sensibility of the peripheral nerves, 
causing anesthesia of the skin and mucous membranes. They impair 
motility and the sexual function, cause great pallor and emaciation, low- 
ered body-temperature, acne on the face and upper extremities, fetid 
breath, dysphagia, sluggish reflexes and defective coordination ; and if 
long continued may even impair the mental faculties, producing halluci- 
nations in some cases, in others melancholia with suicidal tendency; also 
incompetence of the sphincters and paralysis, beginning at the periphery 
and extending to the centres. They sometimes cause maniacal excitement, 
as in the case of a physician who committed suicide in a frenzy caused by 
bromidizing himself for sea-sickness. 

The general result of their action is termed Bromism, and is heralded 
by the acne and lowered faucial sensibility. It is probably due to the 
sedative influence of these agents on the sympathetic system, causing 
general anemia of the brain, spinal cord, sexual organs, and skin. It is 
believed that a previous prolonged use of opium or morphine renders the 
organism extremely susceptible to the action of the bromides. 

Dr. Hammond mentions several cases of fatal bromide-poisoning in one of the last 
chapters of his treatise on Nervous Diseases, and several cases of poisoning by Potassium 
Bromide have been published by Dr. Greenless. The first was that of an epileptic who 
took 75 grains a day for three weeks, when stupor, coma, and extreme prostration and 
death followed. The post mortem showed intense congestion of the meninges. In an- 
other case, an epileptic, the same amount of potassium bromide, 75 grains a day, was 
given, and in ten days coma and death followed. Both the brain and meninges were 
congested and the kidneys were in the advanced stage of cirrhosis. The other cases were 
less prominent and clearly resulted from bromism due to long use of the drug. In some 
cases of inebriety large doses of bromides produce stupor and prostration, from which re- 
covery is slow, and is followed by continued prostration. 

The action of Hydrobromic Acid on the nervous system and circulation is identical 



BROMUM. 223 

with that of the Bromides. Added to a mixture of quinine and water (TT\jj to each grain 
of quinine) it will produce a clear solution. 

Differences in Action between the ordinary Bro??iides. 

Potassium Bromide is the most toxic to the heart and the muscular system, and is the 
least hypnotic. It contains 66 per cent, of Bromine. 

Sodium Bromide is the least toxic, but the most hypnotic, and acts more energetically 
on the circulation. It contains 78 per cent, of Bromine. 

Ammonium Bromide resembles the Potassium salt in action, except that it exerts less 
influence on the heart and on the muscular system, and is somewhat more stimulating. 

Lithium Bromide contains the most Bromine, 92 per cent. , and resembles the sodium 
salt in action. It has proved better than the others in some cases of epilepsy, and is by 
several authorities considered the best hypnotic of the series. 

Calcium Bromide is an efficient hypnotic, but otherwise much less active than the 
other bromides. 

Strontium Bromide is said to be less apt than the other bromides to produce the 
bromic acne and the other results of bromism. 

Zinc Bromide, in large doses, is violently irritant. It is supposed to combine the 
tonic effects of zinc with the sedative action of the bromides. 

Ferrous Bromide is not official. It is supposed to combine the actions of iron and 
the bromides, and to produce the effects of a sedative chalybeate tonic. It is not an 
eligible chalybeate. 

Antagonists and Incompatibles. 

Vaso-motor stimulants, as Digitalis, Ergot, Belladonna, antagonize many of the effects 
of the Bromides, but Morphine is the most efficient antagonist, especially for the mental 
symptoms. Nitrous Ether is incompatible with the Bromide of Ammonium, and Acids 
and metallic salts are so with all the Bromides. 

Therapeutics. 
The Bromides are used as sedatives to the nervous system, to lower 
reflex activity, to produce sleep, to subdue excitement of the genital appa- 
ratus, and to antagonize congestion of the brain. Their use in epilepsy 
is that of a specific, but therein they are terribly abused, by patients, 
nurses, and even by physicians. They should not be used in anemic 
conditions, and never for any length of time without the daily supervision 
of a physician. If Opium be administered in ascending doses for four 
to six weeks before commencing a course of treatment by bromides, the 
latter will be much more effective in smaller doses than otherwise. The 
mixture of Potassium Bromide and Chloral is very unsafe in cases where 
fatty or weak heart exists, both drugs being active cardiac depressants. 
In convulsive and spasmodic affections, the bromides are very efficient, 
and in epilepsy, especially when the seizures are diurnal, the sodium salt 
is used with great advantage over a long period, in sufficient quantity to 
maintain anesthesia of the fauces. It requires occasional purgation to 
prevent its accumulation, and arsenic to combat the acne. In diabetes 
of nervous origin, the ammonium salt, long used, has proved curative by 
its sedative influence on the medulla ; and in acute rheumatism it is an 
excellent alkali. In muscular rheumatism, rheumatic arthritis and myal- 
gia, also in the uric acid diathesis and various affections due to undevel- 
oped gout, the lithium salt gives good results. In tetanus and strychnine- 



224 BROMOFORM. 

poisoning the potassium salt, in large doses, is antagonistic. These 
agents are generally efficient in nervous erethism, insomnia with conges- 
tion, infantile colic, cholera infantum, vomiting of cerebral origin, car- 
diac irritability when not due to anemia, in delirium tremens, melancho- 
lia, whooping-cough and other reflex coughs, seminal losses when plethora 
exists, and nymphomania. The potassium salt is, by some writers, con- 
sidered almost specific in subinvolution of the womb, also in uterine 
hemorrhage not due to a mechanical cause. 

Strontium Bromide has been favorably known for some time for its 
beneficial action in gastric affections, particularly in dyspepsia, acetic and 
lactic fermentation, flatulence from decomposition and vomiting of various 
origin, including the vomiting of pregnancy. In severe cases of the 
latter affection it proved entirely successful, administered in doses of gr. 
xv with meals, twice daily for a month. In epilepsy it has been employed 
with advantage, in doses of gr. xx thrice daily, gradually increased: and 
it has been used in the treatment of nervous and sick headaches, sea- 
sickness, insomnia, and other conditions for which the bromides are con- 
sidered suitable. It is said to be less productive of the bromic acne than 
any of the other bromides in general use. 

The Syrup of Iron Bromide has been reported by some observers as 
very efficient in chorea, and its usefulness therein is as strenuously denied 
by others. 

In hysteria, congestive headaches, neuralgia, and nervous exhaustion, Hydrobromic 
Acid has been found useful. Used as a solvent of Quinine it retards cinchonism, and 
prevents the headache resulting from the full action of Quinine and Iron. As a substi- 
tute for the Bromides of Sodium and Potassium it is highly recommended, being much 
less depressant. It has been especially recommended in tinnitus aurium. Fothergill 
used it for coughs of reflex or spasmodic nature, also for simple continued fever where 
there is cerebral disturbance. 

Bromine is not much used. Its vapor may be inhaled from hot water 
in acute coryza, hay-asthma, etc., and for chancre and hospital gangrene 
it is the best escharotic. In diphtheria and membranous croup, a solu- 
tion of Tr^viij to the §, used internally, and inhalation of the vapor, have 
been used successfully in the most severe cases. 

Bromoform is an analogue of Chloroform, and was discovered in 1832 by Lowig. 
Inhaled, it produces anesthesia on animals, but of shorter duration than that of ether or 
chloroform. Deep narcosis has been produced in children by overdoses taken inter- 
nally ; the little patients having been tempted, by the pleasant taste of the medicine, to 
the surreptitious ingestion of more than was prescribed. It has proven of special efficacy 
in whooping-cough, administered in daily doses of 5 to 20 minims, in glycerin and 
alcoholic solution. It aborts the paroxysms of coughing and reduces their number some- 
what, but has little influence otherwise on the regular course of the affection. Increasing 
doses must not be pushed very far for fear of toxic symptoms, and the drug must be 
absolutely colorless if pure. Inhalations of Bromoform have been used with some suc- 
cess in the treatment of diphtheria ; and it has been employed locally with benefit, as a 
deodorizer, disinfectant and analgesic, in ozena and in tuberculous and other ulcers of the 
larynx. 



BRYONIA. 22 5 

BRYONIA, Bryonia, Bryony, — is the root of Bryonia alba and of 
Bryonia dioica, European perennial plants of the nat. ord. Cucurbitaceae. 
Its taste is acrid and bitter, but it is inodorous. The active principle is 
the glucoside Bryo?ii?i, C 48 H 80 O 19 , which is intensely bitter, and soluble in 
water and in alcohol, but insoluble in ether. Dose, of the powdered 
root, gr. x-xxx. 

Preparations. 

Tinctura Bryonise, Tincture of Bryonia, — a 10 per cent, solution of the root in 
alcohol. Dose, TT^v-^ss. 

Bryonin (Unofficial), — is a violent poison in doses of from 3 to 4 grains. Dose, as a 
drastic purgative, gr. l /e-yi- 

Physiological Action and Therapeutics. 

Bryonia is a pure irritant, setting up local inflammation wherever applied, 
with febrile phenomena. It has a vesicant action on the skirr, and is 
violently irritant to the serous and mucous membranes. Taken internally, 
it has caused fatal gastritis ; introduced into the pleura, fatal pleuritis has 
resulted with fibrinous effusion. It has a specific determination to serous 
and synovial membranes, especially the pleurae, and is also irritant to 
muscular fibre and to the bronchial mucous membrane, causing dry, con- 
tinuous, shaking cough, with soreness behind the sternum. It produces 
cerebral congestion, with frontal headache, vertigo and epistaxis ; also 
hepatic and renal congestion, burning pain and tenderness in the hepatic 
region with bilious disturbance amounting sometimes to severe jaundice, 
vesical tenesmus, and depression of the action of the heart. It is a drastic 
purgative and a powerful diuretic. 

Bryonia is a very old medicine, its most ancient reputation having 
been in epilepsy, hysteria and mania, conditions in which it is now 
superseded by other agents. It is a most valuable drug in the second 
stage of serous inflammations, after Aconite has reduced the pyrexia, es- 
pecially in pleurisy, pleuro-pneumonia and pericarditis, to limit the 
extent of the effusion and to promote its absorption. For this purpose 
small doses frequently repeated are required. Also, in rheumatic fever, 
after the swelling of the joints has been reduced by other means, Bryonia 
is extremely efficient for the pain and stiffness. It is one of the best rem- 
edies for a " cold-on-the-chest," with dry, shaking cough, soreness, or 
shooting pains. It has been used with success in common, continued 
or "gastric" fever, relapsing fever, congestive headaches increased by 
stooping, bilious headache with vomiting, gastralgia with pyrosis and 
soreness of the epigastrium, constipation, cholera infantum during dry, 
hot weather, congestion of the liver, croup, and threatened mammitis. 
Pains of shooting or tearing character, increased by movement, are 
often quickly relieved by this drug. In dropsies it is used as a drastic 
purgative and diuretic to remove the accumulated fluid. 
i5 



226 BUCHU — CACTUS GRANDIFLORA — CADMIUM. 

BUCHU, Buchu, — is the leaves of Barosma beiulina, B. crenu- 
lata, and B. serratifolia, S. African shrubs of the nat. order Rutacese. 
They contain a Volatile Oil, which is probably the active principle, and 
gives them a peculiar and penetrating odor, resembling that of pepper- 
mint ; also Baros??iin, a bitter extractive, and resin, gum, lignin, etc. 
Dose, of the leaves, gr. xv-xxx. 

Preparations. 
Extractum Buchu Fluidum, Fluid Extract of Buchu, — Dose, VC\x-%]. 
Infusum Buchu, Infusion of Buchu (Unofficial), — §j to the pint. Dose, ^ss-ij. 

Physiological Action and Therapeutics. 

Buchu in small doses causes a sense of heat in the stomach, which is 
gradually diffused over the body. It increases the pulse-rate, stimulates 
the appetite, and produces slight moisture of the skin. It increases the 
flow of urine, which becomes of darker color and strongly aromatic odor, 
and deposits a brownish sediment. In large doses it produces vomiting, 
purging and strangury, with a burning sensation at the stomach. 

Buchu is of especial value in chronic affections of the genito-urinary 
mucous membrane, on which the volatile oil acts topically, being elimi- 
nated by the kidneys. It is a very useful remedy in pyelitis, cystitis and 
urethritis; also in lithiasis, in chronic bronchitis, and in affections of the 
prostate gland. It is recommended in atonic dyspepsia, chronic rheuma- 
tism and affections of the skin, also for dropsy, but it is not so actively 
diuretic as to be very efficient in the latter condition. 

The Infusion makes an excellent vehicle for saline diuretics. 

CACTUS GRANDIFLORA, or Night-blooming Cereus (Unofficial),— is a native 
of tropical America, and has long had a local reputation as a remedy for dropsy, but was 
brought into notice as a cardiac remedy by Dr. Rubini. Its active principle, Cactine, a 
supposed alkaloid, has been physiologically studied by Dr. Myers, who finds it possessed 
of very decided stimulant action upon the heart, the arterial tension and the spinal motor 
centres. Therapeutically, this drug has been employed as a cardiac stimulant in the 
functional disorders of the heart connected with anemia, neurasthenia, dyspepsia, tobacco- 
poisoning, exophthalmos, sexual exhaustion and low fevers, also in psuedo angina pec- 
toris. It does not prolong the diastole, as Digitalis does, and on this account it has been 
especially recommended in complicated aortic regurgitation. A tincture is prepared of 
the strength of J iv of the fresh stems to a pint of strong alcohol, the dose of which is 
TT^xx-xxx every 4 hours. 

Pellotine, C 13 H 19 N0 3 (Unofficial), — is an alkaloid obtained from Anhalonium 
Williamsii, a member of the cactus family growing in Mexico. This alkaloid is a power- 
ful hypnotic and also somewhat analgesic, though not possessing the pain-relieving power 
of morphine. It has the advantage of being capable of hypodermic administration, and 
has given relief to the pains of locomotor ataxia and peripheral neuritis. The dose is 
about gr. j for an adult. Mezcaline, another alkaloid from the same plant, seems to be 
the cause of the exaltation produced by drinking the fermented liquor Mezcal prepared 
thereform. 

CADMIUM, Cd (Unofficial). — This metal was official in the Pharmacopoeia of 1870, 
but is no longer so. In its physiological action it resembles both Antimony and Zinc, 
being escharotic, astringent, and a very depressant emetic. In over-doses, its salts act as 



CAFFEA. 227 

irritant poisons, with cerebro-spinal symptoms, such as coma and convulsions. It is 
never used internally. Its salts in general use are — 

Cadmii Sulphas, Cadmium Sulphate (Unofficial), — transparent oblique prisms, efflor- 
escent, and very soluble in water. Used externally in a solution of gr. ss-iv ad 5|j aq. 
destil., or as an ointment (i to 40 of fresh lard). 

Cadmii Iodidum, Cadmium Iodide (Unofficial), — large, white, pearly crystals, soluble 
in water and alcohol. Used as an ointment, I to 8 of lard. 

The Sulphate has been used almost exclusively as a stimulating astringent in gonor- 
rhea and diseases of the eye. Corneal opacities are absorbed under the use of a 
solution of gr. ij to the ^, and in gonorrhea a mild injection (gr. ]^ ad ^j) is very 
beneficial. An ointment of the Iodide has been usefully employed for enlarged glands, 
chronic joint affections, cutaneous diseases, nodes and chilblains. 



CAFFEA, Coffee, the seed of Coffea Arabica, is officially repre- 
sented only by its active principle, Caffeine. The coffee-plant is a small 
tree of the nat. ord. Rubiacese, 15 to 30 feet high, native of South Arabia 
and Abyssinia, but cultivated in various parts of the world. Its seeds 
contain the alkaloid Caffeine (partly free, partly as a tannate), also tannic 
and caffeic acids, sugar, legumin, etc. By roasting them, part of the 
caffeic acid is converted into methylamin, the sugar is changed into cara- 
mel, and several volatile substances are formed, which give to coffee its 
peculiar aroma and some of its stimulant qualities, and are collectively 
known as Caffeone, one of them being called Caffeol. 

Caffeina, Caffeine {Tri-methyl-xanthin), C s H 10 N,O 2 -f H,0. The U. 
S. Pharmacopoeia of 1890 defines Caffeine (Theine) as " a feebly basic, 
proximate principle, obtained from the dry leaves of Thea Sinensis, . . . 
or from the dried seeds of Coffea Arabica, . . . and found also in 
other plants." In the edition of 1880, Guarana was included by name 
among its sources. Therefore, the principles named Caffeine and Theine 
are now officially declared to be identical, and their identity with Guara- 
nine is left unsettled. That all three are identical was the general opinion 
until recently, their composition being expressed by the formula CgH^N^ 
2 , and the physiological action of one being accepted for the others. 
Some investigators, however, doubt the identity of the first two, and some 
observers maintain that Guaranine also is a separate body, distinct from 
either of the others. The Caffeine of commerce is usually obtained from 
old tea leaves, and is in reality Theine. It contains more nitrogen than 
almost any other proximate vegetable principle. It occurs in colorless, 
flexible, silky crystals, which are soluble in 80 of water and in 33 of alco- 
hol at 59 F. Dose, gr. j-v. 

Theine is contained in the leaves of Thea Sinensis, the tea-plant, a native of China 
and Japan, and a member of the nat. ord. Ternstromiaceae. The tea-plant also contains 
much Tannic Acid, and a volatile oil, the latter being most abundant in green teas. 
Theine is found on the market, Merck's being considered the most reliable. Its sol-, 
ubility in water is much increased by adding an equal part of Sodium Benzoate, say 
£j of each to the fluid ^ , with gr. x of Sodium Chloride. Of this, TT\vj equals gr. )4 
of Theine. Dose, gr. l /e-], hypodermically, several times a day, for relief of pain. 



228 CAFFEA. 

Preparations. 

Caffeina Citrata, Citrated Caffeine, — is a very uncertain mixture, and is not consid- 
ered to be a definite compound. It is prepared by dissolving equal weights of Caffeine 
and Citric Acid in double the quantity of hot distilled water, evaporating the solution to 
dryness, and powdering the product, which is white, odorless, of acid taste and acid 
reaction, soluble in about 3 parts of water, precipitated as Caffeine on further dilution 
with water, and redissolved with about 25 parts of water. Dose, gr. ij-x. 

Caffeina Citrate Effervescens, Effervescent Citrated Caffeine, — composed of Caf- 
feine I, Citric Acid I, Sodium Bicarbonate 33, Tartaric Acid 30, Sugar 35, triturated, 
mixed with Alcohol to a paste, dried and powdered. Dose, 3J-ij, in a glassful of water, 
as an effervescing drink. 

Extractum Caffese Viridis Fluidum (Squibb), Fhdd Extract of Green Coffee (Un- 
official), — is intended as a substitute for the fluid Extract of Guarana. Dose, gss-ij. 
[Compare the title Guarana.] 

Physiological Action. 

Coffee is a cerebro-spinal stimulant, a stomachic tonic, and a laxative. 
It is decidedly diuretic, and is somewhat antiperiodic and highly anti- 
septic. The green bean produces effects very different from those of the 
roasted one, exhibiting the action of Caffeine alone, unmodified by that 
of the empyreumatic products. A tincture of green coffee, besides being 
an efficient diuretic, has marked anti-lithic powers, and promotes the 
elimination of the poison of gout from the system. 

As a beverage, if used with moderation Coffee assists digestion, pro- 
motes intestinal peristalsis, allays the senses of fatigue and hunger, lessens 
tissue-waste and consequently decreases the formation and excretion of 
urea (?). Used to excess it disorders digestion, and causes functional 
disturbances of the nervous system, shown by headache, vertigo, mental 
confusion, and palpitation of the heart. It increases secretion, blunts 
sensation, exalts reflex excitability, increases mental activity, and may 
produce insomnia and great nervous restlessness. It first briefly stimu- 
lates the heart and raises arterial tension, but soon depresses both. The 
wakefulness is usually preceded by a brief period of drowsiness. 

The brief stimulation of the intellect, consequent on drinking a cup of 
good coffee, cannot oe obtained from an infusion of raw coffee, and is 
probably due to the volatile constituents developed in roasting. Caffeone 
opposes Caffeine in its action on the circulation, as it quickens the pulse 
and lowers arterial tension. Its action, however, is of brief duration, and 
soon gives way to the influence of the principal constituent. The Tannin 
is the ingredient which enables it to produce dyspepsia, and is most abun- 
dant in those infusions which are kept a long time on the stove before 
being served. 

The Common Stimulant Beverages Compared. 
The qualities possessed in common by these substances, and for which 
they are so universally esteemed by mankind, are three-fold. They all 



CAFFEA. 229 

retard the retrograde metamorphosis of the body-tissues (tissue-waste), 
thereby enabling the work of the individual to be done upon a smaller 
supply of reparative material (food), and with less fatigue. Furthermore, 
when used in moderation, they are more or less stimulating to the mental 
processes, and sedative to the nervous system. 

This similarity of action they owe to the possession of principles, which, if not identi- 
cal, are so closely related to each other that until very recently they have been so con- 
sidered both by chemists and pharmacologists. Their divergence from each other, in the 
finer shades of their action, depends most probably on the existence in each of differing 
aromatic and volatile principles, which modify the action of the alkaloid in some degree. 
Similar principles are developed in them by the various processess of preparation (as 
roasting, drying, etc.), all of which have some part in determining the general action of 
the beverages containing them. 

Coffee {Coffea Arabica, nat. ord. Rubiacese), is more stimulating than 
Coca and less sustaining. It is apt to cause severe palpitation of the 
heart in some persons, and may disorder the digestion if long infused 
before ingestion. The coffee-bean contains only from 0.2 to 0.8 per 
cent, of caffeine. 

Tea {Thea sinensis, nat. ord. Ternstromiacese), is one of the most 
refreshing and stimulating members of the group. Used to excess, it 
powerfully affects the stability of the motor and the vaso-motor nerves, 
the action of the heart, and the digestive function, producing flatulent 
dyspepsia, tremulousness of the limbs, pallor of the surface, irregular 
cardiac action and feeble impulse, hallucinations, nightmare, anorexia, 
headache, nausea and vomiting, obstinate neuralgias, especially of the 
supra-orbital and occipital nerves ; also constipation and a pain in the 
left side are not infrequent. The condition of chronic tea-poisoning is 
termed Theism, and is very often seen among women of the lower class 
in cities, who do not indulge in alcoholic beverages, but freely accept the 
dominion of the " cup that cheers " and worse than inebriates. Tea con- 
tains much more Tannin than coffee, and that used as a beverage by the 
poorer classes is little more than a decoction of tannin, and a fruitful 
source of dyspepsia and other forms of gastric disorder. 

Mate {Ilex Paraguay ensis, nat. ord. Aquifoliacese), is supposed to be 
intermediate as to its effects between tea and coffee. It contains Theo- 
bromine as well as Caffeine, the latter in the proportion of 1.2 per cent., 
also a little tannin. 

Guarana {Paullinia Cupana of Brazil, nat. ord. Sapindaceae), contains 
an alkaloid — Guaranine, in the proportion of 5 per cent., which is prob- 
ably identical with Caffeine, though some think it more nearly analogous 
to Theine. It is especially noted for relieving a nervous headache, for 
which purpose the official fluid extract may be used in doses of til xx, 
three or four times daily, when the basis of that preparation happens to 
be of good quality. [Compare the article on Guarana.] 



23O CAFFEA. 

Coca, or Cuca (Erythroxylon Coca, nat. ord. Lineae), is probably more 
sustaining than either tea or coffee and less of a direct stimulant, at least 
as used by the Peruvian natives. Its habitual and excessive use produces 
a very serious train of nervous symptoms. [Compare the article entitled 
Coca.] Its alkaloid, Cocaine, is allied in action to Caffeine, but is more 
powerful, and its proportion in the leaves of the plant varies greatly in the 
different samples which occur in commerce. 

Cocoa (Theobroma Cacao, the Chocolate-tree, nat. order Sterculiacese), 
pronounced Ko-ko, — is more nutritious than any other of the group, 
containing a large quantity of fat, Oleum Theobromatis (cacao-butter), 
which makes it difficult of digestion to many persons. Its alkaloid, 
Theobromine, is chemically a Dimethylxanthin, and is closely allied to 
Caffeine, the latter being considered a Methyl-theobromine. The various 
preparations of this agent are made from the seeds, after the oil has been 
expressed from them. They are ground in a mill, mixed with rice, barley, 
sugar, flour, etc., and put up in powdered form, called Cocoa, — but when 
flavored with vanilla and pressed into a cake the product is named Choc- 
olate, The thin husks which envelop the seeds are known as Shells, and 
are used to make a beverage similar to but milder than cocoa or choco- 
late. [Compare the article entitled Theobromatis Oleum.] 

Kola (Cola acuminata, nat. ord. Sterculiaceae), is the nut or seed of 
the Kola plant, a handsome tree growing 30 to 60 feet high in the trop- 
ical forests of Africa and in the West Indies. It contains both Caffeine 
and Theobro?nine, the former in larger proportion than any member of the 
group except Guarana ; also Tannic Acid and a glucoside substance named 
Kolanin, which, in the presence of a ferment, splits up into free caffeine 
and glucose, its yield of caffeine being 3 per cent. The Kola nut is highly 
valued by the negroes as a stimulant beverage and food and as an 
aphrodisiac, the latter quality being ascribed to the essential oil, which 
is not present in the dried nuts. It improves the appetite and the diges- 
tion, and promotes cheerfulness of the spirits and inclination to exertion. 
It is becoming a fashionable stimulant under the commercial methods 
which are employed in pushing the sale of the various preparations on 
the market. 

Physiological Action of Caffeine. 

Caffeine is in general terms at first a stimulant and subsequently a 
paralyzant to the nerve-centres in the cerebrum, medulla and cord. In 
small doses it quickens the action of the heart and raises arterial tension ; 
stimulates the cerebral functions, by increasing the supply of blood to the 
brain ; and increases the respiration rate and the secretion of urine. 
Larger doses (gr. v-viij) often over- stimulate the cerebral circulation, 
causing great heaviness of the head, flashes of light before the eyes, tinni- 
tus aurium, insomnia, restlessness, and even delirium, the pulse becoming 



CAFFEA. 23I 

rapid, feeble, irregular and intermittent, and the general body-temper- 
ature elevated, though that of the periphery may be lowered. Large doses 
depress the heart and respiration, and lower the blood-pressure ; in the 
smaller animals it exalts the reflex excitability of the cord, producing 
tetanic convulsions, and in lethal doses paralyzing the cardiac muscle as 
well as its motor ganglia, but causing death by paralysis of respiration. 
It powerfully affects muscular fibre, both voluntary and involuntary kinds, 
throwing it into a state of tetanic contraction resembling rigor mortis. 
Caffeine is a reliable hydragogue diuretic, acting by stimulation of the 
secreting apparatus in the kidney, as well as by generally raising the arte- 
rial tension (Brunton). The action of caffeine on the kidneys is two-fold ; 
during the first stage it causes a fall of general blood-pressure and con- 
striction of the renal vessels; during the second stage, which persists 
much longer than the first, the blood-pressure returns to its normal height 
and the kidney undergoes great expansion (Murrell). If administered in 
sufficient quantity it would doubtless prove fatal to man, but its lethal 
dose for him would be large. Zenetz has recently published the details 
of three cases of sudden death during the use of full doses of caffeine, in 
all of which the heart was found at the autopsy to be so firmly contracted 
that it was cut with difficulty. He infers therefrom that caffeine may 
cause sudden arrest of the heart in systole. 

Caffeine is excreted as such very slightly and slowly by the kidneys. 
In its passage through the body it largely loses its methyl groups, most of 
it being transformed into xanthin which probably breaks up into urea. 

Theine, according to Dr. Mays, agrees in most respects with Caffeine in its action 
upon small animals, except that it requires much larger doses to produce the same 
effects. It differs from caffeine in some important particulars. Theine chiefly affects the 
sensory, Caffeine the motor system. Theine causes spasms and convulsions and impairs 
the nasal reflex, early in the course of the poisoning process ; while Caffeine does so late, 
if at all. Theine decreases the body-temperature, — Caffeine increases it. Theine causes 
convulsions in frogs, a power now denied to Caffeine, though hitherto ascribed to it. 
Both alkaloids tend to produce muscular contraction, but Theine causes a peculiar rhyth- 
mical contraction in voluntary muscles, which lasts for several hours, and seems to act 
transversely across the fibre, as the muscle is elongated at each contraction. In man, the 
principal action of the hypodermic injection of Theine is the production of a profound 
local anesthesia at and below the point of injection, acting therefore outwards along the 
nerve-trunk, and not towards the centre. It does not affect the motor apparatus, nor 
does it seem to produce narcosis. 

Guaranine is generally considered to be identical with Caffeine, though some few ob- 
servers fmd in its action a closer analogy to Theine. It affects both sensory and motor 
nerves, the sensory first, paralyzing them from the centres outwards. [Cocaine and 
Brucine act from the periphery inwards.] It causes general hyperesthesia, and subse- 
quently convulsions of spinal origin, — at first increases and afterwards depresses respira- 
tion and the action of the heart. It seems to have a stronger affinity for the sensory than 
for the motor nerves, and hence resembles Theine more than Caffeine. 

Theobromine has the formula C 7 H 8 N 4 2 , and is closely allied to Caffeine, both phy- 
siologically and chemically. In fact, Caffeine may be considered a Methyl- theobromine, 
C 7 H 9 (CH 3 )N i 2 . During roasting the cocoa-bean develops an aromatic principle which 
gives to chocolate its peculiar flavor. In large doses Theobromine is fatal to small 
animals. 



232 CAFFEA. 

Therapeutics. 

Although without a very extensive range of usefulness, Caffeine is a 
valuable stimulant in many forms of nervous and cardiac depression, and 
has proved especially efficacious in headaches of neuralgic or nervous 
type, the pain being general over the head ; gr. j of Caffeine every half 
hour, or the fluid extract of Guarana, in 20-minim doses every 2 or 3 
hours. In choleraic diarrhea, and that of phthisis, it checks outward 
osmosis by stimulating the depressed nervous apparatus. In cervico- 
brachial neuralgia, Caffeine may be used hypodermically in doses of gr. j, 
increased to gr. v. In lithemia and gout, a tincture of the green bean 
has marked diuretic and antispasmodic powers, and is very useful in these 
conditions. In the insomnia of chronic alcoholism gr. *4 of Caffeine 
hypodermically is often efficient. For adynamic fevers, it may well be 
used in place of alcoholic stimulants. In intermittents Coffee has a cur- 
ative reputation among the inhabitants of the Philippines, which is cor- 
roborated by the Dutch physicians. In asthma, Coffee is valuable for the 
paroxysm if not used habitually. In opium narcosis, Caffeine hypoder- 
mically, or better still, strong black coffee by the mouth, will antagonize 
the increasing torpor of the nervous centres. 

Although Caffeine is an efficient diuretic in cardiac and renal dropsies, 
there are many objections to its use for this purpose. It sometimes acts 
as a purgative as well as a diuretic, and although at first it produces copi- 
ous diuresis, tolerance is soon established and it loses its diuretic power. 
Moreover, it is a powerful cardiac stimulant, and in many persons it 
exerts a very marked excitant action upon the central nervous system. 
Lastly, and as a minor disqualification, it sometimes sets up considerable 
smarting in the penis and produces a mild form of urethritis (Murrell). 
Its tendency to produce tetanic contraction of muscular tissue and its 
possible influence to arrest the heart in systole should be kept in mind 
when it is being administered for any prolonged period. 

Caffeine is contained in many proprietary preparations of which Acetanilid is the active 
ingredient (see page 77). Its office therein is that of a corrigent, to antagonize the 
depressant action of the latter drug upon the heart. A double citrate of caffeine and 
antipyrin, named Migranin is described on page 171. 

Theine, according to Dr. Mays, is a valuable analgesic, especially so 
by reason of its prolonged influence over sensation. Its great field of 
employment is in neuralgia of any kind, in which doses of gr. y& to gr. x / 2 
hypodermically are efficient, and may be kept up as long as required. 
To make a cure, however, the nutrition of the nerves must be attended to. 
In locomotor ataxia and lumbago it has been used with prompt benefit, 
in the same manner, quickly relieving pain without producing any 
narcotic effect. 



CAJUPUTI OLEUM CALAMUS. 233 

Kola is a useful agent in gastric catarrh and in the dyspepsia of alco- 
holic subjects, as an adjunct to other treatment. After an alcoholic 
debauch it will do much in restoring the nervous system to its normal 
condition. It will counteract the depressing effects of tobacco, and has 
been employed with benefit in asthma of both the nervous and cardiac 
forms. As it contains a good deal of tannin, it is especially efficient in 
atonic diarrhea, and in gastro-intestinal irritation with looseness of the 
bowels, a restricted diet and Kola-wine are frequently all that is needed. 
As an aphrodisiac it deserves high rank, though it acts in this respect not 
so much by stimulating the sexual appetite as by enabling the organism 
to escape the sense of exhaustion and extreme debility which neurotic 
patients are apt to complain of (Woodbury). 

Sodio-Theobromine Salicylate, Diuretin (Unofficial), — was introduced under the 
latter title as a proprietary preparation. It occurs as a colorless powder, of sweetish, 
saline and alkaline taste, soluble in ]/ 2 its weight of water, and should contain 46^ per 
cent, of Theobromine. Being a very unstable compound, it should not be prescribed in 
combination with other drugs, and when dispensed it should be well sealed from contact 
with the air, from which it rapidly absorbs carbonic acid, thereby undergoing decomposi- 
tion. If ordered under its chemical name the cost should be less than ]/ 2 that of the 
same article under its proprietary title (Squibb). Dose, gr. x-xv, in powder or aqueous 
solution, several times a day, as a diuretic. 

Diuretin was introduced as a soluble preparation of Theobromine, of value for its 
prompt diuretic action, influencing the kidneys without causing serious or dangerous 
results upon the heart, the action of which, however, it strengthens and regulates. Given 
to healthy persons it does not increase the quantity of the urine, but during its adminis- 
tration in morbid conditions of the renal or cardiac apparatus the volume of urine in- 
creases three- and four-fold, and exudations of non-inflammatory character are rapidly 
absorbed. It may give rise to slight diarrhea, and the author has found the body-tem- 
perature uniformly subnormal in non-febrile patients while under its influence. 

Diuretin has been employed with marked benefit in both cardiac and renal dropsy, in 
hepatic cirrhosis, and in various diseases of the heart and kidneys accompanied by 
edema. The author has seen a large pleuritic effusion disappear rapidly under its use, 
the fluid having re-accumulated after having been once removed by tapping the pleural 
cavity. It should be administered in aqueous solution, avoiding acids or acid vegetable 
juices, which are chemically incompatible, as they precipitate the alkaloid in the form of 
a thick white sediment. 

CAJUPUTI OLEUM, Oil of Cajuput,— is a volatile oil distilled from the leaves 
of Melaleuca Leucadendi'on, a tree of the nat. ord. Myrtacese, native of the Molucca 
Islands. It is a bluish-green or colorless liquid, of camphoraceous odor and neutral 
reaction, freely soluble in alcohol. It contains Cajuputol or Bihydrate of Cajuputene, 
which forms % of it, the other ^ being another oil. Dose, X\ j-v. 

Cajuput Oil resembles Oil of Turpentine, and has similar action to that of the other 
volatile oils, being a stimulant carminative, somewhat diuretic and diaphoretic, antiseptic, 
parasiticide and anthelmintic. Externally used, it is irritant to the skin. Swallowed, it 
produces a sense of warmth in the stomach and accelerates the pulse. 

It is not much used internally, though it has been given with benefit in flatulent colic, 
dropsy, hysteria, chronic rheumatism, scrofula, and syphilis, also in elephantiasis and 
other cutaneous disorders. Externally, as a strong, stimulating rubefacient, it is efficient 
in chilblains, muscular rheumatism and nervous headaches. 

CALAMUS, Sweet Flag, — is the rhizome of Acorus Calamus, a plant of the nat. 
ord. Arace^, native in Europe and North America, having an aromatic odor and pung- 
ent taste. Only the unpeeled root should be used, peeled or bleached calamus being 
almost inert. It contains a volatile oil and Acorin, which is a nitrogenous, bitter 
principle, also benzoic acid, starch, etc. Dose, indefinite. 



234 CALCIUM. 

Extractum Calami Fluidum, Fluid Extract of Calamus, — is made with Alcohol as 
a menstruum. Dose, TTlxv-gj. 

Calamus is an aromatic bitter, and a stomachic tonic, increasing the appetite and stimu- 
lating digestion. It is one of the constituents of the preparations termed " bitters," and 
is chewed as an appetizer. 



CALCIUM, Ca, — is the metal characteristic of Lime, Chalk, and all 
calcareous substances, and although itself unofficial it is represented by 
several official salts and preparations. Lime {Calx) and Chalk (Creta) 
are respectively the Oxide (CaO) and the Carbonate (CaCO s ) of Calcium, 
the carbonate occurring in the native forms called chalk, marble, lime- 
stone, oyster-shells, etc., which are converted into lime by heating to 
full redness (calcination), thereby driving off carbonic acid and leaving 
the oxide behind. The latter, in this form, is known as " burnt lime " 
or " quicklime " ; and, by the addition of ^ to ^ its weight of water, 
combines with one molecule of H.,0 to form Calcium Hydrate , Ca(HO) , 
or "slaked lime," the process being termed "slaking" and being 
accompanied by the evolution of a high degree of heat. 

Lime is one of the four alkaline earths, the other three being Baryta, Magnesia, and 
Strontia. As such, however, it never occurs naturally, though in combination with 
various acids it is found in all the three kingdoms of nature ; its base, the metal Calcium, 
being a widely distributed element, forming the basis of all calcareous and cretaceous 
substances. Besides the forms mentioned above, Calcium occurs as a sulphate (gypsum) , 
also as a phosphate in bones, shells and various organic tissues, and as a silicate and a 
fluoride in certain minerals and vegetables. 

Official Salts of Calcium. 

Calx, Lime [Calcium Oxide), CaO, — is Lime prepared by burning white marble, 
oyster-shells, or the purest varieties of native Calcium Carbonate. Occurs in hard, white 
masses, gradually resolving to a white powder in the air, odorless, of sharp, caustic taste 
and alkaline reaction, soluble in 750 of water and 1 300 of boiling water, insoluble in 
alcohol. Xot used internally except in solution. Is a constituent of Potassa cum Calce. 

Calcii Hydras, Calcium Hydrate {Slaked Lime), Ca(HO) 2 , — official in the Br. Phar.; 
is prepared by pouring I pint of water over 2 pounds of Lime in a metal pot. It should 
be recently prepared and kept excluded from the air. It is sparingly soluble in water 
(gr. xj in Oj) and less soluble in hot water, but its solubility is greatly increased by the 
addition of sugar. 

Calcii Carbonas Prsecipitatus, Precipitated Calcium Carbonate, CaC0 3 , — a fine 
impalpable, white powder, odorless and tasteless, insoluble in water or alcohol, but solu- 
ble in mineral acids or acetic acid with effervescence. Creta (chalk) is native Calcium 
Carbonate. (See next page.) Dose, gr. v-£j. 

Calcii Chloridum, Calcium Chloride, CaCl 2 , — hard, colorless masses, deliquescent, 
of sharp, saline taste, soluble in Ij4 of water and in 8 of alcohol. Dose, gr. iij-x in 
solution. This salt should not be confounded with Chlorinated Lime. 

Calcii Sulphas Exsiccatus, Dried Calcium Sulphate [Dried Gypsum), — contains 
about 5 per cent, of water. A fine, white powder, without odor or taste, insoluble in 
alcohol, soluble in 410 of water at 59 F. , in 3S8 of water at ioo F., and in 476 of water 
at 212° F. Used in the preparation of Calx Sulphurata. 

Calcii Sulphidum, Calcium Sulphide, is described under Sulphur ; Calcii Bro- 
midum, Calcium Bromide, under BROMUM; Calcii Hypophosphis, Calcium Hypo- 
phosphite, and Calcii Phosphas Praecipitatus, Precipitated Calcium Phosphate, under 
Phosphorus. 



CALCIUM. 235 

Preparations of the Oxide, {Lime.) 

Liquor Calcis, Solution of Lime {Lime-water), — contains about o. 17 per cent, of 
Calcium Hydrate, Ca(HO) 2 . A clear, colorless liquid, of saline taste and alkaline reac- 
tion. Dose, >5 ss-iv. 

Syrupus Calcis, Syrup of Lime (Saccharated Solution of Lime), — contains 6j4 per 
cent, of Lime, and 40 of Sugar, the latter aiding the solvent power. Dose, ttVx-gj 
Is an antidote to poisoning by Carbolic or Oxalic Acid. 

Linimentum Calcis, Lime Liniment (Carron Oil), — contains equal volumes of 
Lime-water and Linseed Oil, mixed by agitation. For local use. 

Calx Chlorata, Chlorinated Lime, is described under Chlorum ; Potassa cum 
Calce, Potassa with Lime, under Potassium, and Calx Sulphurata, Sulphurated 
Lime, under Sulphur. 

Preparations of the Carbonate. [Chalk.) 

Creta Praeparata, Prepared Chalk, CaC0 3 , — is native Calcium Carbonate, freed from 
most of its impurities by elutriation ; a white, amorphous powder, odorless and tasteless, 
insoluble in water or alcohol. Dose, gr. x— gj. It is a constituent of Hydrargyrum cum 
Creta, and also of the following : 

Pulvis Cretae Compositus, Compound Chalk Powder, — has of Prepared Chalk 30, 
Acacia 20, Sugar 50 parts. Dose, gr. v-^j. 

Mistura Cretae, Chalk Mixture, — has of the preceding 20 parts, Cinnamon Water 
40, Water to 100, rubbed together and made fresh as required. Dose, ^ss-ij. 

Trochisci Cretae, Troches of Chalk, — each contains of Prepared Chalk 4 grains, 
Acacia I, Sugar 6, with a little Nutmeg. Dose, indefinite. 

Testa Praeparata, Prepared Oyster-shell (Unofficial), — contains animal matter inti- 
mately mixed with the Carbonate of Calcium. Dose, gr. x-xx or more. 

Allied Substances. 

Substances allied to Chalk, and derived from the animal kingdom, are — Crabs'- 
eyes, which are concretions obtained from the stomach of the craw-fish, Coral, Cuttle-fish 
Bone, Egg-shell and Oyster-shells (Testa, see above) ; all of which are mainly composed 
of Calcium Carbonate, but also contain the phosphate and sulphate of calcium and other 
metallic salts in small quantity, as well as organic material. In the past special virtues 
have been ascribed to these substances, and even now some authorities maintain that the 
animal carbonates derange the stomach less than the mineral ones, and are to be pre- 
ferred for infants and delicate persons. 

Physiological Action. 

Lime, in its unslaked form (quick-lime), has a great affinity for water 
and readily combines with sulphur, thereby decomposing and destroying 
organic matter. Upon the skin its action is irritant and superficially 
caustic, but more severe on the mucous membranes, and if inhaled or 
swallowed it may produce dangerous local inflammation, followed by 
ulceration. In weak solution it has an astringent and sedative effect 
both locally and internally, and acts as an absorbent and an antacid. 
Chalk possesses the astringent and antacid qualities of lime without its 
irritant properties. 

Calcium Chloride is a very diffusible salt, and in small doses has re- 
markably alterative action, being apparently a powerful antagonist to the 
condition known as the strumous diathesis. Full doses produce symp- 
toms of muscular poisoning similar to those caused by potassium salts, 



236 CALCIUM. 

with lowered temperature, slowed pulse, and a tendency to cardiac paral- 
ysis. In large doses it is an irritant poison. It increases the amount of 
the urine and probably promotes the excretion of urea. It has a great 
affinity for water, and is used in pharmacy to abstract water from other 
substances, as in the preparation of absolute alcohol and ether. In solu- 
tion it is used as a test for tartrates, citrates and oxalates. 

Calcium Salts play an important part in the circulation and in most 
of the other functions of the body. The heart or any other muscle, de- 
prived of calcium, will no longer contract. These salts have a remark- 
able influence on the nutrition of plants and animals, the Phosphate 
being as essential to the nourishment of the organs of locomotion (carti- 
lage, bone, tendon and muscle) as iron is to the blood or phosphorus to 
the nerve tissue, They possess high coagulating power on the blood; their 
deficiency gives rise to lymphatic and osseous disease, and their absence 
results in emaciation and finally death. They are excreted almost entirely 
by the intestines, a very small portion being absorbed and but little of 
that passes out by the kidneys. t Their absence from water renders the 
latter flat and insipid to the taste, but if present in excess (above 20 
grains of the carbonate to the gallon) the water containing them is be- 
lieved to be one of the factors of goitre. The Sulphate, in even so 
small a proportion as 6 grains to the gallon, is unwholesome, as it is liable 
to irritate the bowels and produce constipation and diarrhea alternately, 
according as its astringent or irritant effect predominates. 

Antidotes, Antagonists and Incompatibles. 

In poisoning by Caustic Lime the antidotes are a dilute Vegetable Acid or Lemon- 
juice or Carbonated Water freely, followed by demulcents or fixed oils to protect the 
mucous membranes. Opium or Alcohol as an antagonist against the vital depression. 
Potassium salts and Calcium salts are mutually antagonistic. Poisoning by Calcium 
Chloride is treated by Albumin, mucilaginous drinks, oils, milk, flour and water, but no 
acids. 

Incompatible with preparations of Lime and Chalk are all the Acids and metallic 
salts, especially the Sulphates and Tartar Emetic ; and borates, alkaline carbonates and 
astringent vegetable infusions are also incompatible with the preparations of Lime. 

Therapeutics. 
Lime may be used as a caustic and depilatory, but is better known as 
an agent for hastening decomposition, which it does by its great affinity 
for water, the resulting hydrate absorbing many of the products. The 
Chlorinated Lime is an excellent antiseptic and disinfectant, but as it owes 
its energy entirely to its power of evolving chlorine it will be described 
under the title Chlorum. Lime-water is a favorite remedy for vomiting, 
especially in children, and is added to milk to increase its digestibil- 
ity. A mixture of milk and lime-water will be retained by the stomach 
when no other food can be borne. Lime-water is an efficient agent in 
acid dyspepsia, mucous enteritis and typhoid fever, as an astringent and 



CALCIUM. 237 

antacid. Locally, it is well employed as an enema against thread-worms, 
as a mouth wash for aphthae, and as a lotion for cracked nipples, eczema- 
tous eruptions, and many mucous and purulent discharges. For such pur- 
poses it may be mixed with oil or glycerin, and if a few drops of carbolic 
acid be added the efficacy of the mixture is much increased. The Lini- 
ment is best known by the name Carron Oil, from the foundries at 
Carron, where it is extensively used. It is one of the best applications 
for burns and scalds, and makes a good dressing for the face in small- 
pox, and for cases of eczema affecting a large area of the skin. The 
vapor of slaking lime, or lime-water in the form of spray, have been use- 
fully employed as inhalations in diphtheria. Lime-water is a good injec- 
tion into the bladder in vesical calculus, in which its benefit is probably 
due to its astringent and soothing effects on the inflamed vesical mucous 
membrane, blunting its sensibility, and preventing the further growth of 
the stone by neutralizing the free acid of the urine. 

One of the curiosities of medical history is the fact that in 1739 the British Parliament 
gave the sum of ^5,000 to Mrs. Johanna Stephens for divulging the nature of a certain 
lithontriptic remedy. This, she stated, consisted of calcined egg-shells and soap, with 
various aromatic bitters, a combination which had previously been recommended by 
Barbette for the same purpose. The nauseousness of this compound suggested to Whytt 
the use of lime-water as a substitute, and the latter was found to be efficacious in many 
instances. 

The Syrup contains more lime in solution than lime-water does, and 
may be used instead of the latter when a strong preparation is indicated. 
It is one of the antidotes in poisoning by carbolic and oxalic acids, while 
lime in any form (wall-plaster, whiting, etc.) is the best antidote for any 
mineral acid. 

Chalk is the basis of all dentifrices, and may be used as a dusting- 
powder on ulcers, burns and excoriations of the skin. Chalk-mixture is 
a common remedy for diarrhea, and is usually employed in combination 
with other astringents, also with opium and aromatics. It is particularly 
serviceable for the diarrheas of children with sour-smelling stools and 
other symptoms of gastro-intestinal acidity. 

Calcium Chloride is used with benefit as an internal remedy in the 
various manifestations of the strumous diathesis. It often causes the 
resolution of glandular enlargements, and the calcification of tubercular 
deposits, aids the cicatrization of ulcerating cavities, and has proved 
curative in eczema and lupus. It is highly praised in phthisis, also in 
chorea, and for the colliquative diarrhea of strumous children. In 
solution used as a fomentation it is said to hasten the maturation of 
boils. 

The therapeutics of the other salts and combinations of calcium are 
described under the titles of their more active ingredients, Bromum, 
Chlorum, Phosphorus and Sulphur. 



238 CALENDULA CALUMBA CAMBOGIA. 

CALENDULA, Marigold, — is the florets of Calendula officinalis, the common 
Garden Marigold, a plant of the nat. ord. Composite, frequently cultivated for ornament. 
The tincture (20 per cent.) is also official, and is exclusively used as a local application 
to promote the healing process in wounds, ulcers, burns and other breaches of tissue. 
Extravagant views of its powers as a vulnerary are promulgated by the so-called " homeo- 
pathic surgeons," and serve as one of their excuses for professing an exclusive position 
in the art of surgery. 



CALUMBA, Columbo, — is the root of Jaieorhiza pabnata, a plant 
of the nat. ord. Menispermacese, native in southeastern Africa, but culti- 
vated in the East Indian Islands. It contains the alkaloid Berberine (see 
under Berberis, ante, page 218), a bitter principle named Calumbin, also 
Calumbic Acid and Starch, but no Tannin. Dose, gr. v-xxx. 

Preparations. 
Extractum Calumbse Fluidum, Fluid Extract of Calumba. — Dose, TtV v-xxx. 
Tinctura Calumbse, Tincture of Calumba, — I in 10. Dose, 3 ss— ij . 

Calumba is the first in alphabetical order of the simple bitters, having 
no astringency or aroma, and its action, as herein described, will apply- 
to other members of that class (Quassia, Gentian, Cornus). It stimulates 
the nerves of taste, increases the flow of saliva, excites the flow of the 
gastric juice and the gastric circulation, thus increasing the appetite and 
aiding digestion, and thereby promoting the constructive metamorpho- 
sis. As it also increases the gastric mucus, its continued use will set 
up catarrh of the stomach and interfere with digestion, though it is one 
of the least irritant of stomachic tonics. 

As Calumba contains no tannin, it may be administered with the salts 
of iron, and is often prescribed with the sub-carbonate. It is useful in 
atonic dyspepsia with pain after eating, in the convalescent stage of disease 
to promote appetite and digestion, in diarrhea and dysentery, vomiting, 
sea-sickness, cholera morbus and cholera infantum. An Infusion of 
Calumba with Ginger and Senna is effective in flatulence, and the same 
preparation is a good vehicle for the administration of acids and alkalies, 
tonics, aromatics, and mild cathartics. Having little or no irritant 
quality, it is an excellent tonic in the hectic fever of phthisis. 

CAMBOGIA, Gamboge, — is a gum-resin, obtained from Garcinia Hanburii, a 
Siamese tree of the nat. ord. Guttiferae. It contains 73 per cent, of Gambogic Acid, a 
resinous substance, also 25 per cent, of gum and 2 of water. It is partly soluble in 
alcohol and ether. The only official preparation is the Pil. Catharticae Co. (described 
under Colocynthis), each pill containing gr. */£ of Gamboge. Its dose, as a cathartic, 
is gr. ij-v, — as a diuretic, gr. j at short intervals. 

Gamboge is an irritant purgative, decidedly diuretic, and its powder is sternutatory. 
Its catharsis is accompanied by vomiting and colic, and the stools produced are watery, 
but not so much so as generally believed. It has no cholagogue action. Full doses are 
liable to produce violent gastroenteritis, and incautiously used (as in Morrison's pills) it 
has frequently caused death. On the other hand, large doses have been given continu- 
ously in some cases, without producing any dangerous symptoms. 



CAMPHORA. 239 

Gamboge was formerly much used as a hydragogue cathartic and diuretic in dropsies, 
but its irritant qualities have caused it to be superseded by other agents (elaterium, digi- 
talis, etc.). However, for dysentery, especially when in young subjects, very small doses 
(gr. T L) at short intervals, up to gr. }( in 24 hours, have proven to be remarkably effi- 
cacious. 



CAMPHORA, Camphor, C 10 H 16 O, — is officially described as a 
stearopten (having the nature of a ketone), obtained from Cinnamomum 
Camphora, a tree of the nat. ord. Laurineae, and purified by sublimation. 
It occurs in white, translucent, waxy masses, of penetrating odor and 
pungent taste, lighter than water, in which it is sparingly soluble (1 to 
1300), but dissolves readily in alcohol, ether, chloroform, benzin, oils, etc. 
The camphor-tree is indigenous to China, Japan, Formosa and other parts 
of Eastern Asia. Borneo-camphor has the formula C 10 H ls O, bears the same 
relation to Japanese camphor as alcohol bears to aldehyde, and is heavier 
than water. Dose, gr. j-xx. 

Derivatives of Camphor are — Ca7nphor-cymol, which is obtained by its 
distillation with zinc chloride, Camphoric and Camphretic Acids, which 
result respectively from its lesser or greater oxidation, and Safrol, also 
contained in Sassafras oil, but obtained in much larger quantities from 
Camphor oil, a waste by-product in the manufacture of crude camphor. 

Official Preparations. 

Aqua Camphorae, Camphor-water, — Camphor 8, Alcohol 5, Distilled Water to 1000. 
Used externally or as a vehicle internally. Dose, 3J-iv. 

Spiritus Camphorae, Spirit of Camphor, — 10 per cent, in Alcohol. Dose, rt^v-xx. 

Linimentum Camphorae, Camphor Liniment, — Camphor 20, Cotton-seed Oil 80. 

Ceratum Camphorae, Camphor Cerate, — has of the Liniment 10, "White Wax 30, 
Lard 60. Used for itching skin-affections. 

Camphora Monobromata, Monobromated Camphor, C 10 H 15 BrO, — colorless, pris- 
matic needles or scales, of mild camphoraceous odor and taste, and neutral reaction; 
almost insoluble in water, slightly in glycerin, freely in alcohol, ether, oils, etc. Dose, 
gr. j-x, in emulsion. 

Camphor is also an ingredient of Linimentum Saponis, Linimentum Sinapis Compos- 
itum, and Tinctura Opii Camphorata. 

Unofficial Preparations. 

Acidum Camphoricum, Camphoric Acid, C 8 H u (COOH) 2 , — is a dibasic acid, ob- 
tained by the action of nitric acid on camphor. Occurs in white, acicular, odorless 
crystals, of feebly acid taste ; insoluble, or nearly so, in cold water, readily soluble in 
hot water, alcohol, ether and fatty oils. Dose, gr. x-xxx, dry on the tongue. 

Rubini's Tincture of Camphor, — is a saturated solution in alcohol, !§j in ^JX> 
of which the dose is from 4 to 10 drops. TTLvij have caused toxic symptoms in an adult. 

Raspail's " Eau Sedative," — contains Aq. Ammonise ^ij, Sodii Chloridum spj, 
Camphorated Spirit of Wine Sjiij, Water Oij. Used externally. 

Camphora Carbolata is a name given to a mixture of 2]/ 2 parts of camphor with one 
each of carbolic acid and alcohol. This preparation, mixed with olive oil, is a good 
non-irritating and antiseptic dressing for wounds and breaches of surface. 

Camphor-Chloral is a fluid obtained by triturating together equal parts of camphor 
and chloral hydrate. It dissolves morphine sulphate readily (gr. xx in gij), also many 



24O CAMPHORA. 

other salts of alkaloids. It is often a serviceable application in superficial neuralgia, and 
is said to allay spasmodic cough if painted over the larynx. 

Camphora Salicylata is obtained by heating together 1 1 parts of salicylic acid and 
14 of camphor. An ointment prepared therefrom has been used with satisfactory results 
in the treatment of phagedena, spreading syphilitic sores, epithelioma, lupus, etc. 

Oleum Camphorata, Camphorated Oil, — strength 10 per cent., is used for hypoder- 
mic injection, in doses of TT^xv-gj. 

Physiological Action. 

Camphor is antispasmodic, anodyne, antiseptic, diaphoretic, a stimu- 
lant expectorant, a cerebral excitant, a gastro-intestinal irritant, and a 
rubefacient. It has an acrid, hot taste, and irritates the skin and mucous 
membranes, in quantity exciting severe gastric inflammation with all the 
effects of an irritant poison. In medicinal doses it stimulates the vaso- 
motor system and the cardiac motor ganglia, and lessens the influence of 
the pneumogastric, — thus increasing the circulation and raising arterial 
tension. It also stimulates respiration and mental activity, even produc- 
ing intoxication ; promotes diaphoresis, allays pain, and increases the 
menstrual flow and the sexual appetite, but its continued use depresses the 
generative function. " Camphora per nares castrat odore mares." 

Large doses cause gastro-intestinal inflammation, depress the heart and 
lower arterial tension, diminish the reflex function of the spinal cord, 
produce coldness of the surface, insensibility, coma, convulsions and per- 
haps death. As many as 200 grains have been taken without fatal result, 
yet 6 or 7 grains have produced extreme drowsiness and weakness of the 
pulse, and 20 grains laid up an Alpine guide for a day. It is eliminated 
by the bronchial mucous membrane, skin and kidneys, and has often 
caused dysuria. 

Monobromated Camphor resembles the bromides, but its action is not 
identical with theirs. In mammals it produces muscular weakness passing 
into paralysis, lowered temperature and respiration, stupor and death. 
In some cases its use by man has been followed by epileptiform convul- 
sions. It is a nervous sedative and hypnotic, and a gastric irritant. 

Antagonists, Antidotes and Incompatibles. 

Arterial sedatives, coffee, cold, etc., antagonize its action. Water precipitates it from 
the alcoholic solution, alkalies and earthy salts precipitate even the small quantity which 
is soluble in water. Emetics to remove as much as possible. Opium and Bromides for 
the convulsions. 

Therapeutics. 
Camphor was much used by the older physicians as an antispasmodic, 
and is greatly valued still in China and Japan. It has a reputation for 
uncertainty of therapeutic action, but is usefully administered in cholera 
and choleraic diarrhea, summer diarrhea and that of infants, vomiting, 
gastralgia, cardiac depression, nervousness and nervous headache, nym- 



CANNABIS INDICA. 24I 

phomania, capillary bronchitis, typhoid and eruptive fevers, dysmenor- 
rhea, afterpains, chordee, strangury, and catarrhal colds. Locally it is 
effective in myalgia, lumbago, toothache, gangrene, and other conditions 
where counter-irritation or a local anodyne is required. A solution in 
ether has been found to be a beneficial application in erysipelas. 

Subcutaneous injections of camphor dissolved in oil have been employed 
with excellent results in the collapse of pneumonia and in other condi- 
tions where collapse is imminent. In fibrinous pneumonia these injec- 
tions produce a depression of about one degree in the temperature, and 
greatly ameliorate the general condition. They are also employed with 
benefit in the treatment of phthisis during the period of softening, ren- 
dering the patient more comfortable and prolonging life. Camphor ad- 
ministered in this manner is not well borne by young children, even in 
minimum doses. 

Monobromated Camphor is used as a nerve sedative and hypnotic, but 
is not particularly efficient. It has been employed with advantage in 
whooping-cough, neuralgia, chorea, hysteria, delirium tremens and epi- 
lepsy, but it is taken with difficulty and is liable to irritate the stomach. 

Camphoric Acid, in solutions of ^ to 6 per cent, strength, has been used with benefit 
as a topical agent in cystitis, also in coryza, acute bronchitis and other affections of the 
respiratory tract. Internally administered it gives good results as an intestinal disinfect- 
ant, and has lately come into prominence as one of the most efficient agents against 
sweating from various causes, especially the profuse night-sweats of pulmonary tubercu- 
losis. For this purpose it is best administered dry on the tongue, in dose of 10 to 30 
grains, not more than two hours before the time for the expected sweating to occur, as it 
is quickly and abundantly eliminated by the urine. 



CANNABIS INDICA, Indian Cannabis, Indian He?np,—\s the 
flowering tops of the female plant of Cannabis sativa, grown in the East 
Indies; a coarse, pubescent, somewhat viscid annual of the nat. ord. Urti- 
cacese. Its odor is peculiar and narcotic, its taste slightly acrid. 

Cannabis Americana, American Cannabis (Unofficial), — is the 
same plant, Cannabis sativa, grown in the Southern States. 

The two varieties are specifically identical with each other, differing 
only in the degree of their action, that grown in India being the most 
powerful. They contain a resin named Cannabin, and a Volatile Oil, 
from the latter of which are obtained Cannabene, 2, light hydrocarbon, 
and Cannabefie Hydride, a crystalline body. Cannabis should not be 
confounded with the so-called "Indian or Canadian Hemp," Apocynum 
cannabinum (see ante, page 185). 

Preparations. 

Extractum Cannabis Indicae, Extract of Indian Cannabis. — Dose, gr. %.-}, if 
active. Hering's English Extract is one of the best. 

Extractum Cannabis Indicae Fluidum, Fluid Extract of Indian Cannabis, — is an, 
16 



242 CANNABIS INDICA. 

alcoholic preparation which in mixtures must be thoroughly emulsified with Acacia, 
otherwise the resinous drug will separate and float to the top or adhere to the sides of the 
bottle. The Dose is put at rr\J-v or x, but the author has frequently administered gj of 
a good fluid extract without untoward results. Whatever may be the reason, it is a fact 
which he has often verified, that if the precipitate, formed when the alcoholic prepara- 
tion is added to water, be of a brownish hue, a dirty, yellow-brown, the sample will 
prove to be almost inert ; — but if of a decided olive-green color, the preparation will be 
active. The activity will be found to increase almost in direct proportion to the decided 
green color of the precipitate. Samples from one manufacturer show this difference, 
often seen between two bottles in the same shipment. The active principle seems to be 
intimately connected with the chlorophyll or other coloring matter present, and to be 
destroyed therewith by whatever injures the latter. 

Tinctura Cannabis Indicae, Tincture of Indian Cannabis, — strength 15 per cent. 
Dose, rr^xx-^j. The above remark on mixtures containing the fluid extract applies also 
to those containing the tincture of this drug. 

Similar preparations of Cannabis Americana are made by the manufacturers and 
may be used in larger quantities. The dosage of all preparations of hemp is uncertain, 
as specimens of the plant vary greatly in activity. The best rule is to begin with ■ a 
small dose, gradually testing the activity of the drug and the susceptibility of the patient 
by cautiously increased doses. 

Cannabin Tannate (Unofficial), — is a yellowish-brown permanent powder, insoluble 
in water and ether, slightly soluble in alcohol, having a not unpleasant odor and a bitter- 
ish, astringent taste. No formula has been published for it, but it is claimed to be the 
tannate of a glucoside by Merck, of Darmstadt, who placed it on the market. Dose, 
as a hypnotic, gr. v-x. 

Preparations used in the East. 

Churrus is an impure resin, prepared by rubbing the leaves of the plant together and 
scraping off the adhering resin. 

Gunjah is the dried leaf and tops as sold in the bazaars for smoking purposes. 

Hashish, Bhang or Siddhi is a confection consisting of the leaves and small stalks 
coarsely broken and mixed with fruits and aromatics. It is employed in the preparation 
of various electuaries and beverages, and is also smoked with or without tobacco. 

Physiological Action. 

Cannabis Indica is antispasmodic, analgesic, anesthetic and narcotic, 
a cerebro-spinal stimulant and a powerful aphrodisiac. It increases intel- 
lectual and motor activity, stimulates the vaso-motor nerves, raising arte- 
rial tension, depresses sensation, and strengthens the energy of the 
uterine muscular fibre, but has no power to initiate uterine contractions. 
In large doses it causes a peculiar but generally pleasant form of intoxica- 
tion, during which the particular traits of the individual are exaggerated, 
and the ideas follow each other so rapidly as to produce a sense of great 
prolongation of time, minutes seeming as if hours or even days. With 
this occurs increased sexual desire and uterine activity, also sensations of 
double consciousness and enormous dimensions. The sight and hearing 
are exalted, pupils dilated, anesthesia sets in, the reflexes are lowered by 
stimulation of inhibition (Setschenow's centre ?), and if the dose be a 
heavy one a cataleptic state is induced. Sleep or coma follows according 
to the size of the dose, but death has never been produced by this drug. 

After-effects are dullness, heaviness, vertigo, headache, confused 
thought, anesthesia of the skin, and marked diuresis, — but no nausea, no 



CANNABIS INDICA. 243 

vital depression, no constipation. Repeated use of the drug causes mental 
weakness and impotence, the result of over-stimulation. A ravenous 
appetite is usually one of its effects. 

Antagonists and Incompatibles. 

Strychnine and Faradism are antagonistic. Caustic Alkalies are incompatible. In 
poisoning by it the stomach should be evacuated, stimulants given cautiously, and respira- 
tion maintained. The effects of a large dose last over 24 hours. Lemon-juice is said to 
antagonize its effects. 

Therapeutics. 

Cannabis Indica was formerly much employed as an anodyne and hyp- 
notic, also as an anesthetic during surgical operations. It is now some- 
what out of fashion. In migraine it is useful to prevent recurrence of the 
attack, and in neuralgia it is often very efficient. Uterine affections, such 
as chronic metritis, subinvolution, menorrhagia and dysmenorrhea, are 
greatly benefited by its anodyne quality and its power over the uterine 
muscular fibre. It is one of the best hypnotics in delirium tremens, and 
in traumatic tetanus and paralysis agitans large doses of this drug will 
lower the reflex activity. Dysuria and retention of urine are often re- 
lieved by it, while in spasm of the bladder and other painful affections of 
that organ it will be found a most efficient remedy. It is useful in func- 
tional impotence, especially if combined with Ergot and Nux-vomica. 
In gonorrhea it lessens the discharge, relieves the inflammation, burning 
pain and restlessness, and allays chordee. The tincture of Cannabis 
Americana is the most useful in this affection, being fully as efficient as 
copaiba or sandal oil, and much more agreeable. It should, however, 
be prepared from the fresh plant, and be given in 3 to 5 drop doses 3 or 
4 times daily after the subsidence of the acute symptoms. Full doses of 
the tincture of the Indian plant are extremely efficient in many cases of 
headache at the menopause, but should be used cautiously until the 
activity of the sample and the susceptibility of the patient are tested. 

Dr. Lees has called attention to the fact that aqueous preparations of 
this drug, which contain but little of the resin, are much used by the 
natives of India for intoxicating and stimulating purposes, which indi- 
cates that the volatile oil and not the resin is the active principle. He 
uses a strong aqueous extract, prepared without heat, which gives all the 
beneficial effects of the alcoholic preparations without the extreme ex- 
hilaration bordering on intoxication so often produced by even medium 
doses of the latter. He finds that, in pulmonary affections generally, 
this Liquor Cannabis Indiccz acts most favorably as an anodyne and hyp- 
notic, while in phthisis pulmonalis it relieves the cough and aids the 
patient by its stimulant and exhilarating qualities to a degree which no 
other drug can accomplish. Dr. Lees has also used it in indigestion 
with constipation, and in many affections of children in which nervous 



244 CANTHARIS. 

symptoms are prominent it has done good service. The adult dose is 
3ss-j. 

Cannabin Tannate is considered by Fronmiiller to be a very useful 
hypnotic, not in any degree dangerous and neither disturbing the secre- 
tions nor leaving unpleasant after-effects. It has been used with benefit in 
acute mania. 



CANTHARIS, Cantharides, Spanish -Flies y— -is the dried beetle, 
Cantharis vesicatoria, an insect of the nat. ord. Coleoptera, about an inch 
long, of a shining green color, the powder being grayish-brown with 
green particles, odor very disagreeable. Contains Cantharidin, C 10 H 12 C\, 
the active principle; also a greenish volatile oil and peculiar fatty bodies. 

Preparations. 

Tinctura Cantharidis, Tincture of Cantharides, — 5 per cent. Dose, TT\j— xx. 

Ceratum Cantharidis, Cantharides Cerate, Blistering Cerate, — Cantharides 32, Yel- 
low Wax, Resin, Lard, of each 18, Oil of Turpentine 15. 

Collodium Cantharidatum, Cantharidal Collodion, Blistering Collodion, — Canthar- 
ides 60, Flexible Collodion 85, Chloroform to 100. 

Emplastrum Picis Cantharidatum, Cantharidal Pitch Plaster, Warming Plaster, 
has of Cerate of Cantharides 8 parts, Burgundy Pitch to 100. 

Physiological Action. 

Cantharis applied to the skin is a rubefacient and vesicant, acting more 
slowly than mustard but much more severely. Internally it is also irritant, 
causing heat of stomach, gastralgia, nausea and vomiting, the circulation 
is stimulated, temperature elevated, urine becomes scanty and irritating, 
is voided with difficulty and pain, and often contains blood and albumin. 
Afterwards the pulse falls, temperature and arterial tension are lowered, 
and depression ensues. A toxic dose produces severe gastro-enteritis, 
abdominal tenderness, tenesmus, mucous or bloody stools, pain in the 
stomach and loins, dysphagia, ptyalism, strangury, priapism, hematuria, 
swollen genitals, abortion, muscular tremor, convulsions, coma and in- 
sensibility. The post-mortem shows evidences of violent metritis, gastro- 
enteritis and general peritonitis. Cantharis is aphrodisiac by causing 
vascular turgescence of the genital apparatus, but only in doses which 
produce dangerous symptoms. It is abortive only in toxic doses. In 
small doses it is diuretic and emmenagogue. 

Counter-irritation by rubefacients or blisters acts on disease probably 
through the nervous system. Its influence is explained by the theory that 
the peripheral extremities of the nerves supplying the skin of the part to 
which the agent is applied undergo some molecular change, which extends 
to the nerve centre and is thence radiated to centrifugal or trophic nerves, 
effecting various changes in nutrition and secretion over the areas to which 



CANTHARIS. 245 

they are distributed. In addition to this method of action, neighboring 
parts are affected by direct extension of the inflammation produced, and 
distant parts are also affected by absorption through the vesicated surface 
of agents having special affinities for certain organs. 

A blister acts primarily as a stimulant to the body generally as well as to 
the organs in its vicinity, but if permitted to remain long enough to pro- 
duce a large bleb, the result is depression proportionate to the amount of 
serum abstracted, the serum of the bleb containing nearly as much albu- 
min as the blood itself. 

Antagonists and Antidotes. 

There is no chemical antidote or physiological antagonist to Cantharis. Evacuation 
of the stomach, mucilaginous drinks freely, Opium for the gastro- enteritis, are the best 
measures in poisoning by this agent. 

Therapeutics. 

As a counter-irritant and vesicant Cantharis is of great value in neu- 
ralgia if applied close to the emergence of the nerve from the spinal 
column, also in sciatica and neuritis, and in acute rheumatism around the 
affected joints. A blister at the nape of the neck controls many head- 
aches, and one behind the ear will modify inflammatory affections of the 
eye. In pleuritic effusions a succession of small blisters (flying-blisters) 
will promote absorption of the pleural contents, and a blister applied to 
the peritoneum will often cure a rebellious gleet. Though valuable as a 
therapeutic measure in very many conditions, blistering is going out 
of fashion except in hospitals and among people who believe in heroic 
treatment. It is invaluable in subacute joint affections. 

As an internal remedy Cantharis must be employed in very small doses 
(nij-iij of the tincture) in order to be efficient. When so used it is an 
admirable agent in acute desquamative nephritis after the active inflam- 
mation and fever have subsided to reduce the albumin and blood in the 
urine. Drop-doses are particularly useful in irritable bladder with frequent 
desire to micturate, so often observed in women, also in the incontinence 
of the aged and of children, and in cystitis, gonorrhea and gleet. The 
same dose thrice daily will generally abate chordee. In spermatorrhea, 
prostatorrhea, scanty menstruation and menorrhagia in subjects of lax 
fibre and general want of tone it is often very serviceable. Cutaneous 
squamae and vesiculae are greatly improved by small doses frequently 
administered and gradually increased, and it is one of the best remedies 
for psoriasis. For alopecia areata it is of the utmost value as an external 
application, and the tincture, largely diluted, is an ingredient of all the 
hair-renewers in common use. In pleurisy, after effusion has taken place, 
it will be found admirable in 1- to 2-drop doses every 2 or 3 hours, and in 
the after-prostration of diphtheria it proves a serviceable stimulant. One* 
of the best applications to burns or scalds is a cloth dipped in a lotion of 



246 CAPSICUM. 

the tincture one part to thirty or forty of water. The same lotion is an 
efficient application to vesicular erysipelas and herpes zoster. 



CAPSICUM, Cayenne Pepper, African Pepper, — is the fruit of 
Capsicum fastigiatum, a plant of the nat. ord. Solanaceae, native in 
tropical Africa and America. It contains Capsicin, which is a thick, red 
liquid, and is the active principle, — also a volatile alkaloid having the 
odor of Coniine. Dose of the powdered drug, gr. v-x. 

Preparations. 

Extractum Capsici Fluidum, Fluid Extract of Capsicum, alcoholic. Dose, TT\j-x. 

Tinctura Capsici, Tincture of Capsicum, — 5 per cent, strength. Dose, Tt\v-xx. 

Oleoresina Capsici, Oleoresin of Capsicum, — extracted by ether. Dose, TT\j-v. 

Emplastrum Capsici, Capsicum Plaster, — prepared by spreading Resin Plaster on 
muslin and then applying a thin coating of Oleoresin of Capsicum, so that each square 
inch may contain about gr. j of the oleoresin. An excellent warming plaster. 



Physiological Action and Therapeutics. 

Capsicum is irritant to the skin and mucous membranes. Externally 
used for sufficient length of time it will produce vesication, internally in 
quantity it will excite gastritis. In medicinal doses it increases the saliva, 
excites a sensation of warmth in the stomach, promotes appetite and 
digestion, and produces easier and more copious alvine evacuations. It 
stimulates the action of the heart, is diaphoretic and diuretic, also decid- 
edly aphrodisiac. It is a general stimulant to the nervous system, but in 
repeated doses produces a slight narcotic effect upon the brain. On the 
vascular system it acts like ergot, powerfully constringing the vessels by 
influencing the unstriped muscular fibre in their walls, either directly or 
through the vaso-motor nerves. 

Capsicum is an excellent stomachic tonic in atonic dyspepsia and in 
that of chronic alcoholism with tremor and insomnia. In acute dipso- 
mania and delirium -tremens large doses are efficient in producing sleep 
and promoting appetite. It is the best substitute for alcohol and opium 
in attempts to cure those habits. It is well used in intermittents, chiefly 
as an adjuvant to more active drugs, — in flatulent colic, especially when 
occurring in hysterical women and hypochondriacs, — also in low fevers 
and cholera as a stimulant. It gives good results in functional impotence, 
in spermatorrhea from loss of tone, in chronic parenchymatous nephritis 
to check the waste of albumin, and it is beneficial in chronic cystitis and 
in prostatorrhea. The tincture internally, and a plaster externally over 
the loins, are efficient in cases of renal congestion with habitual pain in 
the back and a trace of albumin in the urine. Locally the tincture diluted 
(3J to §viij)or the powder with honey, forms an excellent gargle for relaxed 



CAKBO. 247 

throat and its accompanying cough, relaxed uvula, inflammatory sore 
throat, and the cynanche of scarlet fever, but they must be used with 
caution, as such applications are sometimes very irritating. 

The Capsicum plaster is a mild counter-irritant, of great value in lum- 
bago and other muscular rheumatisms as a palliative application. 

CARBO, Carbon, C. — This element is widely distributed through- 
out all the kingdoms of nature. United with oxygen in the form of 
Carbonic Acid Gas, C0 2 , it occurs in the air and in many mineral waters, 
while as carbonates, such as limestone, etc., it constitutes a large portion 
of the surface of the earth. [Compare the article entitled Acidum Car- 
bonicum, ante, page 91.] Another compound with oxygen, Carbonic 
Oxide or Carbon Monoxide, CO, is a highly poisonous gas, which is formed 
to a certain extent during the combustion of charcoal, but does not form 
salts. Two forms of Carbon are official, viz. : — 

Carbo Animalis, Animal Charcoal, — prepared from bone, occurring 
in dull black fragments or powder, odorless and nearly tasteless, insoluble 
in water or alcohol. 

Carbo Ligni, Charcoal, — prepared from soft wood, and very finely 
powdered ; is black, shining, brittle,, inodorous, tasteless and insoluble. 

Preparations. 

Carbo Animalis Purificatus, Purified Animal Charcoal, — the bone-phosphate and 
calcium carbonate being removed by digesting with Hydrochloric Acid and washing. 
Dose, gr. xx-gj. 

Carbonei Disulphidum, Carbon Disitlphide, CS 2 , — is a clear, colorless, diffusive 
liquid, of strong, offensive odor, aromatic taste and neutral reaction ; soluble in alcohol, 
ether, chloroform and oils, and in 535 of water ; vaporizes at ordinary temperatures, and 
is highly inflammable. • Dose, H^ss-j. 

Physiological Action and Therapeutics. 

Charcoal is an efficient deodorant and disinfectant, as it absorbs and 
condenses many gaseous bodies and vapors. It is evacuated unchanged 
by the bowel and exerts no specific action on the body. 

Charcoal is used in pharmacy for decolorizing vegetable principles, 
removing alkaloids from infusions of plants, and making several prepara- 
tions, as acidum sulphurosum, potassii iodidum, etc. 

Externally, it makes an efficient disinfectant, absorbent and deodorant 
application to cancerous discharges, foul ulcers and gangrenous wounds. 
Having no odor it is not open to the charge of substitution of one smell 
for another. A small quantity added to water will keep it sweet for a 
long time. It is an excellent dentifrice if finely powdered. 

Internally, it is used for the same purposes, namely, to absorb gases and 
offending products of indigestion. In flatulent dyspepsia, gastralgia, 
pyrosis, diarrhea, nausea of pregnancy, epidemic cholera, and constipa- 



248 CARDAMOMUM — CARDUUS. 

tion, it has warm advocates. When used internally for any time, an 
occasional purgative should be given to prevent its accumulation in the 
intestines. It has been proposed as an antidote for several alkaloidal 
poisons on theoretical grounds, but its efficacy in this respect is doubtful. 

Carbon Disulphide is largely used in the arts, hence its effects are fre- 
quently observed. Persons exposed to its fumes are affected by headache, 
vertigo, over-excitement of the nervous system, emaciation, incoordina- 
tion of movement, depression of all the special senses with impairment 
of sensation and motility and perhaps insanity. Inhaled directly, it ex- 
cites violent coughing, and produces anesthesia characterized by great 
muscular rigidity. Being a powerful cardiac paralyzant, it is a dangerous 
anesthetic. In 3-drop doses it produces severe nausea and vomiting, 
with a sense of heat in the stomach and a weak and rapid action of 
the heart. It is a good solvent for Caoutchouc and many other sub- 
stances. 

Carbon Disulphide has such a horribly offensive odor that it will 
never be used for any purpose for which another agent can be found. It 
relieves the pain of gastric cancer, and in ^-drop doses will alleviate 
nausea and vomiting, also gastralgia. Locally it has been used as a 
counter-irritant and a local anesthetic, for deafness due to want of ner- 
vous energy, in facial neuralgia and various local pains. 

CARDAMOMUM, Cardamon, — is the fruit of Elettaria repens, a plant of the 
nat. ord. Scitamineae, cultivated in Malabar. It contains about \ l / z per cent, of a Vola- 
tile Oil, C 10 H 16 , isomeric with Oil of Turpentine, the oil being the active principle ; also a 
fixed oil, coloring matter, etc. It is an ingredient of Pulvis Aromaticus and of Ex- 
tractum Aromaticum Fluidum (See under Cinnamomum), as well as of several compound 
preparations. 

Tinctura Cardamomi, Tincture of Cardamon, — 10 per cent. * Dose, gj-ij. 

Tinctura Cardamomi Composita, Compound Tincture of Cardamon, — has of Car- 
damon 20, Cinnamon 20, Caraway 10, Cochineal 5, Glycerin 50, Diluted Alcohol to 
1000 parts. Dose, gj-ij. 

Infusum Cardamomi, Infusion of Cardamon (Unofficial), — may be made in the 
strength of 5 ij to the pint, and used in wineglassful doses. 

Cardamon is aromatic, carminative and stomachic, and is used as an agreeable flavoring 
for bitter mixtures in dyspepsia and other gastric affections. It makes the best flavoring 
addition to saline solutions or mineral waters, and is particularly efficient to correct flatu- 
lence and griping when combined with purgatives. 

CARDUUS (Unofficial), — the seeds of Carduus marianus, or St. Mary's thistle, an 
annual European plant of the nat. ord. Composite. A decoction ( 3 ij ad Oj) is the prep- 
aration usually employed. It is an old remedy revived as a hemostatic, and reported 
as being very efficient in hemoptysis, uterine hemorrhage, melena and amenorrhea 
connected with derangement of the portal circulation. It has proved curative in conges- 
tion of the liver and simple jaundice, and in Germany it has long been popularly deemed 
efficacious in gall stones and liver affections generally. Dose of the decoction, ^j-^ss, 
of a tincture, TTLx-xx. 

Carduus Benedictus, the " blessed thistle," also called Cnictis benedictus and Cen- 
taurea benedicta, is another plant of the same order, formerly held in high esteem as a 
popular "cure-all." It contains Cnicin, an amorphous bitter principle, which has been 



CARUM CARYOPHYLLUS. 249 

used as an antiperiodic in doses of gr. v-x, but generally produces burning sensations 
and pharyngeal constriction, with nausea, vomiting, colic, and diarrhea. It acts chiefly 
as a bitter tonic, resembling Calumba and Taraxacum most closely. 

CARUM, Caraway, — is the fruit of Carum Carta, a European plant of the nat. ord. 
Umbelliferae. Its odor and taste are aromatic and agreeable. The active principle is 
the Volatile Oil, which is also official. Caraway is an ingredient of Tinctura Carda- 
momi Composita. 

Oleum Cari, Oil of Caraway, — is the volatile oil distilled from Caraway, and is 
resolvable into Carvene, C 10 H 16 , isomeric with Turpentine, and Carvol, C 10 H u O, isomeric 
with Thymol. It is an ingredient of Spiritus Juniperi Compositus. Dose, rnj-v. 

Infusum Cari, Infusion of Caraway (Unofficial), — £>j-ij ad Oss. Dose, ^ss-ij. 

The Oil of Caraway is fatal to small animals, and in one case gj produced cerebral 
congestion, delirium and rigors in man. The chief use of Caraway is as a flavoring 
agent, but it is efficient in the flatulent colic of children, and to prevent griping from the 
use of purgatives. 



CARYOPHYLLUS, Cloves,— are the unexpanded flowers of 
Eugenia aromatica, a handsome evergreen tree of the nat. ord. Myr- 
tacese, cultivated «in the East and West Indian Islands. They exude oil 
when scratched, have an aromatic odor and a pungent, spicy taste, and 
are contained in Tinctura Lavandulae Composita, Tinctura Rhei Aromatica 
and Vinum Opii. They contain a heavy Volatile Oil, which is official ; 
also Eugeni?i, C 10 H 12 O 2 , a crystalline body; Caryophyllin, C 10 H 16 O, a 
camphor; Caryophyllic Acid, and tannin, gum, etc. 

Preparations. 

Oleum Caryophylli, Oil of Cloves, — a volatile oil distilled from Cloves, soluble in 
alcohol, and of sp. gr. 1.060. It consists of a light and a heavy oil, the latter containing 
jEugenol, C ]0 H 12 O, a phenol-like compound, and Caryophylli7i, C 10 H ]6 O, which yields as 
a product of its oxidation, Caryophyllinic Acid, C 20 H 32 O 6 . Dose of the oil, TT\J-iv. 

Infusum Caryophylli, Infusion of Cloves (Unofficial),, may be made of strength 
I to 40, and used in doses of one to two fluid ounces. 

Physiological Action and Therapeutics. 

Cloves may be considered as a type of several agents yielding aromatic 
oils, which as a rule consist of terpenes with camphors, resins, fatty and 
other acids, etc., and are closely allied to phenol and benzoic acid, the 
balsams and gum-resins. Such are Orange, Lemon, Allspice, Cajuput, 
Caraway, Peppermint, etc. Their oils are antiseptic, locally anesthetic, 
stimulant and irritant, antispasmodic, stomachic and carminative. In- 
ternally they increase the circulation and temperature, promote digestion 
and nutrition (though in quantity they may cause inflammation), relieve 
pain and spasm, and are excreted by the kidneys, skin, liver and the 
bronchial mucous membrane, stimulating and disinfecting their routes 
throughout the organism. 

These agents are used to flavor pharmaceutical preparations, to correct' 
the griping tendency of many purgatives, to correct flatulence, to relieve 



250 CASCA BARK — CASTANEA. 

pain in the stomach and bowels, and to promote the flow of saliva and 
gastric juice. As external applications they are efficiently employed for 
anesthetic and counter-irritant purposes, to relieve pain in chronic rheu- 
matism, myalgia, lumbago, superficial neuralgia, toothache, etc. The 
Oil of Cloves is an effective deodorizer for sponge-tents, a good application 
to a painful tooth, and is occasionally applied over the course of an aching 
nerve with relief to the pain. 

CASCA BARK, Sassy Bark, Ordeal Bark (Unofficial),— is the bark of Erythro- 
phlceiiDi Guinense, an African tree, used by the negroes as an ordeal in trials for witch- 
craft. It contains a poisonous glucoside, Erythrophlein, and when used in quantity 
produces nausea and vomiting, stricture across the brow, severe cephalalgia, narcosis and 
death. It is used as a remedy for intermittent fever, dysentery, diarrhea and colic, and 
is considered to resemble Digitalis in action and uses. A tincture is made ( ^ij ad Oj) 
of which the dose is rr\,x ; or a watery extract may be used in doses of gr. j. 

Erythrophlcein, the active principle, is a glucoside, and is said to be a local anes- 
thetic of extraordinary power, even surpassing Cocaine. It is found in Africa in a red 
mass, called " Hayah," which is proven to be identical with an extract of the original 
plant described by Oertel early in this century, and deposited by him in the Berlin 
Museum. It closely resembles Digitalis in action, being a cardiac tonic and a hydragogue 
diuretic. 

CASCARA AMARGA, Honduras Bark (Unofficial),— is the bark of a Mexican 
tree of the nat. ord. Simarubacese, which has been used with apparent success as an 
alterative tonic and diuretic in syphilis and various chronic skin affections. The use of 
tobacco and alcohol seems to counteract its usefulness. It is certainly a very powerful 
tonic and has been employed by competent observers with uniformly good results in 
syphilis and syphilodermata, chronic liver complaints, chronic eczema, chronic nasal catarrh 
and psoriasis. A Fluid Extract is on the market, of which the dose is gss-j thrice daily. 

CASCARILLA, — is the bark of Croton Eiuteria, a shrub or small tree of the nat. 
ord. Euphorbiaceae, growing in the Bahamas. It contains Cascarillin, a crystalline prin- 
ciple, two resinoid extracts, aromatic volatile oils, with tannic acid, etc. There are no 
official preparations, but an Infusion (i to io) or a Tincture (i to io) may be prepared 
and given in doses of 3J-^j- 

Cascarilla is an aromatic bitter. It increases appetite and digestion, the mucous secre- 
tion, the flow of saliva and gastric juice, stimulates the intestinal secretions, and acts as 
a mild astringent by the influence of its tannin. Large doses produce nausea, vomiting 
and diarrhea, and in medicinal doses continued it will set up gastric catarrh and conse- 
quently indigestion. It has slight antiperiodic power. 

It has been used, with success in epidemic dysentery, flatulent dyspepsia, debility, 
chronic bronchitis, intermittents, and low nervous fevers. It is difficult to dispense, as 
the infusion decomposes quickly, and acids precipitate the resin from the tincture. 

CASSIA FISTULA, Purging Cassia, — is the fruit of Cassia Fistula, a tree of the 
nat. ord. Leguminosse, growing in tropical regions of Asia, Africa and America. No 
active principle has been isolated as yet. The pulp is the only valuable part of the drug. 
There are no official preparations, but it is one of the ingredients of Confectio Sennse. 

Cassia-pulp is laxative in doses of 3^j — ij , and purgative in large quantitives, producing 
nausea, flatulence and griping. It is rarely prescribed alone, owing to its tendency to 
cause colic and flatulence. 

CASTANEA, Chestnut, — the leaves of Castanea dentata, a stately tree of the nat. 
ord. Cupuliferae, which should be collected while green. They contain tannic and gallic 
acids, salts, gum, etc. 

Extractum Castanea Fluidum, Fluid Extract of Castanea. — Dose, gss-gij. 



CATECHU CAULOPHYLLUM CERA. 25 I 

This drug has not been studied as to its physiological action, if it has any. It is classed 
among the vegetable astringents by reason of its containing tannin. Its only reputation 
therapeutically is as a remedy for whooping-cough, in which it is said to be very effica- 
cious. An infusion or a decoction of the leaves has been used, in indefinite doses. 

CATECHU, — is an extract prepared from the wood of Acacia Cate- 
chu, a tree of the nat. ord. Leguminosse, native of the East Indies. It 
occurs in irregular masses, bark brown and brittle, nearly inodorous, but 
of astringent and sweetish taste, soluble in alcohol, and partly so in water. 
It contains Catcchutannic Acid 50 per cent. ; also Catechuic Acid, which 
is converted into the former by heat. Dose, gr. j-£ss. 

Preparations. 

Tinctura Catechu Composita, Co7npoiind Tincture of Catechit, — contains Catechu 
10, Cinnamon 5, Diluted Alcohol q. s. ad 100 parts. Dose, TTLx-^j. 

Trochisci Catechu, Troches of Catechu, — each troche contains of Catechu nearly I 
grain, mixed with Sugar, Tragacanth and Orange-flower Water. 

Catechu is a powerful astringent, acting by virtue of its tannic acid. 
(See ante, page 96, for action and incompatibles.) Its uses depend en- 
tirely on its astringency. In the diarrhea of children the Tincture with 
Chalk-mixture is very serviceable, and with Opium it is efficient in dysen- 
tery. It is also used as a gargle and mouth-wash in relaxed conditions of 
the pharyngeal mucous membrane, as an injection in leucorrhea, and to 
control passive hemorrhages, to harden spongy gums, etc. 

CAULOPHYLLUM, Blue Cohosh, — is the rhizome and rootlets of Caulophyllum 

thalictroides, a plant of the nat. ord. Berberidaceae, growing in Canada and the northern 
United States, and contains Saponin aglucoside, and two resins. Dose, gr. v-xx. There 
are no official preparations. The eclectic preparation Caulophyllin is a resinous precipitate 
obtained by pouring an alcoholic extract into water. 

Caulophyllum is a new addition to the pharmacopoeia, and has not yet been made the 
subject of experimental work by reliable observers. It was much used by the aborigines 
of this country in all affections to which their women were peculiarly subject, and was 
known among them by the name " squaw-root." It is said to produce intermittent con- 
tractions of the gravid uterus, to have diuretic, emmenagogue, and antispasmodic powers ; 
and is used as a remedy for deficient labor-pains, spasmodic after-pains, spasmodic pains 
in the uterus at any time, spasmodic dysmenorrhea, and pains in other organs seemingly 
in sympathy with uterine affections. It has somewhat of a reputation in acute rheuma- 
tism of the hands and fingers, and as a preparative medicine for labor. 

CERA, Wax, — a mixture of Myricin, Ceroiic Acid and Cerolein, is 
formed by the honey-bee, and exists in the pollen and leaves of many 
plants, particularly in Myrica cerifera, the wax myrtle. That produced 
by the bee is alone official. 

Cera Alba, White Wax, — is yellow wax bleached. 

Cera Flava, Yellow Wax, — is a concrete substance prepared by Apis 
mellifica, the honey-bee. It is a yellowish solid, of agreeable odor and 
faint, balsamic taste, insoluble in water or in cold alcohol, but soluble in* 
35 of ether, n of chloroform, in boiling alcohol, fixed and volatile oils. 



252 CERII OXALAS CHELIDONIUM. 

Ceratum, Cerate, — consists of White Wax 30, Lard 70. 
Unguentum, Ointment, — consists of Yellow Wax 20, Lard 80. 
Wax is also a constituent of the 5 compound Cerates, 2 of the 22 compound Ointments, 
and 2 of the 13 Plasters. 

Wax owes its value to its power of resisting decomposition and many 
chemical agents. Its fusibility at a moderate degree of heat, and its 
solidity at the temperature of the body, together with its unirritating 
quality, make it a valuable ingredient of the cerates and ointments to 
give them consistence. Ceratum and Unguentum may be used as simple 
protective applications. They form the bases of almost all the com- 
pound preparations so named. 

CERII OXALAS, Cerium Oxalate, Ce 2 (C 2 4 ) 3 -j- 9H 2 0,— is a white, slightly 
granular powder, odorless and tasteless, insoluble in water or alcohol, but soluble in 
diluted sulphuric or hydrochloric acid. Dose, gr. j-x, in pill or powder. 

Cerium Oxalate is a gastric sedative, and is thought to possess selective action as such 
on the motor distribution of the pneumogastric nerve. It is considered to be particularly 
useful in vomiting of reflex origin, especially in the vomiting of pregnancy, but it often 
fails, probably because not given in sufficient doses. To be effective, at least 4 or 5 grains 
should be given 3 times a day to adults, and no results promised until after it has been 
used -several days. It is also recommended in the vomiting of phthisis and bronchitis, 
cough with vomiting, chorea, and diarrhea. 

CHAULMOOGRA OIL (Unofficial),— is a fixed oil expressed from the seeds of 
Gynocardia odorata, an East Indian tree of the nat. ord. Bixaceae. It is nauseous and 
bulky, and soluble in alcohol, ether, chloroform, etc. Its active principle, Gynocardic 
Acid, is the best preparation for use, and may be given internally in doses of gr. ss-iij,or 
applied as an ointment, gr. xx ad ^ j of Petrolatum. Dose of the oil, gtt. v-x, in capsules. 

Chaulmoogra Oil is credited with a few cures of leprosy, and several cases improved 
by its use both internally and externally. It is recommended as an external application 
in scaly eczema, psoriasis, syphilitic skin-diseases, chronic rheumatism, rheumatic 
arthritis and tabes mesenterica. 

CHELIDONIUM, Celandine, — is the plant Chelidonium majus, 
nat. ord. Papaveracese, which grows in Europe and N. America, about 
rocky places. It contains 2 alkaloids, Chelidonine, C 19 17 N 3 3 , and Chel- 
erythrine, the latter being identical with Sanguinarine : also Chelidoxan- 
thin, a yellow, crystalline substance, and Chelidonic Acid, supposed to be 
identical with Succinic Acid. Dose of the plant, gr. x-xxx, — of the 
fresh juice rr^v-xx. There are no official preparations. 

Chelidonium used externally is irritant, internally it is a drastic purga- 
tive but an unreliable one. It is also perhaps diuretic, diaphoretic and 
expectorant. In overdoses it is considered poisonous. It is an old rem- 
edy for jaundice and liver affections, but has been obsolete for some 
time. The fresh juice is a popular application for warts and corns, and 
a tincture in whiskey is used in Indiana as a remedy for phthisis, the 
menstruum being probably the most useful agent. It seems to be of real 
service in simple jaundice, whooping-cough, right-sided pneumonia with 
hepatic involvement, and the catarrhal pneumonia of children. 



CHENOPODIUM CHIMAPHILA CHINOLINUM. 253 

CHENOPODIUM, American Wormseed, — is the fruit of Chenopodium ambro- 
sioides, var. anthelmintiawi, a plant of the nat. ord. Chenopodiaceae, indigenous to the 
United States. Its active principle is a Volatile Oil which is official. 

Oleum Chenopodii, Oil of Chenopodium, — a thin, colorless or yellowish liquid, of 
aromatic odor and pungent, bitter taste. Dose, mv-xv. 

The Oil is the only preparation used and that rarely, its odor and taste being very dis- 
agreeable. It increases the cardiac rate, and promotes the secretions of the skin, bronchi 
and kidneys. It is an efficient anthelmintic against the round worm in doses of gtt. x 
three times a day for two days, followed by a cathartic. It seems to possess some tonic 
properties, and certainly is a diffusible stimulant. As such it has been used with benefit 
in chorea, hysteria, flatulent dyspepsia, and chronic malaria. 

CHIMAPHILA Pipsissewa, — the leaves of Chimaphila umbellata, or Prince's 
Pine, an evergreen plant of the nat. ord. Ericaceae, indigenous to all parts of the United 
States, It contains Chimaphilin, a yellowish crystalline principle, Arbutin, also crystal- 
line but colorless, with tannic acid, etc. 

Extractum Chimaphilae Fluidum, Fluid Extract of Chimaphila, — Dose, ^ss-ij. 

Decoctum Chimaphilae, Decoction of Chimaphila (Unofficial), — I to 17. Dose, Jj-iij. 

Chimaphila is a tonic, astringent diuretic, belonging to the same class as Buchu, Uva 
Ursi, Pareira and Scoparius. It is probably the most active diuretic among this group, 
stimulating all the excretory organs but especially the kidneys. It is an agreeable 
tonic, excites the appetite and promotes digestion. The fresh leaves, bruised and ap- 
plied to the skin, are rubefacient and vesicant, showing the presence of some irritant 
principle. 

Chimaphila is a good diuretic in dropsy, and is efficient in several forms of chronic 
kidney disease with albuminuria, and in chronic catarrhal affections of the urinary pas- 
sages, as hematuria, ischuria, dysuria and gonorrhea. It is believed to check the secre- 
tion of uric acid, and should prove useful in gout and rheumatism. Externally, it has 
been applied to ulcers and tumors with benefit. 



CHINOLINUM, Chinolin (Leucolin, Quinolin), C 9 H 7 N (Unoffi- 
cial), — is a constituent of coal-tar oil, but may be obtained from quinine 
or cinchonine by their destructive distillation with potassium hydrate, 
and is artificially prepared by heating anilin or nitro-benzol with glycerin 
in the presence of a dehydrating agent. Chemically, it is considered to 
be formed by a union of benzene and pyridine atoms. (Compare the 
article Cinchona.) It is a colorless, oily liquid, strongly refractive, 
turning dark on exposure to the air ; soluble in alcohol, ether and carbon 
disulphide, sparingly soluble in water. It combines, like an alkaloid, 
with acids to form crystalline salts ; all of which, except the tartrate, are 
very deliquescent. 

Chinolini Tartras, Chinolin Tartrate (Unofficial), — a white crystalline powder, of 
pungent odor, sharp taste, stable in the air and soluble in water. Dose, gr. v-xx. 

Chinolin is a valuable antiseptic and antipyretic, being nearly as effec- 
tive in this respect as quinine, which it closely resembles in chemical char- 
acteristics and physiological action. It is one of the most powerful anti- 
pyretics of the substances which have been discovered in the search for 
an artificial quinine (hydroquinone, antipyrin, pyrocatechin, resorcin, 
thallin, kairin, etc.). Chinolin itself has a very disagreeable taste and 



254 CHIRATA — CHLORAL. 

smell, and is irritant in action, hence the tartrate is preferred for medi- 
cinal use. It has been extensively used as an antipyretic in pneumonia, 
typhus, diphtheria, typhoid and other fevers, with varying success. In 
diphtheria, a 5 per cent, solution in weak alcohol is painted on the 
affected surface with great benefit. The tartrate has been used bene- 
ficially in neuralgia and whooping-cough, and as an antiperiodic in inter- 
mittens. 

Quinalgen, Ortho-cethoxy-ana-mono-benzoyl-amido-quinolin (Unofficial), — is a de- 
rivative of Chinolin, and is a reformed and renamed Analgen (see ante, page 78), differ- 
ing therefrom by having the benzoyl instead of the acetyl radicle. Its action is similar 
to that of Antipyrin, except that it is claimed for this substance that no unpleasant effect 
or after-effects are noticed after taking it. It has been used in gout, influenza, migraine, 
sciatica, neuralgia, hay fever and rheumatic pains, with asserted benefit. Dose, gr. 
viij-xv, not to exceed gr. xlv daily. 

Chinosol, Quinosol, Potassuim Oxy-chinolin-sulphonate (Unofficial), — is a lemon- 
yellow powder, soluble in water, and said to be powerfully antiseptic, disinfectant and 
deodorant, even in weak solutions. The powder is irritant to wounds when applied dry, 
but not when in solution. Its advocates claim for it greater antiseptic efficacy than possessed 
by mercuric chloride, also that it is non-toxic and does not coagulate albumin. On the 
other hand Ahlfeld and Vahle state that its germicidal power is feeble and that it disturbs 
the functional activity of the kidneys. It is much used as an antiseptic in gynecological 
and obstetrical practice, generally in aqueous solution of I in 1 000. 

CHIRATA, Chirata (Chiretta), — is the Indian plant Swertia Chirata, nat. order 
Gentianaceas, occurring in bundles composed of all but the coarser woody stems. It is 
inodorous, but intensely bitter, and contains two amorphous bitter principles, named 
Chiratin and Ophelic Acid, but no tannin. Dose of the powdered plant, gr. xv-xxx. 

Extractum Chiratae Fluidum, Fluid Extract of Chirata, — made with glycerin and 
diluted alcohol. Dose, TTLxv-xxx. 

Tinctura Chiratae, Tincture of Chirata, — 10 per cent. Dose, gss-ij. 

The action of this plant is that of a simple bitter, like its congener Gentian. It is an 
excellent tonic, in this respect rivalling Cinchona, and is used in India as a substitute for 
the latter. It is laxative and stomachic, diminishes flatulency and acidity, and is particu- 
larly serviceable in the dyspepsia of gouty subjects. As it contains no tannin, it may be 
administered with preparations of Iron. 



CHLORAL, Chloral, {Chloral Hydrate), C 2 HC1 3 + H 2 0,— is a 
crystalline solid, composed of Trichloraldehyde (Chloral) with one mole- 
cule of water. It occurs in colorless, transparent, rhomboidal crystals, 
slowly volatilizing when exposed to the air \ of aromatic, penetrating and 
slightly acrid odor, bitterish, caustic taste, and neutral reaction. It is 
freely soluble in water, alcohol, ether, chloroform, oils, etc. ; liquefies 
when triturated with about an equal quantity of camphor, menthol, thymol 
or carbolic acid; melts at 136 F. and is decomposed by alkalies into 
chloroform and a formiate of the alkaline base. Its aqueous solution 
becomes acid, but the alcoholic solution remains neutral. 

Chloral itself, (Trichloraldehyde, C 2 HC1 3 0), is an unstable, oily, color- 
less fluid, formed by the action of chlorine upon alcohol, whence its 
name, Chlor-al. The Hydrate is the only official preparation. 



CHLORAL. 255 

The Dose varies much with individual susceptibility and with the presence or absence 
of cardiac and pulmonary disease. Death has been caused in several instances by gr. xxx, 
in one case by gr. x, and in another gr. vijss produced alarming symptoms, all being in 
adults. On the other hand, recovery has occurred after the ingestion of an ounce, several 
hundred grains having been taken at a time in more than one instance without fatal 
results, and where tolerance has been established by habitual use 3 ij- 3 iij are frequently 
taken without poisonous symptoms. An average dose for a healthy adult is gr. xx, 
for a child gr. j for each year of age up to gr. vj. It is best given in Syrup of Tolu, or 
in Peppermint water. 

Caution is necessary when prescribing this drug in combination with alcoholic pre- 
parations, as the Chloral is then very apt to separate as an alcoholate, especially if the 
Bromides of Potassium or Sodium are used in the same mixture and if the solutions are at 
all concentrated. In this way great danger is incurred of giving a heavy overdose, as 
the alcoholate floats on the surface of the mixture, and the entire amount of Chloral 
contained therein may be taken at a single dose. 

Unofficial Preparations. 

Chloralamid, — is described under its own title. 

Hypnal is a combination of Chloral and Antipyrin, occurring as tasteless and odor- 
less rhombic crystals, soluble in 6 of water, and credited with simultaneous action as a 
hypnotic and an analgesic. Dose, gr. xv-xxx in aqueous mixture with some alcohol, 
flavored with syrup of orange. It is said to cause no gastric disturbance. Although Chloral 
and Antipyrin are incompatible with each other, they form, when heated together, the 
above described compound, which resembles both and yet differs from each. Its 
chemical appellation is Tri-chloraldehyd-phe7iyl-diniethyl-pyrazolon. 

Somnal, — is the suggestive name given to a liquid preparation formed by the union 
of Chloral, Alcohol and Urethan, described as Ethylirtes Chloral-urethan, represented 
by the formula C 7 H 12 C1 3 3 N, and claimed to be a complex body, not a simple mixture of 
its constituents. It occurs as a colorless liquid, resembling chloroform in its behavior 
with cold water, with which it forms globules and refuses to mix or dissolve. It is 
soluble in hot water, in alcoholic solutions, and in alcohol, 3 parts in I. The advantage 
claimed for Somnal is that when administered in 20-grain doses it induces within half an 
hour a quiet sleep lasting from six to eight hours without any inconvenient results. 
Doses of 45 and even 60 minims produced no depression of the circulation or respira- 
tion. In doses of gss its action is usually very prompt, the dose is well borne, easily 
taken (in a little syrup of tolu or whiskey), and entirely without deleterious results. 
The effects are much more striking and certain than those of Urethan, and far less 
depressing than those of Chloral ; and there is no vertigo or depression, as may follow 
the use of Sulphonal. In drachm-doses, this drug is not powerful enough to decidedly 
control delirium tremens, maniacal delirium or severe pain. (Dr. Gilman Thompson. ) 

Somnal manifests its hypnotic and sedative action to best advantage in the insomnia 
of convalescence from acute disease, but where an adynamic condition exists it must be 
used with caution. In whooping-cough, spasmodic laryngitis, asthma, the so-called 
" nervous cough " and in chorea, it shows decided sedative properties. A great element 
of safety in its use is that its action is never out of proportion to the quantity ingested, 
nor does it act in a cumulative or other unexpected manner. It seems to have little or no 
influence over insomnia due to acute inflammation. (Myers.) It is injurious in acute 
mania and general paralysis, but is of great value in cases of melancholia, in which it 
promotes sleep and produces a soothing effect on the mental condition by removing 
depression and gloomy forebodings. It is contra-indicated when the digestion is out of 
order. (De Montyel.) 

Official Analogue of Chloral. 

Paraldehydum, Paraldehyde, — is described under its own title. 

Unofficial Analogues of Chloral. 

Amylene Hydrate, C 5 H 12 0, Di-methyl-ethyl-carbinol, — is a tertiary alcohol, occur- 
ring as a clear, colorless fluid, of peculiar odor, soluble in 8 of water and readily miscible 
with alcohol. It is one of the most valuable hypnotics, in power standing between 
chloral and paraldehyde, but being much more agreeable to the taste and safer than either 
of those agents. Its action is exerted chiefly on the cerebrum in doses sufficient to pro- 



256 CHLORAL. 

duce profound narcosis ; and in medicinal doses it leaves behind no unpleasant effects, 
and has no perceptible influence on the heart or respiration. By very large dosage the 
medullary centres are paralyzed, including those governing respiration and cardiac action. 
Dose, ^j-^jss. 

Chloral Butylicum, Croton- Chloral, — is described under its own title. 

Hypnone, C 6 H 5 (CO)(CH 3 ), Phenyl-methyl-acetone, — is a member of the Ketones, 
occurring above 70 F. as a colorless, mobile liquid, having a strong almond and orange 
odor. It is insoluble in water or glycerin, and is best given in capsules. It is a hypnotic 
of only moderate intensity, but said to be especially useful in the insomnia of alcoholism. 
Its use is devoid of danger, and leaves behind no unpleasant effects, except a disagree- 
able odor of the breath, the drug being eliminated by the lungs as well as by the kidneys. 
In very large doses it has induced coma, followed by paralysis of the heart and respira- 
tion. Dose, TTLv-x, in capsule, TT\,vij or TT^viij being usually required. 

Methylal, CH 2 (OCH 3 ) 2 , Methylene-di-methyl Ether, — is one of the products of the 
oxidation of Methylic Alcohol, occurring as a volatile, mobile liquid of pleasant, aromatic 
odor and taste, readily soluble in water, alcohol, etc. It is a local anesthetic, and an 
efficient hypnotic, producing a deep sleep of short duration, with more or less general 
anesthesia and lowered reflex excitability. It is depressant to the heart, respiration and 
body-temperature, but in medicinal doses does not cause any bad after-effects. Dose, 
rr^iv-v, repeated thrice at short intervals. 

Urethan, Ethyl Carbamate, NH 2 C0 2 C 2 H 5 , — occurs in crystals which are readily 
soluble in water, with scarcely any taste or odor, devoid of irritant action, and hence may 
be administered hypodermically. It is a pure hypnotic, but a mild one at best, and not 
so reliable as paraldehyde or chloral. It does not affect the circulation, nor does it de- 
press (but rather stimulates) the respiration. It acts directly on the cerebrum, causing a 
sleep which closely resembles the normal, and has no unpleasant after-affects. In very 
large doses it slows the heart, lowers the temperature, and induces muscular resolution 
and general anesthesia. In small animals it effectually antagonizes the action of Strych- 
nine. Dose, gr. xv-gj, an average hypnotic dose being gr. xxx ; but it is best given 
in 5 grain doses repeated frequently, as a large dose may cause vomiting. It is a safe 
and efficient hypnotic for children. (Squibb.) 

Physiological Action. 

Chloral is a powerful hypnotic, also an antispasmodic, an antiseptic, a 
preventive of the coagulation of fibrin, indirectly an anesthetic, and es- 
pecially a depressant of the cerebral, medullary and spinal centres and of 
the cardiac muscle. It is more hypnotic than chloroform but less anes- 
thetic. Applied to the skin or mucous membranes a 1 per cent, solution 
(gr. v ad gj) is antiseptic, but strong solutions are irritant and vesicant, 
may produce sloughing ulcers, and if taken internally may excite gastritis 
with nausea and vomiting. 

After a brief period of stimulation a medicinal dose depresses the 
heart, dilates the peripheral vessels and lowers arterial tension, diminishes 
oxidation and decreases the body-temperature. On the brain cells it has 
a selective action, producing a deep sopor very like normal sleep, from 
which the patient may be awakened, but immediately falls asleep again, 
and which is not followed by headache or depression. This effect is con- 
sidered by some authorities to be the result of cerebral anemia produced 
by the drug. In some persons, instead of sleep it causes headache, in- 
somnia and delirious excitement. It is not an anodyne, as it does not 
affect the conductivity of the sensory nerves, and does not interrupt the 
transmission of pain; but by overwhelming the centres it drowns the 



CHLORAL. 257 

consciousness of pain, and is therefore indirectly anesthetic. A toxic 
dose produces profound narcotism, abolishment of reflexes and sensibil- 
ity, complete muscular relaxation, and a great fall of body-temperature. 
Death may result in the chloral sleep from paralysis of the respiratory 
centre or the cardiac motor ganglia, or by sudden failure of the heart- 
muscle in cases of fatty degeneration or in old drunkards. 

On the blood its action is to increase the fluidity, to crenate the red cor- 
puscles, and to destroy the leucocytes if used in large quantity. It is 
rapidly diffused and is excreted by the kidneys partly unchanged, but 
chiefly as urochloralic acid, producing some diuresis, — also by the skin, 
causing various eruptions if used for any lengthened period. It has been 
held that the blood, being an alkaline fluid, decomposes it, setting free 
chloroform, but there are many facts against this theory. 

The Chloral- habit produces a state of marked anemia and muscular 
weakness, especially of the legs ; its subject presenting a weak, irritable, 
often irregular heart, deranged hepatic functions, jaundice, bileless stools, 
perhaps purpura and sloughing of a finger from decreased blood-supply. 
Its votaries are on the border of insanity, excitable, uncontrollable in 
speech and action, talking in a silly manner and very volubly, and show- 
ing a marked loss of power of the limbs, so much so as to simulate paral- 
ysis thereof. Many cases of insanity have their origin in chloralism. 

Chloral and Atropine, though antagonistic in their action on the spinal 
cord, both produce motor paralysis, the former by paralyzing the cord, 
the latter by direct paralysis of the motor nerves. 

Antagonists and In compatibles. 

Atropine antagonizes its cardiac, respiratory and spinal depression, and should be in- 
jected in small doses frequently repeated, until its effects are apparent. Morphine ad- 
ministered with Chloral antagonizes the tendency to cardiac failure, while synergistic to 
the hypnotism. While Chloral is the antagonist to Strychnine, opposing the spinal action 
of that drug, the reverse is true only to a very limited extent ; yet in a case described by 
Dr. Colenso in the British Medical Journal, Nov. 3, 1 894, in which recovery occurred 
after the ingestion of an ounce of Chloral, nine-tenths of a grain of Strychnine was em- 
ployed by hypodermic injection in broken doses. Heat is a necessary application, to 
maintain the body-temperature. Artificial Respiration should be employed if required. 
All Alkalies are incompatible with preparations containing Chloral. 

Therapeutics. 
Chloral Hydrate is of great value as a hypnotic and antispasmodic, 
but must be cautiously used if at all in persons with weak or fatty heart, 
atheromatous vessels or advanced pulmonary disease. In combination 
with Potassium Bromide it is much used in asylum and general practice, 
and equally abused, both drugs being active cardiac poisons. It is by far 
the best hypnotic in acute mania and in delirium tremens, but has been 
too incautiously employed therein. The condition of acute alcoholic 
intoxication seems, however, to antagonize its depressant action on the 
17 



258 CHLORAL. 

heart to a great extent, even in old topers, for 30-grain doses, repeated 
twice within 7 or 8 hours, are commonly used in inebriate asylums and 
by police surgeons, for the purpose of straightening up a case of acute 
alcoholism, with no fatal effects resulting from its direct action. Chloral 
possesses marked power to relax spasmodically contracted unstriated 
muscle and to dilate the peripheral vessels, properties which govern its 
employment in many morbid conditions. Associated with Potassium 
Iodide it is of service in bronchial asthma, and has been used in the form 
of an enema for checking hemoptysis by the revulsion which it produces 
in dilating the cutaneous vessels. Chloral is exceedingly efficient as a 
gastric antiseptic and sedative in the so-called nervous dyspepsia of neu- 
rotic persons, characterized by severe pain in the cardiac region of the 
stomach. It is very serviceable in fevers, when high temperature exists 
with excitement, restlessness and a sthenic condition, as it lowers tem- 
perature and prevents the coagulation of fibrin. In the algid stage of 
cholera and in violent cases of cholera morbus it has been injected hypo- 
dermically in 15-grain doses with extraordinary efficacy. In sea-sickness 
small doses (gr. v) two or three times a day are generally very efficient. In 
obstetrics it is used to relieve suffering, relax the os uteri, palliate convul- 
sions and relieve afterpains. For nocturnal epilepsy a full dose at bedtime 
is a useful palliative. In neuralgia it may be triturated with Camphor and 
applied over the course of the affected nerve, and the same mixture is 
efficiently employed as a local application for toothache and earache. 

Chloral is well borne by children, and is an excellent remedy for in- 
fantile convulsions and colic, chorea, whooping-cough, laryngismus stri- 
dulus and the first stage of diphtheria, but it should not be used when the 
first sound of the heart becomes dull and weak. It is highly efficient for 
the purpose of calming children in scarlet fever. In these affections it 
may be given with paregoric, as its combination with Opium enhances 
its value and guards the patient against its dangers. Its hypnotic power 
in adults is much increased by the conjoint administration of laudanum 
or morphine, and this combination is an excellent remedy in colic, 
cholera and cholera morbus. Tetanus is well treated by Chloral and 
Potassium Bromide given together in full doses. In Strychnine poison- 
ing Chloral is the antagonist. It is generally given by the mouth in very 
dilute solution with some simple elixir, syrup of tolu, or cinnamon-water, 
but is well absorbed by the rectum. Its hypodermic administration is 
liable to result in great local irritation and even sloughing ulcers. 

Chloral may be applied to the skin as an antipruritic in the eruptive 
diseases, for which purpose it is well combined with Carbolic Acid, ten 
grains of each to an ounce or two of water or oil. It is said to be the 
best of all local applications for boils, gjss in giv each of glycerin and 
water constantly applied to the boil by a tampon of cotton. For ulcers 



CHLORAL BUTYLICUM — CHLORALAMIDUM. 259 

and cancers a 25 per cent, solution is a good antiseptic and anodyne 
application. 

The chief contra-indication to the use of Chloral is the presence of a 
cardiac affection, although it may be prescribed with much benefit in 
neurotic palpitation of the heart and in pseudo angina pectoris. Other 
contra-indications are rosacea, or a tendency to it, and hysteria of grave 
character. It readily produces congestion of the face, and in hysterical 
subjects it may excite paroxysms of delirium and hallucinations. 

CHLORAL BUTYLICUM, Butyl-chloral Hydrate, Croton-chloral, C 4 H 5 C1 3 - 
0,H 2 (Unofficial), — is formed by the action of Chlorine upon Aldehyde, adding to 
the Butyl-chloral thus produced the necessary water. It occurs in crystalline scales, 
insoluble in chloroform, sparingly soluble in water, (1 in 100), but freely soluble in alco- 
hol, in hot water and in glycerin, (1 in 4). Dose, gr. v-xx, in syrup or pill; — but the 
best method is to give 5 grains every half-hour until 20 grains have been taken or 
until relief is afforded. 

The action of Croton-chloral closely resembles that of chloral, but it is feebler as a 
hypnotic, less depressant to the heart, and generally less poisonous, but more disagreeable 
to the taste. It has a specific paralyzant power over the fifth nerve, and over its distribu- 
tion causes an anesthetic condition long before it produces general anesthesia (Liebreich). 
It has been used with benefit in various neuralgise, especially tic-douloureux, also in 
sciatica and dysmenorrhea. All statements concerning the action and therapeutics of 
this drug are to be received with hesitation, as wide differences therein are reported by 
the best authorities. 



CHLORALAMIDUM, Chloralamid, Chloral Formidate, (Un- 
official), is chemically a union of Chloral Anhydride (C 2 HC1 3 0) with' 
Formamide (CHO.NH 2 ). It is a proprietary drug, having been both 
patented and trade-marked, wherever possible, by its proprietor and ex- 
clusive manufacturer, Schering, of Berlin. It occurs as colorless, faintly 
bitter, odorless crystals, which are decomposed in hot water or warm 
solutions, and are soluble in 20 parts of cold water, or in 1^ of alcohol ; 
rapidly decomposed by caustic alkalies and slowly by alkaline carbonates. 

The Dose is put at from 10 to 60 grains. The average adult hypnotic quantity is about 
30 grains, given in a teaspoonful of whiskey or brandy, or in any alcoholic compound ; 
for example, 30 grains in 2 drachms each of Tinct. Cardamom. Co. and Elixir Simplex, 
at one dose. By some observers 45 grains are considered the limit of safe dosage and 
equal to 30 grains of Chloral Hydrate ; by others this amount is considered necessary for 
its certain hypnotic action. Sixty grains have frequently been administered, and in one 
case 140 grains were taken at one dose, without producing unpleasant symptoms ; — but, 
as Dr. Steele has pointed out, the slow solubility of the drug in the watery contents of 
the stomach must be taken into account, and when considering its effect, the action of the 
menstruum and the condition of the gastric mucous membrane should be known. 

Physiological Action and Therapeutics. 
The action of Chloralamid is essentially hypnotic ; it has been exten- 
sively advertised as the least depressant and most efficient sleep-producer 
at our command, — without unpleasant after-effects from ordinary doses, 
except in 2 per cent, of the cases in which used, 1 per cent, having gastric 
and the other 1 per cent, having cerebral symptoms ; while these were 



260 CHLOROFORMUM. 

always slight unless the dose of 30 grains had been exceeded. The more 
severe and unusual effects (from doses above 30 grains) are vertigo, thirst, 
nausea, dry mouth, vomiting, anorexia, slight delirium, cardiac weakness, 
rapid and feeble pulse, and restlessness. The drug does not seem to have 
any cumulative action, or any tendency to provoke a habit of using it. 
It is also credited with considerable analgesic power in certain conditions 
(see below), as well as with anti-dyspneic and anti-hydrotic action. 

The main field for the use of Chloralamid is found in the treatment of 
insomnia, particularly the simple or idiopathic form, and when not due 
to excitement or severe pain, but from nervousness, hysteria, chronic 
alcoholism, and similar states ; also in that accompanying typhoid fever, 
asthma (both cardiac and bronchial), organic heart disease, the opium 
habit, and diabetes mellitus (Steele). It is less effective in organic 
nervous affections and mental disorders, and is useless in these conditions 
when the insomnia is due to excitement, hallucinations, or severe pains. 
As an analgesic, it has lessened and checked the pains of aneurism, car- 
cinoma of the stomach and liver, sarcoma of a rib, erysipelas, rheumatic 
fever, gall-stone, etc. ; and in dysmenorrhea it has given entire relief, 
used just as the painful period approached, in a single dose of 30 grains. 
It has been reported curative of chorea, in doses of 15 grains thrice daily 
for five days, in a boy of eleven years ; and in a girl who had resisted all 
other treatment for the same affection, it was successful in 8 days. 

Compared with Sulphonal, Chloralamid is preferred for all cases in which collapse is 
feared, by reason of its apparent freedom from depressant action on the cardiac centres or 
the respiratory mechanism. In phthisis it has proven efficient against the most obstinate 
night-sweats, while at the same time securing rest in cases in which the cough was not 
very violent. To secure its best hypnotic results, the drug should be given about an 
hour and a half before sleeping-time, in a dilute alcoholic menstruum, and on a stomach 
containing little or no watery fluids to interfere with its solution and absorption. 



CHLOROFORMUM, Chloroform, CHC1 3 (or CHC1 2 C1), Ab- 
solute Chloroform, the Terchloride of Methyl, or the Chloride of Bichlor- 
inated Methyl (Di-chlor-methyl Chloride), — is formed by the substitu- 
tion of 3 atoms of Chlorine for 3 of Hydrogen in Methyl Hydride 
(marsh-gas, CHJ. In practice it is obtained from Ethylic Alcohol or 
Methylated Spirit by the action of Chlorinated Lime, or from Chloral 
by an alkaline hydrate, and is known chemically as Normal Chloroform. 
If prepared from Methylic Alcohol (wood-spirit) it is called Methylic 
Chloroform, and is purified with great difficulty. The object of purifica- 
tion is to remove the chlorinated pyrogenous oil. Absolute Chloroform 
has a sp. gr. of 1.500, and decomposes easily in sunlight or diffused day- 
light, but when reduced to a sp. gr. of 1.485 to 1.490 by alcohol it will 
keep well. The official form is — 

Chloroformum, Chloroform, CHC1 3 , — a liquid consisting of 99 to 



CHLOROFORMUM. 26 1 

99.4 per cent, by weight, of absolute Chloroform, and 0.6 to 1 per cent, 
of Alcohol. A heavy, clear, colorless, mobile and diffusible liquid, of 
characteristic, ethereal odor, a burning, sweet taste, neutral reaction ; 
volatile, not inflammable ; soluble in 200 of water, freely so in alcohol 
or ether, also in oils, benzol or benzin. Sp. gr. not below 1.490 at 59 F., 
or 1.473 at 77° F. Dose, internally, n^ij-xx, for inhalation gss-j, re- 
peated until the desired effect is produced. 

Chloroformum Venale, Commercial Chloroform, (Unofficial), — is a liquid containing 
at least 98 per cent, of Chloroform, and having a sp. gr. not lower than 1.470. It con- 
tains sundry Hydrocarbons, free Chlorine, Aldehyde and Hydrochloric Acid, and is used 
only for external applications, or to make the purified article. 

Preparations. 

Aqua Chloroformi, Chloroform Water, — a saturated solution, prepared by agitating 
an excess of chloroform in distilled water and pouring off the needed quantity of the 
solution. Dose, £ss-gij. 

Emulsum Chloroformi, Emulsion of Chloroform, — has of Chloroform 4, Expressed 
Oil of Almond 6, Tragacanth 1*4,, Water to 100. Dose, gj-.^j. 

Spiritus Chloroformi, Spirit of Chloroform, — has of Chloroform 6, Alcohol 94. 
Dose, V(\x-^i, well diluted. 

Linimentum Chloroformi, Chloroform Liniment, — has of Chloroform 30, Soap 
Liniment 70. 

Linimentum Chloroformi Compositum, Compound Chloroform Liniment, (Un- 
official), — has of Chloroform ^j, Oil of Turpentine ^j, Tincture of Opium ^ss, Tincture 
of Aconite 3 ij. 

Chlorodyne, (Unofficial), — is a celebrated secret mixture, put forth by Dr. J. Collis 
Browne, of London, and since imitated by many others. It contains Morphine, Chloro- 
form, Ether, Cannabis Indica, Hydrocyanic Acid, Capsicum, etc., and is powerfully 
anodyne, antispasmodic and narcotic, and therefore highly dangerous in non-professional 
hands. Dose, TT^x-xxx, according to the quantities of Morphine and Chloroform present, 
these being the active agents in the preparation. A tabular comparison of the principal 
formulae which are used in imitation of Browne's Chlorodyne, with the formula of the 
latter preparation itself, is given in the Appendix to this book, and will show the wide 
differences between them in Morphine strength. A list of 25 formulae for Chlorodyne 
was published in the Therapeutic Gazette for October, 1883. 

Tinctura Chloroformi et Morphinae (B. P.), — has been made official as a substitute 
for Browne's Chlorodyne. Each dose of 10 minims contains of Chloroform Y^lft , Ether 
TT\^, Alcohol y\%, Morphine Hydrochlorate gr. ^, Dilute Hydrocyanic Acid TT\,^$, 
Oil of Peppermint TT^-jL , Fluid Extract of Liquorice tt\i^{, Treacle and Syrup q. s. 

Tinctura Chloroformi Composita (B. P.), — has of Chloroform 2, Alcohol 8, and 
Compound Tincture of Cardamom 10. Dose, tf^xx-gj. 

Anesthetic Mixtures containing Chloroform, — see under /Ether, ante, page 114. 

Some Unofficial Chlorinated Anesthetic Compounds. 

Ethylene Bichloride, Dutch Liquid, Chloric Ether, C 2 H i Cl 2 . — is a rapid and power- 
ful anesthetic, probably safer than Chloroform and less so than Ether. It always par- 
alyzes the respiratory centre before the heart, so that its effects may be easily watched 
and controlled. This is the substance which Guthrie supposed he had obtained when he 
discovered Chloroform. 

Ethylidene Chloride, Chlorinated Muriatic Ether, CH 3 ,CHC1 2 ,— is a mixture of 
varying sp. gr., and is not inflammable. It closely resembles Chloroform both physically 
and physiologically, but is less depressant to the heart, consequently safer, and recovery 
from its effects is very prompt. 

Methyl Chloride, CH 3 C1, — a colorless gas, slightly soluble in water, of sweetish odor 



262 CHLOROFORMUM. 

and taste, inflammable, burning with a greenish flame. Cold liquefies it, and the liquid 
boils at — 7. 6° F. It is used locally in neuralgiae to produce intense cold, and with re- 
markable success. 

Methylene Bichloride, Dichloro-methane, CH 2 C1 2 , — is an effective anesthetic which 
it was supposed would displace Chloroform as being much safer. Dr. Richardson intro- 
duced it and Sir Spencer Wells advocated its use, but though little used as compared with 
other anesthetics several deaths have occurred from its employment. It kills by paralyz- 
ing the heart. 

Carbon Tetrachloride, CC1 4 , — is less irritant than Chloroform, but far more danger- 
ous to the heart. 

Physiological Action. 

The action of Chloroform is similar to that of Ether (see ante, page 114) 
with several important differences. It is more irritant to the mucous 
membranes, and if swallowed undiluted it produces violent gastroenteri- 
tis, which becomes apparent after the subsidence of the profound narcotism 
which at first follows its ingestion in quantity. A dose of ^j internally 
may cause death, though recovery has taken place after the ingestion of 
one, two and even three ounces (Wood). It clots the blood outside the 
body, converting it into a mass resembling sealing-wax. 

The inhalation of Chloroform produces sensations which are rather 
agreeable than otherwise, and many persons acquire a liking for it. 
After a few whiffs the patient experiences noises in the ears and flashes of 
light before the eyes, also a feeling of weight upon the chest ; the heart is 
felt to be beating wildly and a throbbing sensation is felt in the carotid 
arteries. In this first stage hysterical symptoms may become manifest, 
the patient laughing, crying, screaming or swearing. The pulse is at 
first quite rapid from nervousness, but soon falls in frequency and gains 
in force. In a short time all sensation of discomfort passes away, the 
patient becomes quiet, breathes easily, and is evidently comfortable. The 
consciousness is soon affected, questions being heard but not fully under- 
stood, and being answered hesitatingly and slowly and in an irrelevant 
manner. After a brief period of repose there may be another spell of 
excitement, during which the patient may struggle and endeavor to get 
up ; but this soon passes away, and the muscles, which were contracted, 
become flaccid, and the patient gradually assumes a condition of com- 
plete insensibility. In this state all reflex action is abolished and pain is 
not experienced ; the pupils are contracted, and the limbs, when raised 
and let go, fall heavily. Dangerous symptoms are — (1) respiration be- 
coming stertorous or shallow, (2) sudden dilatation of the pupils, (3) 
signs of cardiac failure. 

As compared with Ether the inhalation of Chloroform is less stimu- 
lating, much more depressant to the vital functions, and much more 
dangerous on account of its direct paralyzant action on the heart. Its 
vapor is less irritant to the air-passages, uninflammable, more agreeable, 
more prompt in action, produces much less subsequent vomiting, a shorter 



CHLOROFORMUM. 263 

stage of excitement and a more profound degree of narcosis ; and should 
be diluted with 96^ per cent, of air to produce anesthesia with safety, 
according to the general teaching on this subject. Its mortality is much 
greater, being about 1 in 5,600, against 1 in 13,000 for Ether, and fatal 
cases continue to be reported, though none of these have occurred in 
obstetrical practice. 

The Hyderabad Chloroform Commission's investigations, conducted under the direc- 
tion of Dr. T. Lauder Brunton, led to the conclusion that Chloroform and Ether act in 
the same manner upon the heart and respiration, both paralyzing the respiratory centre 
before the heart, and Chloroform acting more quickly and powerfully than Ether in both 
directions. Prior to this investigation it was taught that death from Chloroform is almost 
always sudden and occurs by cardiac paralysis, while from Ether it is slow and usually 
by paralysis of respiration. The subsequent researches of Gaskell, McWilliam and others 
tend to sustain the latter view, and show that the verdict of the commission cannot be 
accepted as conclusive. There is very little doubt but that Chloroform may paralyze the 
heart without first affecting the respiration ; and it is probable that the paralysis of the 
vaso-motor centre, and the consequent withdrawal of blood from the heart and brain to 
the dilated splanchnic area, may be an important factor of a fatal result. Chloroform 
undoubtedly exerts a powerfully depressant action on the heart. Injected into the jugular 
vein it instantly arrests the cardiac action and destroys its muscular irritability. Its vapor, 
applied to the exposed heart, paralyzes it, and even when artificial respiration is main- 
tained the effect is very apparent. There can be no doubt but that Chloroform destroys 
the contractile power of the cardiac muscle (Murrell). 

At a certain stage of chloroform anesthesia women often exhibit marked 
signs of sexual excitement, and on recovery it is not uncommon for them 
to bring charges of improper conduct against some one present, with no 
false intention but in the belief that impropriety actually occurred. It is 
never safe to administer an anesthetic to a woman without the presence 
of a third party (Murrell). 

For the modes of dying from anesthesia see under the title ./Ether, 
ante, page 115. 

Treatment of Chlorofor7n Poisoning. 

There is no chemical antidote, and if the drug has been swallowed the stomach should 
be evacuated, and the case treated as one of irritant poisoning. Oxygen or Amyl Nitrite 
may then be given by inhalation, and Strychnine or Atropine hypodermically to sustain 
the heart. Artificial respiration should be used as soon as possible. 

In cases of danger from Chloroform inhalation prompt measures must be taken. The 
tongue should be pulled out with forceps and kept out. The doors and windows should 
be thrown open so as to produce a current of fresh air, but care must be taken that the 
body is not cooled thereby. The face and chest should be slapped with a wet towel, 
and Artificial Respiration should be commenced at once and kept up for some time, not 
faster than 20 to the minute. A succession of quick, sharp blows on the chest, over the 
cardiac region, will sometimes provoke the heart to renewed action after it has apparently 
failed. Venesection is wrongly neglected in such cases; it relieves the right cardiac 
engorgement, which is so constantly found at the autopsy. Galvanism may stimulate 
the heart into action. Atropine hypodermically has. rendered excellent service in several 
cases in the author's experience. Strychnine is considered antagonistic by many authori- 
ties, and has been used with good results. Oxygen is the best antagonist of all (Sayre). 

Therapeutics. 
Chloroform has a large field of therapeutic action besides its use as an 
anesthetic. It is frequently employed in liniments as a rubefacient and 



264 CHLOROFORMUM. 

anodyne application, also to promote the passage of other agents through 
the epidermis, and to relieve itching. The vapor may be directed onto 
the raw surface of an ulcer or a superficial burn in order to relieve pain ; 
and that arising from a few drops placed in the hand and held close to 
the eye will relieve photophobia. Internally it is administered with great 
benefit in vomiting, colic, dysmenorrhea, and cholera morbus; also in 
true cholera, in which disease it has probably been more efficient than any 
other single remedy, and in gastric ulcer, gastralgia and other painful 
affections of spasmodic character. In three to ten drop doses well diluted 
it markedly improves all the functions of the stomach, and is a valuable 
remedy for many gastric disturbances, especially acute dyspepsia. In 
sciatica, tic-douloureux and other neuralgias of important nerves the deep 
injection of ni^v-xv of pure Chloroform in the vicinity of the nerve is 
highly recommended, though it may cause dangerous local disturbance. 
In several cases of severe supra-orbital neuralgia, the writer has injected 
two or three minims of Chloroform into the vicinity of the supra-orbital 
nerve just above its foramen of exit, with the most gratifying permanent 
results, though severe local pain and considerable swelling were experi- 
enced for several days. 

The vapor of Chloroform inhaled in small quantities from warm water 
or from a handkerchief is a very useful remedy in many neuroses, as hay- 
fever, spasmodic asthma and reflex cough. It is one of the best pallia- 
tives in the cough of phthisis, as was long ago pointed out by Spencer 
Wells. It may be used with much benefit as a pulmonary antiseptic in 
many affections of the air-passages, as acute nasal catarrh, influenza and 
bronchitis ; and has promptly checked a severe case of catarrh extending 
into the antrum and causing great pain. Carried to the production of 
muscular relaxation it is often used as an aid to diagnosis, especially in 
cases of malingering, in suspected disease of the abdominal viscera, 
and to aid in reducing dislocations and hernias. It is used with great 
benefit in parturition, decreasing the sensibility to pain, relaxing the 
passages, and easing the labor, while it does not interfere with the uterine 
contractions, or predispose to inflammation, hemorrhage or convulsions. 
In such cases the quantity needed is very small, a few whiffs from time 
to time being quite sufficient. In some cases, as in acute mania, a patient 
may require to be kept under the influence of chloroform for a long time, 
— for hours, days, or even weeks ; and this has been done in the digital 
treatment of subclavian and other aneurisms. The writer, on one occa- 
sion, kept an insane woman continuously under its influence for a period 
of three weeks, except during the time necessary for taking food. 

For the production of complete anesthesia the use of Chloroform is 
steadily decreasing in favor of Ether, except for young children and in 
obstetrical practice. Its vapor being four times denser than air, and the 



CHLOROFORMUM. 265 

rule for its effective use requiring fully 96^ per cent, of air with it, its 
administration according to the orthodox fashion requires most careful 
management, and should never be attempted in any but the recumbent 
posture. An ounce of Brandy and a hypodermic injection of Morphine, 
gr. 1, with Atropine, gr. j^-q, given 20 minutes before commencing the 
inhalation, are means of great utility in sustaining the heart and respira- 
tion, as well as in rendering the anesthesia more profound. No opera- 
tion, especially on parts supplied by the fifth nerve, should be undertaken 
during partial chloroform anesthesia, for the reasons given on page 115. 
For the Schleich method with a mixed anesthetic see under JEtker, ante, 
page 117. 

Dr. Luckett, of Mt. Sinai Hospital, New York, in ten years adminis- 
tered chloroform in 4,263 cases with but one death, and ether in 4,673 
cases with no death. Syme administered chloroform in 5,000 cases with- 
out a single death, and ascribed this excellent record to his adherence to 
the following rule : li Never mind the pulse, never mind the heart, leave 
the pupil to itself, but keep your eyes on the breathing, and if it becomes 
embarrassed to a grave extent, pull the tongue well out with an artery 
forceps." The Edinburgh rule is practically this: " Watch the respira- 
tion, the heart will take care of itself" ; but Professor Stewart suggests 
that a second one should be inculcated, namely — " Watch both the 
breathing and the pulse ; and if the heart threatens to fail for want of 
blood, fill it by raising the legs and compressing the abdomen." 

The elder Sayre administered Chloroform in a manner which would startle an 
uninitiated observer who is impressed by the orthodox rule of 96^ per cent, of air 
with 3j^ per cent, of the anesthetic as the only safe proportion. Having been made 
familiar with the practice of Dr. Sayre through observance of his methods as employed 
by some of his pupils, the writer sought for more direct instructions from that distin- 
guished surgeon, and received from him a letter from which the following paragraphs are 
extracted : — 

" I have employed no other method for more than twenty years, have used it in this 
manner in some thousands of cases without the least appearance of danger, and can 
therefore speak with confidence as to its safety. 

" My plan is simply to anesthetize the patient with the smallest amount of Chloro- 
form possible ; and as Oxygen is the Antidote to the anesthetic I exclude all air that is 
not impregnated with the anesthetic. 

" In this manner a very few inspirations will produce immediate anesthesia without 
the muscular struggling which always follows when pure air is admitted with the chloro- 
form. I always measure my dose with the same care as if I were administering Arsenic, 
Strychnine, Corrosive Sublimate, or any other potent agent ; and then I know what I am 
doing. If by accident there should be some peculiarity about the patient, making him 
unduly susceptible, a few artificial respirations would soon remove the influence of the 
few drops which had been inhaled, and thus all danger can be avoided. Five, ten, or 
twenty drops of Chloroform administered in this manner is all that is requisite to pro- 
duce immediate and profound anesthesia. I have explained my method hundreds of 
times at my clinical lectures in Bellevue Hospital, many of which have been published 
at different times in different medical journals by various persons who have made steno- 
graphic reports of my lectures. In the ' Transactions of the International Medical Con- 
gress,' held in Philadelphia in 1876, is a verbatim report of my remarks on this subject 
made while I was performing an exsection of the hip-joint in the hospital before the 
Congress." 



266 CHLORUM. 

CHLORUM, Chlorine, CI, — is a greenish-yellow gas having a 
suffocating odor, belonging to the Halogen group of elements ; and 
though not official itself, it is represented in medicine by several of its 
compounds, as well as by several preparations which furnish it. 

The so-called Halogen Elements derive their title from clIq, the sea, — because the 
most important members of the group are obtained, directly or indirectly, from the ocean, 
viz. : Chlorine, from sea-salt ; Bromine, from sea-water ; and Iodine, from sea- weed. 
They are all noted for their affinity for hydrogen, and consequent power as decomposers 
of organic matter. 

Chlorine Compounds, described under the titles of their respective 
metallic bases, are — the Chlorates of Potassium and Sodium ; the Chlo- 
rides of Ammonium, Calcium, Potassium, Sodium, Mercury, Gold, Iron, 
Zinc, etc. ; — also Hydrochloric Acid, classed with the mineral acids (see 
page 97), and Chloral, Croton-chloral, and Chloroform. 

Preparations. 

Aqua Chlori, Chlorine Water, — is an aqueous solution of Chlorine, containing at 
least 0.4 per cent, of the gas ; and is prepared by heating together Manganese Dioxide 
10 parts and Hydrochloric Acid 35, then saturating 400 of distilled water with the gas 
so obtained. It is a clear, greenish-yellow liquid, of suffocating odor and disagreeable 
taste. Dose, ^j-^ss, well diluted, as a lotion or spray ; internally, TlLx-xx, in water. 
Chlorine Water may be extemporaneously prepared by mixing in a mortar Chlorate of 
Potassium 40 grains and Hydrochloric Acid l / 2 ounce, and adding a pint of distilled 
water by agitation during the evolution of the vapors. If done in a closed vessel danger 
may arise from the explosive gas, C1 2 4 , which is liberated at the same time. It should 
be quickly bottled. 

Calx Chlorata, Chlorinated Lime {Chloride of Lime), — is a compound resulting 
from the action of Chlorine upon Calcium Hydrate, and containing at least 35 per cent, 
of available Chlorine. It is obtained by exposing slaked Lime to the action of Chlorine 
gas as long as the latter is absorbed, and should not be confounded with Calcium Chlo- 
ride (see ante, page 234). It occurs as a whitish, dry powder or in friable lumps, gradually 
decomposing in the air, of saline, disagreeable taste, and a feeble Chlorine odor, partially 
soluble in water and in alcohol, and when dissolved in dilute Hydrochloric acid gives off 
Chlorine gas. Dose, gr. iij-yj in water; for external use a I to 3 per cent, solution. 
Liquor Calcis Chloratce, B. P., is ; a solution of I pound in I gallon of water. 

Liquor Sodae Chloratae, Solution of Chlorinated Soda {Labarraque' 's Solution), — a 
pale-greenish liquid, of faint chlorine odor, and alkaline taste and reaction ; prepared by 
adding together wa'ery solutions of Sodium Carbonate 150, and Calx Chlorata 75, each 
in water, then adding Water up to 1000. Is an aqueous solution of several chlorine- 
compounds of sodium, containing at least 2.6 percent., by weight, of available chlorine. 
Dose, TTb x_ 3J m 2 ° parts of water. 

Physiological Action. 
In the presence of moisture Chlorine is one of the most powerful of 
disinfectants and deodorants, and an antiseptic and antifermentive agent 
of the highest activity ; its power in these respects being due to its affinity 
for hydrogen, decomposing all bodies which contain hydrogen as a molec- 
ular constituent, forming hydrochloric acid and setting oxygen free in 
its nascent form (ozone). Administered internally, it is converted, on 
reaching the stomach, into hydrochloric acid and chlorides, losing all 
action on the organism in its own character. Locally applied, it is irri- 



CHLORUM. 267 

tant to the skin and mucous membranes, producing a sense of heat, with 
burning sensations and even vesication. Inhaled in any quantity, it 
causes cough, sneezing, and spasm of the glottis, also inflammation of the 
mucous lining of the air-passages and of the lungs. 

Antidotes. 

Ammoniacal Vapors inhaled after Chlorine to form Ammonium Chloride. Ammonium 
Sulphide has a simdar reaction, but should be inhaled in great moderation. Albumin is 
the antidote if Chlorine preparations have been taken into the stomach, and a little Aqua 
Ammonias, sufficiently diluted, may also be administered with advantage. 

Therapeutics. 

The Chlorinated preparations are used as disinfectants and deodorizers 
of rooms, drains and discharges from the body. They are rarely used 
about the person or clothing of 'patients by reason of the irritation pro- 
duced by them when inhaled, and their power to destroy the color of 
fabrics. In dilute solution they are well employed as local applications 
in aphthae, gangrene, scarlet fever and diphtheria, in which their principal 
action is to destroy fetor. The same may be said of their use in slough- 
ing ulcers and gangrenous wounds, foul discharges, etc., as they are rarely 
employed about the person in sufficient strength to have any destructive 
effect on disease-germs. A strong solution of Chlorinated Soda is a good 
application to bites of serpents and insects, to wash the hands after con- 
tact with infectious material, and to prevent infection by the syphilitic 
poison. A combination of Potassium Chlorate and Tinctura Ferri 
Chloridi makes a solution of Chlorine, Euchlorine, Potassium Chloride 
and Ferric Chloride when diluted with water, and gives one of the best 
and most innocuous solutions of antiseptics. It makes an excellent gargle 
for sore throats, simple or diphtheritic. Glycerin should never be added 
to it, as the resulting mixture will be liable to explode violently. These 
preparations have been administered internally in septic diseases, low 
fevers, etc., but without producing any marked beneficial results, except 
in diphtheria, for which disease the internal administration of Chlorine 
Water diluted has many advocates among practicing physicians. 

Chlorine gas is a powerful local stimulant, and has been used with 
great benefit to promote healing in old ulcers. Absorbent cotton may be 
exposed to the gas extemporaneously prepared as directed on page 266, 
and bandaged on the surface of the ulcer. Chlorine inhalations were 
used forty years ago, by Sir James Simpson and others, in phthisis pul- 
monalis, with apparent benefit. 

Chlorinated Lime, freshly prepared, in solutions of varying strength, 
from 1 in 60 to 1 in 12, is used by hypodermic injection in Australia as 
an antidote to serpent venom. The solution is injected into several- 
points above the wound, 20 to 100 minims being inserted at each place. 



268 CHRYSAROBINUM CIMICIFUGA. 

In some cases this procedure causes great pain, but it does not seem to 
induce any local inflammation, and it is highly efficient for the purpose 
for which it is used. A common method of disinfecting a sick-room is 
to place a pound of Chlorinated Lime into a canvas bag and immerse it 
in a mixture of common Hydrochloric Acid, 1% pint, and Water 4^ 
pints, allowing it to remain for 24 hours. A still better method is to 
mix common salt, Manganese Dioxide and Sulphuric Acid in a saucer. 
The Chlorine generated is heavier than atmospheric air, so that the vessel 
should be placed on a high shelf and not on the floor, in order that it 
may be diffused throughout the room. 

CHRYSAROBINUM, Chrysarobin, — is a mixture of proximate principles ex- 
tracted from Goa-pozvder, a substance found in cavities formed by decay in the wood of 
the trunk of Andira Araroba, a Brazilian tree of the nat. ord. Leguminosae. It is com- 
monly misnamed " Chrysophanic Acid " (one of the constituents of Rheum) — though easily 
converted into that substance. Occurs as an orange-yellow powder, odorless and taste- 
less, nearly insoluble in water and in alcohol, but readily soluble in ether, solutions of 
alkalies and sulphuric acid. Dose, gr. y%. 

Unguentum Chrysarobini, Chrysarobin Ointment, — Chrysarobin 5, Benzoinated 
Lard 95 parts. Should be diluted for average use from I to 3 times. 

In 20-grain doses Chrysarobin is a gastro-intestinal irritant, producing large, watery, 
bilious stools, with repeated vomiting but not much nausea. Locally it produces diffuse 
dermatitis, often followed by follicular and furuncular inflammation. It stains the skin a 
dark yellowish-brown color, which may be removed by a weak solution of chlorinated 
lime. The use of this remedy is confined to superficial parasitic skin diseases of vege- 
table origin, and for psoriasis, in the latter affection being the best remedy known. It 
may be used in weak ointment locally, and internally in */£-grain doses. 



CIMICIFUGA, Black Snake-root, Black Cohosh, — is the rhizome 
and roots of Cimicifuga racemosa, a plant of the nat. ord. Ranunculaceae, 
native in the United States. It contains a Volatile Oil when fresh, resin, 
tannic and gallic acids, also an acrid, crystallizable, neutral principle. 
Cimicifugin or Macrotin is an impure resin obtained by precipitation from 
a concentrated tincture by the addition of water. The active principle 

has not been isolated. 

Preparations. 

Extractum Cimicifugse, Extract of Cimicifuga. — Dose, gr. j-v. 
Extractum Cimicifugae Fluidum, Fluid Extract of Cimicifuga. — Dose, rr\v-xx. 
Tinctura Cimicifugse, Tincture of Cimicifuga , — 20 per cent. — Dose, n\x-g]. 
Macrotinum, Afacrotin, (Unofficial). — Dose, gr. ss-ij. 

Physiological Action. 
Cimicifuga is stomachic, antispasmodic, aphrodisiac, diaphoretic, diu- 
retic and expectorant. Its taste is bitter and nauseous, resembling that 
of Opium. It acts on the heart and circulation similarly to Digitalis, and 
on unstriped muscular fibre like Ergot, but is much feebler in activity 
than either of these agents. Small doses stimulate digestion and secre- 
tion, the generative function and the menstrual flow, and especially the 



CINCHONA. 269 

secretions of the bronchial mucous membrane and the kidneys. Full 
doses slow the heart while increasing its force, raise arterial tension and 
stimulate uterine contraction. Large doses dilate the pupils and produce 
dimness of vision, vertigo, intense headache, nausea, vomiting, and in 
some persons soporific and anodyne effects. 

Therapeutics. 

Cimicifuga closely resembles Digitalis in action, but it is safer, and 
should be more frequently used when the latter drug is indicated. In 
cardiac diseases it is very efficient, especially in weak or fatty heart where 
Digitalis would be dangerous. It is a good stomachic tonic, particularly 
in the irritable dyspepsia of alcoholism. As an expectorant it is used in 
acute and chronic bronchitis. It is a good nerve-tonic in delirium tre- 
mens, and in functional impotence it is often efficient. In rheumatoid 
arthritis and rheumatism of the localized muscular variety, as lumbago, 
torticollis, intercostal rheumatism, etc., it is one of the most efficacious 
remedies, having a strong affinity for the muscular system. Neuralgias of 
various kinds are benefited by it, particularly ovarian neuralgia. Chorea 
about the age of puberty is one of the affections in which it is most use- 
ful, and the same may be said of the hysterical form of this disease. 

Many uterine disorders are remarkably benefited by Cimicifuga, such 
as amenorrhea, neuralgic and congestive dysmenorrhea, subinvolution, 
spinal irritation due to some obscure sympathetic or neuralgic affection 
of the womb, sympathetic pains and neuralgias arising from the so-called 
irritable womb, passive menorrhagia, etc. In obstetrics it gives excellent 
results when used to initiate uterine contractions, to check hemorrhage, 
and to allay afterpains and nervousness after delivery. In puerperal 
mania and peritonitis its good effects are frequently remarkable, and in 
puerperal hypochondriasis it is strongly recommended by very high 
authority. 

CINCHONA, Peruvian Bark.— The Cinchona tree belongs to the 
nat. ord. Rubiacese and is a native of the eastern slope of the Andes, but 
has been largely planted in India, Ceylon, Java and Burmah, with the 
result of improving the quinine-yielding value of many species by culti- 
vation. In late years the test of appearance has given way to that of 
assay in judging of the various barks of commerce, and only those are 
official which yield 5 per cent, of total alkaloids of which at least 2 l / 2 per 
cent, must be Quinine. Yellow bark contains most Quinine (as high as 
9 per cent, having been obtained from one specimen), pale bark contains 
most Cinchonine and least Quinine, while red bark contains these alka- 
loids in about equal proportions. The Columbian varieties afford the 
largest percentage of Cinchonidine. The official species are: — 



270 CINCHONA. 

Cinchona, Cinchona, — the bark of Cinchona Calisaya, Cinchona offici- 
nalis, and of hybrids of these and of other species of Cinchona, yielding, 
when assayed by a prescribed process, not less than 5 per cent, of total 
alkaloids, and at least 2^ per cent, of Quinine. 

Cinchona Rubra, Red Cinchona, — is the bark of Cinchona Succi- 
rubra, containing not less than 5 per cent, of its peculiar alkaloids. 
From it is prepared the Compound Tincture of Cinchona. 

Bark may be administered in doses of gr. x-^j, but it is never used 
now in substance, being bulky and very disagreeable to the taste. 

The principal varieties of the sub-order Cinchonese, the barks of which are found in 
commerce and are used by manufacturers of the alkaloids, are — Cinchona Calisaya, 
Cinchona FJava, Yellow Bark, from Peru, Bolivia and India; C. Succiruba, Red Bark, 
from Ecuador, Java and Ceylon ; C. Conda??iinea, Pale Bark, from Ecuador and Peru ; 
C. Pitayensis, Pitaya Bark, from New Granada ; C. Micrantha, Gray Bark, from 
Peru and Bolivia. Altogether there are some 31 species acknowledged by botanists, 
and the list is constantly increasing, from the tendency of the different trees to hybridize. 
Several trees formerly acknowledged as Cinchonas are now placed in the genus Casca- 
rilla, but their barks are to be found on the market. Cuprea bark is from trees of the 
genus Remijia, growing in Columbia ; it contains Quinine and a peculiar alkaloid, Cin- 
chonainine, but no Cinchonidine. 



Composition of Cinchona. 
Cinchona bark contains 21 natural alkaloids (of which 4 are official), 
8 artificial alkaloids, 2 simple acids, 2 tannic acids, a resinoid and a color- 
ing matter, as follows : — 

Quinine, C 20 H 24 N 2 O 2 , — a strong base, fluorescent, the most valuable of all the alka- 
loids ; heated with glycerin to 374 F. , it is converted into the isomeric base, Quinicine. 

Quinidine, C 20 H 2i N 6 O 2 , — isomeric with Quinine, fluorescent, probably the most power- 
ful as an antiperiodic, but existing in very small quantity. 

Cinchonine, C 19 H 22 N 2 0, — the least active of the official four, having about half the 
therapeutic power of quinine. Not fluorescent. 

Cinchonidine, C 19 H 22 N 2 0, — isomeric with Cinchonine, not fluorescent, one of the 
most powerful of the alkaloids. 

The other alkaloids are of no interest medicinally. 

Kinic and Kinovic. Acids, — are combined in the bark with the alkaloids. The for- 
mer is used to make a Kinate of Quinine, and the latter occurs in non-official pharmacy 
as Kinovate of Lime, an ingredient in Deloudre's Extract, which is used in Europe and 
India for dysentery. 

Kino-tannic and Kinovo-tannic Acids, — give to bark its peculiar and powerful 
astringent qualities. They have not been fully studied. 

Kinovin, — is a bitter, amorphous resinoid, which is resolvable into Kinovic Acid and 
sugar. It is soluble in alcohol, but not in water. 

Cinchona Red, — a reddish -brown, insipid, inodorous substance. 

Preparations of the Bark. 
Extractum Cinchonse, Extract of Cinchona. — Dose, gr. j-v. 
Extractum Cinchonae Fluidum, Fluid Extract of Cinchona. — Dose, ttpt-^j. 
Tinctura Cinchonae, Tincture of Cinchona, — has of Cinchona 20, in Alcohol 
67^, Water 25 and Glycerin 7^. Dose, 3 ss— ij . 



CINCHONA. 271 

Tinctura Cinchonae Composita, Compound Tincture of Cinchona, — has of Red 
Cinchona 10, Bitter Orange Peel 8, Serpentaria 2, in Alcohol 85, Water 7^ and 
Glycerin 7^ ; and is intended , to replace Huxham's Tincture of Bark (see below). 
Dose, gj-iv. 

Infusum Cinchonae, Infusion of Cinchona, — has of Cinchona 6, Aromatic Sulphuric 
Acid I, Water to 100. Is the only official infusion containing this acid. Dose, 3J-^j. 

Huxham's Tincture of Bark, 1788 (Unofficial), is still used. Red Cinchona Jiv, 
Orange-peel % iij, Serpentaria gr. lxxx, Spanish Saffron gr. clx, Cochineal gr. lxxx, 
Brandy ^xl, digested for 4 days, expressed and filtered. Dose, gss-ij. 

Quinine and its Salts. 

Quinina, Quinine, C 20 H 24 N 2 O 2 -j- 3H 2 0, — a white, amorphous or minutely crystal- 
line powder, of alkaline reaction and very bitter taste, soluble in 1670 of water and in 6 
of alcohol at 59 F. , in 23 of ether, 5 of chloroform, and readily in dilute acids. Dose, 
gr. j-xx, or xl in special cases. Is insoluble in saliva. 

Quininae Sulphas, Quinine Sulphate, (C 20 H 24 N 2 O 2 ) 2 .H 2 SO 4 -4- 7H 2 0, — very light, 
snow-white, fragile crystals, of very bitter, persistent taste, soluble in 740 of water and 
in 65 of alcohol at 59 F., in 30 of boiling water, 3 of boiling alcohol, also in acidulated 
water. Dose, gr. j-xx, or even gr. xl in special cases. 

Quininae Bisulphas, Quinine Bisulphate, C 20 H 24 N 2 O 2 .H 2 SO 4 -j- 7H 2 0, — clear, col- 
orless, efflorescent crystals or small needles, of very bitter taste and strongly acid reac- 
tion, soluble in 10 of water with blue efflorescence, and in 32 of alcohol, at 59 F. 
Dose, gr. j-xxx, or even gr. Ix in special cases. 

Quininae Hydrobromas, Quinine Hydrobromate, C 20 H 24 N 2 O 2 HBr -j- H 2 0, — color- 
less needles, of very bitter taste, soluble in 54 of water and in 0.6 of alcohol at 59 F., 
very soluble in boiling water and in boiling alcohol. Dose, gr. j-xx. 

Quininae Hydrochloras, Quinine Hydrochlorate, C 20 H 24 N 2 O 2 HCl -f- 2H 2 0, — white 
needles in tufts, of very bitter taste, soluble in 34 of water and in 3 of alcohol at 59 F., 
in 1 of boiling water or alcohol. Is used hypodermically. Dose, gr. j-xx. An excel- 
lent salt which should be more generally used ; 5 to 10 gr. doses are antipyretic. 

Quininae Valerianas, Quinine Valerianate, C 20 H 24 N 2 O 2 C 5 H 10 O 2 -j- H 2 0, — white, 
pearly crystals, of valerianic odor and bitter taste, soluble in 100 of water and in 5 of 
alcohol at 59 F. Dose, gr. j-iij. It is supposed to be the only salt of Quinine affected 
by the constituent acid. 

Quininae Hydrochloras Carbamidata, Quinine Carbamide Hydrochlorate (Unoffi- 
cial), — is a new compound salt of Quinine and Urea, soluble in equal parts of water and 
therefore admirably adapted for hypodermic administration in a '50 per cent, solution. It 
is almost unirritating to the tissues, and is given subcutaneously in doses of gr. j-iij. 

Chininum Amorphum Boricum, Amorphous Quinine Borate (Unofficial), — is a 
new preparation, soluble in an equal quantity of water, and claimed by its introducers to 
be as satisfactory as any Quinine salt, and better borne by the stomach than any other. 
It is said to cause little or no congestion of the membrana tympani. 

Tinctura Pyrexialis, Warburg 's Tincture (Unofficial), — is a celebrated preparation, 
formerly secret, but published in 1875 by the originator, whose formula is as follows : — 
R . Aloes soc. lb j ; Rad rhei (chinens. ), Sem. angelicae, Confec. Damocratis,* aa ^ iv ; 
Rad. helenii (s. enulae) , Croci sativi, Sem. foeniculi, Cretae prep. , aa ^ i j ; Rad. gentianae, 
Rad. zedoarise, Pip. cubebse, Myrrhae elect., Camphorae, Bolet. laricis, aa^j. Digest 
the whole with 500 oz. of proof spirit in a water-bath for 12 hours, express, add 3 x Bi- 
sulphate of Quinine, dissolve by aid of a water-bath, cool, and filter. Dose, 5 j, in two 
doses 3 hours apart. Hager's modification of the original formula is — R • Quininae sulph. 
part j, Spt. camphorae part ij, Elix. proprietatis (Tinct. aloes et myrrhae) part xxij, Alco- 
holis part xvj. The evidence published in favor of this preparation goes to show that its 
power does not lie wholly in the quinine, camphor, aloes or rhubarb, but partly in some 
of the aromatic plants contained in it. 



* For the formula for this ingredient see the article on Confections in the section on 
Extemporaneous Pharmacy, Part IT 



2/2 CINCHONA. 



Other Official Alkaloids and their Preparations. 

Cinchonina, Cinchonine , C 19 H 22 N 2 0, — white, lustrous prisms or needles, of bitter 
after-taste, almost insoluble in water, readily so in dilute acids and in 1 16 of alcohol at 
59 F. Dose, gr. j-xxx or more. 

Cinchoninae Sulphas, Cinchonine Sulphate (C 19 H 22 N 2 0) 2 H 2 S0 4 -j- 2H 2 0, — white, 
shining prisms, of very bitter taste, soluble in 66 of water and in 10 of alcohol at 59 F., 
and readily soluble in dilute acids. Dose, gr. v-xxx or more. 

Cinchonidinae Sulphas, Oinchonidine Sulphate (C 19 H 22 N 2 0) 2 H 2 S0 4 -f- 3H 2 0, — 
white, silky crystals, of bitter taste, soluble in 70 of water and in 66 of alcohol at 59 
F., freely soluble in acidulated water. Dose, gr. j-xx or more. 

Quinidinae Sulphas, Quinidine Sulphate (C 20 H 24 N 2 O 2 ) 2 H 2 SO 4 -|- 2H 2 0, — white, 
silky needles, of bitter taste, soluble in 100 of water and in 8 of alcohol, readily in acidu- 
lated water, at 59 F. Dose, gr. j-xx or more. It is not so bitter as Quinine, is less 
expensive, and is a valuable antipyretic and antiperiodic. 

Unofficial Preparations. 

Chinoidinum, Chinoidin, Quinoidin, — a mixture of alkaloids, mostly amorphous, 
obtained as a by-product in the manufacture of the crystallizable alkaloids from Cinchona. 
A black solid when cold, plastic when warmed, of bitter taste, almost insoluble in water, 
freely soluble in alcohol and in dilute acids. It contains the 4 alkaloids in amorphous 
condition, and has about ]/ 2 the therapeutic power of Quinine. Dose, gr. v-xxx or more. 

Quinquinina, Quinetum, — is an Indian preparation containing the total alkaloids 
extracted from bark by acidulated water, then precipitated by soda and dried. In India 
it is called " febrifuge." 

Cinchonidinae Salicylas, Cinchonidine Salicylate, — has anti-malarial power only 
inferior to that of the salts of Quinine. 

Substitutes for Quinine. 
The synthetical production of Quinine has been the "philosopher's 
stone " of the modern chemists, who have prosecuted with untiring energy 
the search for an artificial product possessing all its properties. Though 
in this they have as yet been unsuccessful, they have discovered several 
organic bodies, which closely resemble each other and also quinine, both 
in chemical constitution and physiological action. These substances 
belong to the aromatic series of carbon compounds, all of which are de- 
rivatives of Benzene or Benzol, C 6 H 6 , the hydride of the organic radicle 
Phenyl, C 6 H 5 . The distinctive action of the lower members of this series 
is their antiseptic and antipyretic powers,— as that of the fatty series of 
carbon compounds is stimulant and anesthetic (Brunton). Many of these 
agents are obtained from coal-tar oil (petroleum) by fractional distilla- 
tion, etc., and they are all derivatives of Benzene (Benzol), either 
directly or from some one of the products formed therefrom by substitu- 
tion, various radicles replacing the different constituent atoms of H and C. 

Thus by the ring-arrangements of atoms peculiar to this series, there are formed from 
Benzene (C 6 H 6 ), the following substances, viz. : — 

Phenol, or Carbolic Acid, C 6 H 5 OH — by replacing H by OH (hydroxyl). 
Pyrocatechin, or Ortho-\ C 6 H 4 (OH) 2 . 

Resorcin, or Meta- I dioxybenzol, — by replacing 2H by 2OH. 

Hydroquinone, or Para-) C 6 H 4 (OID 2 . 



CINCHONA. 273 

Pyrogallol, Pyrogallic Acid, Tri-hydroxybe7izene, C 6 H 3 (OH) 3 , — 3H by 3OH. 
Amido-benzene ', or Anilin, C 6 H 5 . NH 2 — by replacing H by NH 2 (amidogen). 
Nitro- benzene, C 6 H 5 .N0 2 — by replacing H by N0 2 (nitroxyl). 
Benzoic Acid, C 6 H 5 CO.OH— by replacing H by CO.OH (carboxyl). 
Salicylic Acid, HC 7 H 5 3 — by replacing 2H by OH and CO.OH. 

-by uniting two Benzenes in an over-lapping ring. 

-by replacing tetrad C by triad N. 

-by uniting Benzene (C 6 H 6 ) and Pyridine (C 5 H 5 N). 

Derived from Chinolin is the hypothetical base — 

Chinicin or Quinicin, C 9 H 9 N 2 , — represented in Antipyrin. 
Also Kairin, Thallin, and other compounds. 

The most important of these are Antipyrin, Acetanilid, Resorcin, 
Chinolin and Naphtalin, which are respectively described in separate 
articles. Others of the same class are the following, viz. : — 

Some Unofficial Antipyretics. 

Kairinum, Kairin [Ilydrochlorate of Oxy-ethyl-chinolin- hydride), C 10 H 13 NO.HC1. 
H 2 0, — is an artificial alkaloid prepared from Chinolin, belonging to the phenol group 
of carbon compounds, and a powerful antipyretic in 8-grain doses hourly. It stains the 
urine a deep green, and has not proven fatal though 220 doses have been administered 
in one case. In some cases of typhus it has caused cyanosis and collapse. It produces 
profuse sweating and vomiting, and the subsequent rise of temperature after its antipyretic 
influence has worn off is generally ushered in by a severe rigor. It occurs in white 
crystals, which are freely soluble in water, but is best given in wafer paper, or capsules. 
Dose, gr. iij-xxx. 

Kairolinum, Kairolin {Sulphate of Tetra-hydromethyl-chinolht), — is antipyretic, but 
much less efficient than Kairin. 

Thallin, Tetra-hydro-parachinanisol, — is a synthetically prepared substance, having 
also another chemical name, Tetra-hydro-para?nethyl-oxy-chinolin. It occurs as a color- 
less powder which is soluble in water, and enters into combination with acids, forming 
salts, of which the tartrate and sulphate are the most eligible, especially the latter. The 
dose of Thallin or its Sulphate ranges from gr. ij to gr. xv, a mean average dose being 
about 5 grains, given in the form of compressed tablets. Thallin is an antipyretic of 
very great power, doses of 5 to 12 grains lowering the temperature in typhoid fever 4 
to 5 in 2 hours' time, the effect lasting nearly 3 hours. In tuberculosis similar results 
were obtained. Large doses, however, produce very profuse sweating and a dangerous 
degree of depression ; so that this agent is not a favorite remedy for hyperpyrexia. 

Hydroquinone, Para-di-hydroxy-benzene, C 6 H 4 (OH) 2 , — is isomeric with Resorcin 
(see ante, page 272). It crystallizes in rhombic, colorless prisms which are slightly sol- 
uble in water, readily so in alcohol and in ether. It is obtained from Arbutin, a gluco- 
side constituent of Uva Ursi and other Ericaceae, by hydrolysis; also from Anilin by 
oxidation with chromic acid mixture and subsequent reduction of the Quinone thus 
formed by sulphurous acid. It is an efficient antipyretic, without injurious effects so far 
as observed, but its influence is only temporary. Dose, as an antipyretic, gr. xv-xx, best 
given in alcohol. Gr. xl have been given without disagreeable effects. 

Pyrocatechin, Catechol {Ortho-di-hydroxy-benzene), C 6 H 4 (OH) 2 , — is also isomeric 
with Resorcin, and is one of the acid constituents of coal-tar but is also obtained from 
wood-tar and from kinic acid. It is a good antipyretic, but much inferior to Quinine or 
Resorcin, and its use has been abandoned on account of its by-effects. 



Physiological Action. 
Cinchona is an astringent bitter and a stomachic tonic. At first it 
promotes appetite, digestion, the flow of saliva and of gastric juice; long, 
continued it sets up a gastric catarrh, impeding digestion and causing 



274 CINCHONA. 

constipation. The action of Cinchona in sufficient dose is generally that 
of its alkaloid Quinine, except that the bark is decidedly astringent, more 
of a gastric irritant, and its active principles are more slowly absorbed by 
reason of its bulk. In large doses (3ij) the powdered bark has produced 
flatulence and eructation, and in many well-authenticated instances has 
apparently caused a well-marked febrile paroxysm, beginning with chill, 
then fever and headache, which gradually subsided with slight perspira- 
tion. So also, Quinine, while incapable of producing intermittent fever 
in a healthy person, may, if taken in large doses unnecessarily, throw the 
nervous system into high commotion, and if untimely used by a malarial 
subject may reproduce the paroxysm with greater or less severity. 

Quinine is a bitter tonic, antiseptic, antiperiodic and antipyretic, a 
diminisher of reflex action, a protoplasmic poison and a cardiac depressant. 
It is rapidly diffused and slowly excreted, being found in the urine in 15 
minutes after its administration and for two or three days afterwards. 
Occasionally it produces renal and vesical irritation. Its action on the 
stomach is similar to that of cinchona. It arrests the movements of the 
white blood-corpuscles though increasing their number, and prevents 
acetification and decay of the blood. It is actively destructive of lowly 
organized life, a solution of 1 in 500 being fatal to infusoria and fungi, 
while one of double this strength prevents alcoholic fermentation and 
checks putrefactive decomposition. The heart and arterial tension are 
somewhat stimulated by small doses, but depressed by large ones (gr. 
xl-lxxx), which slow and enfeeble the pulse by direct action on the car- 
diac ganglia. The brain is rendered hyperemic and exhilaration is caused 
by small or moderate doses, and large ones produce a train of congestive 
cerebral symptoms, including a sense of fulness and constriction in the 
head, tinnitus aurium, vertigo, staggering gait, amblyopia and deafness, 
great headache, dilated pupils, delirium, coma, and in animals convul- 
sions. The eyes and ears, though suffering severely, are rarely injured 
permanently. The foregoing symptoms are collectively termed Cin- 
chonism. 

Quinine reduces the size of the spleen when enlarged, and lowers the 
temperature of pyrexia by lessening oxidation, though it does not depress 
the body-temperature in health. Large doses lower the reflex function 
of the spinal cord. In some subjects it produces sexual excitement, in 
others cutaneous eruptions sometimes followed by desquamation. It 
lessens the excretion of uric acid but not that of urea, and is a 
uterine stimulant in labor, but probably has no power to initiate uterine 
contractions. 

Quinidine and Cinchonidine correspond in action with Quinine both 
qualitatively and quantitatively, the latter however producing less severe 
head symptoms. Cinchonine also corresponds in effect, but is much the 



CINCHONA. 275 

least active of the four alkaloids. It is said to produce greater headache 

and much precordial pain and muscular weakness, but to have little effect 

on sight or hearing. 

Antagonists and Incompatibles. 

Morphine antagonizes its cerebral action, Atropine its nervous, cardiac and antipyretic 
powers. Free Tannic Acid is incompatible with the Infusion of Cinchona. Iodine 
preparations, Alkalies, Alkaline Carbonates and Earths, are incompatible with solutions 
of the alkaloids, the first-named forming insoluble compounds therewith and the latter 
precipitating them. 

Therapeutics. 

Cinchona is used as a tonic, and has many applications. The Infusion 
or Compound Tincture with a mineral acid is extremely serviceable in 
atonic dyspepsia, gastric catarrh of alcoholics, adynamia, convalescence, 
asthma, chronic bronchitis, and generally in weak subjects of flabby flesh 
and freely perspiring skin. 

Quinine finds its principal field of action in the malarial diseases, over 
which its influence is specific, by reason of its power to prevent the de- 
velopment of the plasmodium to which malaria is due. In intermittents, 
a ten-grain dose of the sulphate should be given in the sweating stage and 
again 5 hours before the expected time of the next paroxysm. In the 
intervals Arsenic is better used, as quinine may cause a daily exacerba- 
tion of temperature if long continued. In remittents from 20 to 30 
grains are administered once or twice daily until the temperature becomes 
normal, and in pernicious remittents doses of 30 to 60 grains are neces- 
sary to the safety of the patient. In chronic malarial toxemia Chinoidin 
is considered more effective than quinine. As a prophylactic against 
malarial fevers the use of small doses of quinine, 3 to 5 grains daily, has 
been universally approved until recently, especially in tropical countries. 
Professor Koch considers this to be dangerous practice and to be respon- 
sible for the increased death-rate in certain parts of West Africa during 
late years. He holds that the indiscriminate use of quinine as a prophyl- 
actic in malarial countries is in many cases the indirect cause of the per- 
nicious " black- water " fever, one of the most virulent forms of malarial 
disease ; also that this drug seriously weakens the action of the heart 
when taken regularly in excessive doses, and will so inure the system to 
its influence that it becomes useless as a remedy when required for that 
purpose. 

The Hypodermic Injection of Quinine is advocated by many authorities as more 
effectual in obstinate cases than any other method of administration. It becomes neces- 
sary in malarial fevers when vomiting is persistent and the rectum irritable, if the pa- 
tient is insensible and cannot swallow, also when life is in imminent danger and the 
earliest possible action of the drug is important (Manson). The best salts for hypo- 
dermic use are the acid Hydrochlorate and the Hydrobromate, which are soluble in 
their own weight of water ; but the Sulphate may be employed, its solution being 
effected by adding one-half its weight of tartaric acid. Ten to fifteen grains dissolved 



276 CINCHONA. 

in sterilized water would be a full hypodermic dose, which in grave cases should be 
given three times in 24 hours, injected deeply into the substance of the gluteal or scap- 
ular muscles. Laveran? s Formula for this purpose is — Quinine Hydrochlorate 3, Anti- 
pyrin 2, Distilled Water 6 parts, giving a 50 per cent, solution, the injection of which is 
painless. This solution was used extensively during a severe epidemic of malaria in 
Algiers in 1894 and always proved satisfactory (Blum). In it is formed by chemical 
transformation a new salt, named Chinopyrin, which is similar but not equivalent to the 
quinine salt (Santesson). 

Quinine is used as an antipyretic with good results, especially in septic 
fevers, typhus, typhoid, variola, pneumonia and acute rheumatism. In- 
flammations may, at their inception, be aborted by 15- or 20-grain doses, 
combined with Morphine, which in this respect is synergistic to quinine. 
Acute tonsillitis and acute catarrh may sometimes be aborted by a full 
dose. In surgical fevers, pyemia and exhausting suppurative conditions, 
also in septicemia, hectic fever, and before surgical operations, quinine 
is much employed. Neuralgias of malarial origin are amenable to it, as 
also neuralgia of the ophthalmic division of the fifth nerve. In eruptive 
fevers, especially scarlet fever, erysipelas and measles, it is advantage- 
ously administered throughout their course. In some skin diseases, par- 
ticularly erythema nodosum, it is quite efficient, also in whooping-cough 
and hay-fever. In the latter affection a solution of gr. vj of the neutral 
hydrochlorate to the g is a very useful local application. Antipyresis 
has of late received considerable attention, particularly in the German 
hospitals. The most certain and safe of all antipyretics is undoubtedly 
the cold bath, but it is not always the most practicable, especially in 
private practice. Internal antipyretics are therefore of great value, and 
of these the safest and best is Quinine, next in order being Lactophenin 
and Phenacetin. 

Warburg's Tincture has obtained a very high reputation in the hands 
of Indian army-surgeons in the treatment of remittent and other malarial 
fevers of the most malignant types, in malarial neuralgias, acute nervous 
exhaustion and sudden collapse without organic disease. The most pro- 
nounced testimony to its value is that of Dr. Maclean {Med. Times and 
Gazette, Nov., 1875), whose authority will not be questioned by the most 
captious. He affirms that the influence of this combination to arrest an 
exacerbation of remittent fever is far more powerful than that of quinine 
alone. The remedy has become much less of a favorite since its origina- 
tor was induced to make public the secret of its composition. 

The persistently bitter taste of quinine and its salts is best obviated by administering 
them in pill form, made with glycerin as an excipient, or by using Licorice, Eriodictyon 
or Chocolate to cover the taste if given in solution or powder. The taste is extremely 
well covered by using as a vehicle a combination of Glycyrrhizin and Fluid Extract of 
Eriodictyon, named " Veldtine" but the Quinine must be suspended therein by the aid 
of mucilage, for when an acid is used to dissolve it the bitter taste cannot be disguised. 

For hypodermic use the best salt is the Carbamide Hydrochlorate, by reason of its 
ready solubility and freedom from irritant quality. 



CINNAMOMUM COCA. 2J "J 

CINNAMOMUM, Cinnamon, — is official under the three following titles, viz.: — 

Cinnamomum Cassia, Cassia Cinnamon, — is the bark of the shoots of one or more 
undetermined species of Cinnamomum (nat. ord. Laurineas), grown in China. Is a con- 
stituent of the compound tinctures of Cardamon, Catechu and Lavender. Cinnamo- 
mum Saigonicum, Saigon Cinnamon, — the bark of an undetermined species of 
Cinnambmum. Cinnamomum Zeylanicum, Ceylon Cinnamon, — the inner bark of 
the shoots of Cinnamomum Zeylanicum. 

The latter occurs in light, yellowish-brown quills, consisting of several pieces rolled 
together, each very thin, while the Chinese variety comes in single quills of irregular 
form and rougher texture. The taste is warm and aromatic, and the odor very fragrant. 
The active principle is a Volatile Oil, and they also contain a resin, and tannic and cin- 
namic acids. Dose, gr. x-xx. 

Oleum Cinnamomi, Oil of Cinnamon, Oil of Cassia, — a volatile oil distilled from 
Cassia Cinnamon. A yellowish liquid, soluble in an equal part of alcohol or of glacial 
acetic acid. Becomes darker and thicker by age and exposure to air. Dose, gtt. j-v. 

Aqua Cinnamomi, Cinna?non Water, — has of the Oil 2, triturated with Precipitated 
Calcium Phosphate 4, and Distilled Water to 1000. Dose, indefinite. 

Spiritus Cinnamomi, Spirit of Cinnamon, — has 10 per cent, of the oil in Alcohol 
to 100. Dose, rr^v-xxx. 

Tinctura Cinnamomi, Tincture of Cinna?non, — has of Ceylon Cinnamon 10, Gly- 
cerin 5, Alcohol and Water to 100. Dose, gss-ij. 

Pulvis Aromaticus, Aromatic Powder, — has of Ceylon Cinnamon 35, Ginger 35, 
Cardamon 15, Nutmeg 15, triturated together to a fine powder. Dose, gr. x— xxx. 

Extractum Aromaticum Fluidum, Aromatic Fluid Ext?-act, — has of Aromatic 
Powder 100 per cent, in Alcohol. Dose, TT^x-xxx. 

Cinnamon is an agreeable carminative, somewhat astringent and stimulant, also highly 
aromatic and antiseptic. The Oil is not astringent but is a stimulant to the nervous and 
vascular systems, and is by some believed to exercise a specific action on the uterus, par- 
ticularly as a hemostatic. In overdoses it acts as an irritant and narcotic poison. 

The various preparations are in general use as flavoring excipients, and the Aqua is a 
pleasant vehicle for extemporaneous mixtures. The Bark and its preparations are used 
to check diarrhea in combination with opium, chalk, or some vegetable infusion. 

Cinnamon was formerly used with success in uterine hemorrhage, generally in com- 
bination with sulphuric acid, which is itself an efficient uterine hemostatic. The Oil is a 
good remedy for flatulence, paralysis of the tongue, cramp of the stomach, enteralgia and 
similar complaints, and is sometimes used to check nausea and vomiting. It has an an- 
cient reputation for healing properties, and its antiseptic powers have long been known, 
especially on the mucous membranes, being utilized as an injection in gonorrhea. It 
has lately been employed in France as an internal germicide, with great satisfaction ; and 
has given particularly good results in the treatment of typhoid fever, against the bacillus 
of which disease it is believed, by its advocates, to have specific and destructive powers. 

COCA, Coca, Cuca, — the leaves of Erythroxylon Coca, a small shrub 
of the nat. ord. Lineae, indigenous to the mountains of Peru and Bolivia, 
and cultivated in those and other S. American states, also in India and 
Java. Its odor is tea-like, its taste slightly bitter and aromatic. It con- 
tains a crystalline alkaloid, Cocaine, C 17 H 21 N0 4 , which when heated with 
HC1 is split up into methylic alcohol, benzoic acid and another alkaloid 
named Ecgonine. In the Java leaves is found an alkaloid Trofiacocaine, 
which is also a compound of benzoic acid and a base. Other constitu- 
ents are the alkaloids Cocamine, Isococamine, Homococamine and Homo- 
isococamine, together with an aromatic oil and coca-tannic acid. The 
leaves grown in Peru and Bolivia contain more cocaine than the others 
and very small quantities of the other alkaloids ; those from India and 



278 COCA. 

Java contain less cocaine but a greater amount of the other alkaloids. 
Coca should not be confounded with Cocoa, the seed of the chocolate- 
tree, Theobroma Cacao. Dose of the leaves, 3J-iv. 

Prepa rations. 

Extractum Cocse Fluidum, Fluid Extract of Coca, — Dose, 3 ss-ij. Leaves of good 
quality are often so difficult to obtain that Dr. Squibb, the well-known pharmaceutist, 
more than once omitted the fluid extract from his trade list, with the explanation that " it 
is impossible to get Coca of proper quality for medical use." 

Cocaina, Cocaine, C 17 H 21 N0 4 (Unofficial), — crystalline, colorless and of bitter taste, 
very soluble in ether, almost insoluble in water or alcohol, and of decided basic proper- 
ties, combining with acids to form salts. It exists in the leaves in very small quantity, 
viz. — from 0.02 to 0.04 per cent. Dose, gr. Y%-]. 

Cocainse Hydrochloras, Cocaine Hydrochlorate, C n H 21 N0 4 HCl, also called Co- 
caine Muriate, but is more properly Cocaine Chloride, — occurs in colorless crystals, odor- 
less, of saline, slightly bitter taste, producing on the tongue a tingling sensation followed 
by numbness. Soluble in 0.48 of water, and in 3^ of alcohol. Is used in aqueous 
solutions of 2 to 10 or more per cent, hypodermically, or locally to mucous surfaces as a 
local anesthetic. Dose, internally, gr. y%-] ; by hypodermic injection, gr. yi-%. 

Cocainse Oleas, Oleate of Cocaine (Unofficial), — a 10 per cent, solution of the alka- 
loid in Oleic Acid, for external use. 

Wines, Lozenges, Elixirs, Glyceroles, Pastes, etc., of Coca are being manufactured 
and marketed in great variety. The Citrate and Salicylate of Cocaine are products of the 
laboratory and may be obtained in the shops. 

Celerina, (Unofficial), — a proprietary preparation said to contain in each fluid-drachm 
gr. v each of Coca, Celery, Kola and Viburnum, with aromatics. Dose, 3J-ij. 

Tropacocaine, Tropain, Benzoyl-pseudotropeine (Unofficial), — was first obtained 
from the Java coca leaves and was afterwards made synthetically. It is much less toxic 
than Cocaine. The Hydrochloride is used to produce anesthesia of the eye. It produces 
local anesthesia more rapidly than Cocaine but for a shorter time, and causes less dilata- 



Physiological Action. 

Coca is an aromatic bitter tonic, a diuretic and a cerebral and nervous 
stimulant. Small doses improve digestion, stimulate respiration, increase 
the heart's action after a brief depression, raise the arterial tension, and 
increase the excitability of the sensory nerves. It stimulates the brain by 
increasing its blood-supply, producing wakefulness, a sense of well-being, 
and a marked diminution of the senses of fatigue, hunger and thirst. 
Under its daily use a considerable amount of labor and loss of sleep can 
be borne without suffering. Though diuretic, it lessens the quantity of 
urea eliminated by checking the processes of waste. Large doses produce 
impaired coordination, hallucinations and delirium. 

Cocaine acts upon the lower animals similarly to Caffeine. It tetanizes 
frogs, and in large doses paralyzes their sensory nerves and the posterior 
columns of the spinal cord. It kills rabbits and dogs by paralysis of the 
respiratory centre. In proper doses it raises arterial tension by stimulat- 
ing the vaso-motor centres and the cardiac motor system. An effect of 
cocaine, observed in mice, is a wide-spread destruction of the hepatic 



COCA. 279 

cells, which become vacuolated and frequently necrosed, and the liver is 
much enlarged and pale from fatty infiltration. 

On man, in small doses Cocaine is a cerebral, cardiac, respiratory and 
nervous stimulant and a prompt diuretic. It improves digestion, stimu- 
lates respiration, increases the heart's action, raises the arterial tension 
and exalts the irritability of the sensory nerves. It stimulates the brain 
by increasing its blood-supply, producing wakefulness and marked dim- 
inution of the senses of fatigue and hunger. Though decidedly diuretic, 
it lessens the quantity of urea by checking the processes of waste, thus 
acting as an indirect nutrient, and enabling the body to maintain its 
energy on a lessened supply of food. It first decreases and then increases 
the cutaneous circulation, flushing the surface, exciting perspiration and 
a sense of heat, and does actually raise the body-temperature. It dilates 
the pupil, both when locally applied and when taken systematically, and 
stimulates intestinal peristalsis as well as the evacuation of the bladder in 
a few minutes after its ingestion. 

An overdose produces symptoms of cardiac and respiratory embarrass- 
ment in a very short time. The pulse, at first quick and forcible, becomes 
small, rapid and intermitting, the heart apparently standing still in 
systole once in every 10 or 12 beats. Respiration is slow and shallow, 
and a sense of tightness about the chest is often very marked; the skin 
grows cold and clammy, and the subject is seized with a sense of impend- 
ing dissolution. Death occurs in animals by paralysis of the respiration, 
but in man a tetanoid spasm of the cardiac muscle seems to occur, which 
is equally dangerous to life. Maurel has shown that, as the capillaries 
contract powerfully under the influence of cocaine, thromboses and 
embolisms, particularly pulmonary embolisms, capable of causing fatal 
accidents, may be produced thereby. It profoundly affects the leucocytes, 
which become spherical and rigid, increase in size, and no longer adhere 
to the walls of the vessels. Other symptoms are impairment of coordi- 
nation, hallucinations and delirium. Lethal doses paralyze the intra- 
cardiac motor ganglia, the posterior columns of the cord, the sensory 
nerves, and the respiratory centre. 

Several years ago, Satterwhite, as a result of the study of one hundred cases of 
poisoning by this alkaloid, called attention to the dangers attending the use of even very 
small doses, and at about the same time another author, after summarizing the records of 
fifty cases, made a similar announcement. A case is reported by Broughton in which 
unconsciousness, an irregular, slow respiration, and a slow pulse, followed the application 
of three minims of a twenty per cent, solution within the cavity of a tooth. Whistler, 
after the application of a four per cent, solution to the nasal cavity, noted vertigo and 
threatening syncope. In a case of glossitis, Ricket states that the patient became mori- 
bund after the use of a similar solution. Myrtyle dropped three minims of a three per 
cent, solution into each eye, which immediately caused a sense of numbness in the back 
of the tongue and throat, palpitation, threatened syncope and nausea. Bettleheim records 
that in one case the hypodermatic injection of one-sixth of a grain induced alarming 
symptoms; and in another, one-eighth of a grain similarly injected caused unconscious- 



280 COCA. 

ness, congestion of the face, irregular breathing and trismus. Baker mentions a case in 
which one grain injected into the gums by a dentist produced death in a few minutes, 
and Hsenel records the case of a man in whom the injection of 1^ grains was followed 
by a fatal result. 

As a Local Anesthetic the power of Cocaine is very great over a limited 
area. Applied to such structures as the Schneiderian membrane, and the 
mucous covering of the glans penis, or injected hypodermically in other 
locations, it blanches the structures and causes a profound but temporary 
anesthesia throughout a small space. Applied to the tongue it tempor- 
arily destroys both taste and tactile sensibility; — to the ocular conjunctiva, 
it produces profound anesthesia of that membrane, together with dilata- 
tion of the pupil, partial paralysis of accommodation, enlargement of the 
palpebral fissure, slight lachrymation, and sometimes temporary ptosis. 
This profound degree of anesthesia is thought by some to be caused by 
its paralyzing the terminal twigs of the sensory nerves, — by others to be 
due to vaso-motor stimulation rendering the nerves bloodless and there- 
fore unable to transmit sensory impressions. It produces mydriasis by 
stimulation of the ends of the sympathetic in the iris, and does not affect 
the third nerve or the sympathetic centre. 

In general action, Cocaine resembles Atropine very closely, especially 
in its influence upon the pulse and blood-pressure, the respiration, pupils, 
salivary glands, sweat-glands and intestinal peristalsis. In its symptoms, 
both from large and small doses it exactly parallels Sparteine, another 
cardio-inhibitory depressant. 

Antagonists. 

Ammonia and Amyl Nitrite combat the earliest symptoms of cardiac depression, — 
then Alcohol and Opium as stimulants to the heart, also Artificial Respiration. The 
most direct antagonist is Chloral, so also are Chloroform and Ether. Morphine is also 
directly antagonistic at almost all points of its action. 

The Cocaine- Habit. 

Cocainism,-the Cocaine-habit, is now presenting itself to observation, numerous in- 
stances of persons addicted to its excessive use being met with. Loss of digestive power, 
absolute insomnia, enfeeblement of the intellect, great emaciation, ascites, general maras- 
mus, nausea, decay of the teeth, an excessively fetid breath, amblyopia, visual hallucina- 
tions and complete anorexia, form a consensus of symptoms which rival the worst effects 
of the opium habit. Peculiar hallucinations are characteristic of the action of cocaine. 
One patient was always scraping his tongue to extract from it little black worms ; another 
made his skin raw in the endeavor to draw out cholera microbes ; a third was constantly 
looking for crystals in his skin. Two of these subjects suffered from epileptic attacks and 
the third from cramps. (Magnan and Saury.) Some observers report the most extraor- 
dinary mental changes resulting from Cocainism, exceeding those produced by any other 
drug. Intense selfishness, utter disregard of all social and domestic duties, the most 
debasing habits, complete destruction of all noble qualities, and a general condition of 
depravity, are some of the results which are charged to this drug. The author's expe- 
rience with a large number of such cases convinces him that a cocaine habitue who has used 
the drug daily for a month is practically an insane individual while under the influence 
of the drug ; but that the mind soon resumes its normal condition after withdrawal 
thereof, which can be done, in nearly all cases, at once, without involving any great 
suffering. 



COCA. 28l 

Many of the proprietary catarrh-snuffs contain cocaine, and their use may cause the 
cocaine-habit, which, however, is in most cases acquired by morphine habitues who go 
to cocaine in the expectation of finding help in their struggle against the tyranny of the 
former drug. In this hope, however, they are always disappointed when the drugs are 
in their own hands. The victim soon finds that one of these agents antagonizes the 
other to a great extent, while, at the same time, it sets up peculiar troubles of its own ; 
and that there is a constant need of more morphine to counteract the cocaine-symptoms, 
and of more cocaine to antagonize the symptoms due to the increased amount of morphine. 
The result will be that one who is using only a moderate daily amount of morphine, will, 
if cocaine be added, soon be using a very great amount of morphine, as well as of 
cocaine, and " the last state of that man is worse than the first." 

As the stimulant effect of a single hypodermic injection passes off very quickly, within 
about 15 or 20 minutes, the cocaine habitue is under the necessity of constantly injecting 
the drug, so that, as one such expressed it, "I had no time to go home, — no time to do 
anything except to prepare and take one 'shot' after another." The effect of such re- 
peated puncturing of the skin is very disastrous to that tissue, causing great induration 
and numerous sloughing sores. 

Therapeutics. 

Coca-leaves are chewed by the Peruvians for the purpose of sustaining 
them during arduous labors and long journeys, and are so highly esteemed 
as to be represented on their national coat-of-arms, the people using them 
much as we do tea, coffee or tobacco. This example was imitated by 
Weston, the pedestrian, who is said to have been detected chewing the 
coca-leaf during one of his protracted walks. Cocaine is a useful 
stimulant to the brain and the nervous system in many morbid conditions, 
particularly cerebral and spinal anemia, neurasthenia, melancholia, hys- 
terical and hypochondriacal insanity, and in protracted mental depression 
with suicidal tendency. It may be employed with benefit in wasting 
diseases to retard waste and to stimulate digestion, in convalescence from 
fevers and other acute maladies, and in migraine and neuralgia due to 
depression of the nervous system. It is very beneficial in some cases of 
the vomiting of pregnancy, in stomatitis and gastralgia, and in functional 
impotence due to general atony of the system. 

A wine of the leaves is thought by singers and speakers to relieve hoarse- 
ness, to make tense the vocal cords and to improve the timbre of the voice. 
Coca-leaves may be smoked in cigars or cigarettes to obtain the exhilar- 
ating effects of the drug, and for the relief of asthma, hay-fever and many 
irritable throat affections. The Oleate of Cocaine is an efficient palli- 
ative application to painful hemorrhoids, fissures of the anus, burns, boils, 
and irritable ulcers; also in pruritus pudendi et ani and skin diseases 
attended with intolerable itching. 

Cocaine Hydrochlorate has achieved celebrity as a local anesthetic, 
and is of great value in many operations on the eye and ear, nasal pas- 
sages, uterus and urethra. A 2 to 4 per cent, solution is brushed lightly 
over the mucous surface or injected into the urethral canal, the applica- 
tion being repeated within 5 or 10 minutes if profound local anesthesia 
is required. After about fifteen minutes any superficial operation may 



282 COCA. 

be performed without giving the slightest pain. Its anesthetic action is 
so entirely local and generally free from unpleasant after-effects that it is 
considered to be one of the most efficient and desirable agents of the 
kind. It has been used in the same manner with decided benefit in con- 
gestion of the nasal passages from acute catarrh and hay-fever ; and is 
applied to the cervix uteri to relieve the first pains of labor, to the ear for 
tinnitus aurium, and by inhalation to strengthen the vocal cords, to relieve 
hoarseness and cough, and to improve the quality of the voice. It is in- 
jected hypodermically around the prepuce to prevent pain during circum- 
cision, into the vicinity of the supra-orbital and infra-orbital foramina 
to cut short neuralgia of those nerves, and into hemorrhoids previous to 
their ligation. It may be injected into the bladder before lithotrity, 
into the urethra before the passage of sounds or catheters or to relieve 
chordee, and it is an excellent application to the gums of teething infants. 
To be efficient it must reach the terminal filaments of the sensory nerves 
in sufficient concentration. Rhus poisoning, by either the oak or ivy, is 
promptly controlled by the application of a 5 per cent, solution or oleate, 
freely over the affected surface. It gives instant relief from the burning 
and itching, and speedily reduces the dermatitis. 

The rapid accumulation of cases in which alarming symptoms followed the local appli- 
cation of small quantities of cocaine, together with the fact that these untoward effects 
are due to individual idiosyncrasy and do not invariably occur immediately, is a positive 
warning to the profession that this powerful substance should not be used in any case for 
the first time without the proper antidotes at hand and the patient being kept under 
surveillance for at least a half hour. There seems to be no doubt that cocaine is absorbed 
with extraordinary rapidity and that the stronger the solution which is locally applied, 
the greater the danger of toxic symptoms, but whether the latter are to be attributed 
merely to the larger dose or to some obscure action, is not apparent. Falk has found 
that the rapidity of absorption varies in the different tissues — absorption taking place 
most rapidly through the conjunctiva, then in the following order : nose, larynx, mouth, 
and ear. It is generally conceded that a 5 per cent, solution is sufficiently strong for 
most purposes, besides being free from many of the dangers attending the use of stronger 
ones. Havilland Hall employs a solution containing 10 per cent, of Resorcin and 20 
per cent, of Cocaine Hydrochlorate, for the production of local anesthesia, applying it 
by means of cotton on a suitable holder, and not by the spray. He claims that the resor- 
cin diminishes the toxic effect of cocaine, increases its anesthetic effect, prevents its 
crystallizing out and acts as an antiseptic in the solution : and says that with this double 
solution, even slight toxic symptoms have been of rare occurrence. 

As a mydriatic for ophthalmological use, Cocaine has peculiar qualities 
which make it the most serviceable of the class. The dilatation produced 
by it is great, is quickly attained, lasts only 12 to 20 hours, is promptly 
overcome by the application of physostigmine, and. is not accompanied 
by much photophobia. The latter is due to the fact that the cocainized 
pupil is not rigidly dilated (as with atropine), but reacts to light. The 
accommodation, moreover, is greatly reduced, but not entirely paralyzed, 
and is quickly regained. 

As an antagonist Cocaine is of especial value in narcotic poisoning by 
chloral or opiates, where depression of the cardiac and respiratory cen- 



COCCUS COLCHICUM. 283 

tres exists. It is also indicated in chronic depressant poisoning from the 
bromides, and in spinal paralyses. In these cases it has all the advan- 
tages of strychnine without its poisonous character. It has no value in 
the proper treatment of morphinism except to antagonize certain heart 
symptoms, for which purpose it should be administered only by the phy- 
sician in charge of the case; but never as a regular remedy, at regular 
intervals of time, even by him. 

Unofficial Substitutes for Cocaine. 

Eucaine-A, C 19 H 27 N0 4 — is an artificial alkaloid, which is much less toxic than 
Cocaine and almost as efficient as a local anesthetic, but causes irritation and some pain. 
The Hydrochloride is soluble in 10 of water and in 3 of alcohol, and is applied to the 
throat, nose and ear, also by injection into the gums, in 2, 5 and 8 per cent, solutions. 
Its solutions may be sterilized by boiling without decomposition, and those prepared with 
distilled water remain clear and require no preservative. 

Eucaine-B, C 15 H 21 N0 2 — is preferred to Eucaine-A for ophthalmic work, being 
less irritant. Solutions of the Hydrochloride of I to 2 per cent, are used in the eye, of 
2 to 5 per cent, for other mucous surfaces and for hypodermic injection. This salt is 
soluble in 20 of water and in 14 of alcohol, and its solutions may be sterilized by boiling 
without undergoing decomposition. The Eucaine preparations are proprietary, being 
manufactured by patented processes. 

Orthoform, a patented product, is the methylester of amido-oxybenzoic acid, and has 
no chemical relation to cocaine, which it resembles only in its action on the sensory nerve 
terminations. It occurs as a white, crystalline, odorless and tasteless powder, very 
slightly soluble in water. It is non-toxic, somewhat antiseptic, and has little or no effect 
upon the sensibility of the unbroken skin or upon healthy mucous membranes, while its 
insolubility precludes its use by hypodermic injection. It is efficient as a local anesthetic 
only when it is in actual contact with exposed nerve endings, and is chiefly used as a 
dusting powder or ointment for painful surfaces, such as abrasions, ulcers or burns. In 
doses of gr. viij-xv it has been given internally for the relief of pain in ulcer and cancer of 
the stomach. A saturated solution in collodion may be used as a paint, and an emulsion in 
glycerin is employed during operations within the uterus. The Hydrochloride is more 
soluble in water and may be used for internal administration or urethral injection, but is 
too acid for hypodermic injection or eye application. 

Holocaine, — is a patented synthetic product prepared by the interaction of Phena- 
cetin and Paraphenetidin. The Hydrochloride is soluble in 50 of water and in 6 of 
alcohol. It is highly toxic and cannot be used hypodermically, but is employed by 
ophthalmologists in a I per cent, solution. Its instillation into the eye causes a slight 
burning sensation which soon passes away. It produces complete and rapid anesthesia 
and neither dilates the pupil nor affects the bloodvessels. 

COCCUS, Cochineal, — is the dried female of Coccus cacti, an insect of the order 
Hemiptera, which feeds on the cactus plants of Mexico and Central America. It is of 
ovate, plano-convex form, of a purple-gray or purple-black color, yielding when crushed 
a dark-red powder, which contains Carminic Acid, or Carmine, the red coloring-matter, 
which is soluble in water and alcohol, but not in oils. Cochineal is an ingredient of 
Tinctura Cardamomi Composita, and is used in pharmacy solely as a coloring material. 

The only therapeutic use of Cochineal is in whooping-cough and neuralgia, in which 
affections it is supposed to have considerable influence, especially in the former. Its dose 
for an infant is about gr. y z thrice daily. 

COLCHICUM, Meadow Saffron, — is the corm and seed of the 
Colchicwn autumnale, a European plant of the nat. ord. Liliaceas. It 
contains an intensely bitter, poisonous alkaloid, Colchicine, C 17 H 19 N0 5 , 
which by the action of acetic and mineral acids is converted into Colchi- 



284 COLCHICUM. 

ceine and a resin ; also tannic and gallic acids, resin, starch, sugar, etc. 
It is official in two forms, namely — 

Colchici Radix, Colchicum Root, — the corm, about an inch long, 
white internally, grooved on one side, inodorous, taste sweetish, bitter 
and acrid. Is less active than the seed. Dose, gr. ij~viij. It contains of 
Colchicine, 0.45 part per 1000. 

Colchici Semen, Colchicum Seed, — about -^ inch thick, sub-globular, 
resembling black mustard seed but larger, very hard and tough, inodorous, 
of bitter and acrid taste. Dose, gr. j-v. It contains of Colchicine, 3.35 
parts per 1000. 

Preparations. 

Extractum Colchici Radicis, Extract of Colchicum Root, — made with Acetic Acid 
35 parts to 100 of the root, and sufficient water. Dose, gr. j^-ij. 

Extractum Colchici Radicis Fluidum, Fl. Extract of C. Root. Dose, Tt^ij-x. , 

Extractum Colchici Seminis Fluidum, Fl. Extract of C. Seed. Dose, TT\j-v. 

Vinum Colchici Radicis, Wine of Colchicum Root, 40 per cent. Dose, tt\v-xv. 

Vinum Colchici Seminis, Wine of Colchicum Seed, 15 per cent. Dose, TlLx-xxx. 

Tinctura Colchici Seminis, Tincture of C. Seed, 15 per cent. Dose, rr^x-xxx. 

Colchicina, Colchicine, C 17 H 19 N0 5 (Unofficial), — a white or yellowish, amorphous 
powder, of saffron-like odor and bitter taste, soluble in water and in alcohol. Dose, gr. 
xio~6V ^ s sm table for hypodermic injection. 

Laborde and Houde condemn all preparations made with acetic acid, also those made 
from the tubers and all wines. The best preparation is Colchicine, in granules or in a 
wine ; or a strong tincture made from fresh seed with the shell on, the latter containing 
a very volatile but active oil. Of this seed ^j to y^ pint of highest proof alcohol, stand- 
ing for 2 weeks. Of this ^v to water q. s. ad 0}4, of which the dose is t ^ss every 4 
hours night and day, avoiding acids, until nausea, vomiting and purging set in. 

Colchicine Salicylate (Unofficial), — is marketed in capsules, each capsule containing 
Colchicine, gr. ^Ip and natural Methyl Salicylate (Oil of Wintergreen), gr. iij. Dose, 
I capsule every 2 hours, up to 10 or 15 daily. 

Physiological Action. 
Colchicum is emetic, diuretic and diaphoretic, a drastic purgative, a 
gastro-intestinal irritant and a cardiac depressant. In small doses it 
increases secretion, especially the urine and the sweat. In full doses its 
action is emeto-cathartic, producing profuse watery discharges, great 
nausea and extreme muscular feebleness. In large doses it is a powerful 
irritant of the gastro-intestinal tract, causing severe griping, choleraic 
discharges, lowered arterial tension and depression of the heart by reflex 
action over the distribution of the pneumogastric, — then great prostra- 
tion, convulsions and collapse, death occurring from exhaustion, with 
consciousness preserved until carbonic acid narcosis sets in. The extent 
of its influence on the excretion of uric acid and urea is very much dis- 
puted, but it probably increases the flow of bile, and certainly unloads the 
portal circulation. 

Antagonists and Incompatibles. 

Tannic Acid to retard absorption. Emetics and cathartics, also warm demulcent drinks 
freely. Morphine hypodermically to antagonize the cardiac depression, also Alcohol. 



COLOCYNTHIS. 285 

Therapeutics. 
Colchicum is a specific palliative in gout of acute form, in which it 
should be given with an alkali, and kept short of emeto-catharsis. It 
does not prevent relapses, and its power in this disorder is weakened by 
repetition. In ascites from obstructive disease of the liver it is most 
effective, given in full doses to establish a profuse drain, with opium to 
sustain the heart. In acute cerebral congestion and in portal congestions 
it is well given as a drastic purgative. It is often used with marked suc- 
cess in acute rheumatism, but frequently fails, and in no case should it be 
continued long in this affection. It has been used with good results in 
the treatment of gonorrhea and chordee. The alkaloid is probably the 
best preparation for general use, and is admittedly superior to the other 
preparations in acute gout. The preparation known as Colchicine Sali- 
cylate is a solution of colchicine in oil of wintergreen. It should prove 
to be a reliable remedy for gout and rheumatism, and also for many dis- 
orders in which the rheumatic diathesis is a factor. 

COLOCYNTHIS, Colocynth,— is the fruit of Citrullus Colocyn- 
this, deprived of its rind. The plant is a native of Spain and Asiatic 
Turkey, and belongs to the nat. ord. Cucurbitacese, the fruit being of the 
size of a small orange, white, light, spongy, inodorous, very bitter, con- 
taining many flat, brown seeds which should be rejected before the pulp 
is used. Its active principle is Colocynthin, C 56 H 84 23 , an amorphous but 
crystallizable bitter glucoside, readily soluble in water. It also contains 
Colocynthein, a resin, and Colocynthitin, a tasteless, crystalline powder, 
soluble in ether but not in water, and devoid of purgative action. 

Preparations. 

Extractum Colocynthidis, Extract of Colocynth. — Dose, gr. ^-ij. 

Extractum Colocynthidis Compositum, Co?7iponnd Extract of Colocynth, — con- 
tains of the preceding 16 parts, Aloes 50, Cardamom 6, Resin of Scammony 14, Soap 14, 
Alcohol 10. Dose, gr. v-xx. 

Pilulae Catharticae Compositae, Compound Cathartic Pills, — have of the preceding 
8, Calomel 6, Extract of Jalap 3, Gamboge i 1 /^, Water to make 100 pills. Dose, j-iij. 

Pilulae Catharticae Vegetabiles, Vegetable Cathartic Pills, have of Compound 
Extract of Colocynth 6, Extract of Hyoscyamus 3, Extract of Jalap 3, Extract of Lep- 
tandra Ij4, Resin of Podophyllum ij^, Oil of Peppermint 0.8, Water to make 100 pills. 
Dose, j-iij pills. 

Laville's Anti-Gout Remedy, — is a proprietary medicine prepared in France and 
purporting to be " a mixture of prepared Kino-colocynthine." The published formula 
is as follows: Active principle of Colocynth 2.y z , Quinine and Cinchonine 5, Spanish 
Wine 800, Alcohol 100, Water to 1000 parts ; but there is good reason for believing that 
it contains Colchicine instead of Colocynthin. 

Colocynth is classed among the tonic-astringent and resin-bearing 
purgatives. In moderate doses it increases peristalsis and the intestinal 



286 CONIUM. 

glandular secretions, producing bilious, watery evacuations with much 
colicky, griping pain. Its purgative action is specific, and may be ob- 
tained by its application to the skin over the abdomen. In large doses 
it is a violent irritant of the gastro-intestinal tract, and has frequently 
produced fatal gastro-enteritis. It is popularly supposed to be aborti- 
facient, but this is true only of quantities sufficient to endanger life. It 
is an indirect diuretic. 

Colocynth is too severe an agent to be administered alone for consti- 
pation, but it makes a useful factor in compound purgatives, as the com- 
pound carthartic pills. In cerebral congestion it may be used to produce 
rapid derivation, and in ascites to set up a profuse drain from the intes- 
tinal canal. In certain cases of chlorotic amenorrhea it stimulates the 
pelvic nerves and vessels with excellent results. There seems to be abun- 
dant evidence that in very small doses (ttl -^"tV of a tincture) Colocynth 
is an efficient remedy in colic, sciatica, ovarian and other neuralgise, as 
well as in the pain of glaucoma. These actions may be due to its two 
non-purgative principles, which may prove to possess powers not hereto- 
fore suspected, an example of which is seen in the cardiac influence of 
Convallaria, a drug which was formerly known only as a purgative and a 
diuretic. 



CONIUM, Hemlock, — is the full-grown fruit, gathered while green, 
of Conium maculatum, the spotted hemlock, nat. ord. Umbelliferse. It 
contains 3 alkaloids, namely, — Coniine, C 8 H 15 N, liquid and volatile, 
Methyl-coniine, C 8 H 14 NCH 3 , and Conhydrine, C 8 H 17 NO, solid and vola- 
tilizable ; also Conii'c Acid and a volatile oil. Paraconi'ine is an artifi- 
cial substance produced by the reaction between Butyric Aldehyde and 
an alcoholic solution of Ammonia, and is isomeric with Coniine but not 
identical with it. The leaves of Conium are no longer official. 



Preparations. 

Extractum Conii, Extract of Conium, — each grain represents a grain of the crude 
drug. Dose, gr. ij-v up to gr. xl. 

Extractum Conii Fluidum, Fluid Extract of Conium, — has the same strength as 
the extract. Dose, n\ij-v up to rr^xl. 

Coni'ina, Coniine, C 8 H 15 N (Unofficial), — an oily, limpid, volatile liquid, of acrid taste, 
alkaline reaction, and an odor comparable to that of the urine of mice. It is quickly de- 
composed by heat, and if exposed to the air soon becomes inert. Dose, gr. -eV~To' or m 
minim doses, rr\, T V-ij. Is too irritant for hypodermic use, unless carefully neutralized 
by acetic acid. The Hydrobromate in watery solution of gr. viij to the ^ , of this TT^x = 
gr. ye, is a good form for subcutaneous or stomachal administration, and may be given 
in doses of gr. y 1 ^ to gr. j, as it is not actively toxic. 

All the preparations of Conium are uncertain in action, particularly the extract, as the 
active principle is very volatile. Any specimen must be carefully tested before deciding 
on its dosage, and if the powerful mouse-like odor of. the drug be absent, the preparation 
is probably worthless. 



CONIUM. 287 

Physiological Action. 

The special action of Conium and Coniine is the production of motor 
paralysis without loss of consciousness or sensation. It paralyzes the 
motor nerves, the action commencing at the peripheral end-organs and 
extending upwards, involving the nerve-trunks and finally the centres, 
but the muscular irritability remains unaffected. Methyl-Coniine, on the 
contrary, stimulates the spinal cord, and produces the convulsions often 
seen in Conium poisoning. The sensory nerves are not affected, but the 
general sensibility is impaired, a feeling of numbness being experienced 
in the extremities. 

Gastric irritation is usually the first sensation produced by a full dose 
of Conium, nausea and vomiting being its symptoms. Then occur weak- 
ness of the legs, numbness and fatigue, drooping eyelids, diplopia, slightly 
dilated pupils, vertigo, impaired utterance, slow and labored breathing, 
and if the dose be lethal, paralysis of the voluntary muscles occurs, those 
of the lower limbs being first affected ; speech and vision are lost, and 
finally death occurs from paralysis of the muscles of respiration. The 
heart is not affected and the mind remains clear but torpid and indifferent, 
until carbonic acid narcosis sets in. Muscular movement counteracts the 
effects of the drug to a very great extent. 

Conium is believed' to have been the state poison of the Athenians, by 
the juice of which Socrates and Phocion died. It is closely allied in its 
physiological action to Curare. 

Antagonists and Incompatibles. 

Nnx Vomica and its alkaloids, Picrotoxin and other tetanizers are antagonistic. 
Tannic acid and caustic alkalies are chemically incompatible. 

Therapeutics. 
Conium is especially indicated in diseases characterized by excessive 
motor activity. Large doses are required, as some physiological action is 
necessary. Children bear it well, their constant activity preventing its 
full action. In chorea and paralysis agitans it palliates, by depressing the 
motor nervous system. In acute mania and delirium tremens, to quiet 
motor excitement and prevent exhaustion, it is remarkably efficient, 
especially when given conjointly with morphine. When pain and spasm 
are present, it will prove a useful agent ; and in tetanus, blepharospasm, 
asthma, whooping-cough, and other spasmodic affections it is frequently 
used with very great benefit. The pain of cancer seems to be especially 
amenable to its influence when locally applied, and Coniine-vapor is an 
admirable palliative of the tickling cough of phthisis and the irritability 
of the air-passages in acute bronchitis. In pneumonia and pleurisy the 



255 CONVALLARIA. 

hypodermic use of Coniine to afford the organs rest by inducing a paretic 
state of the respiratory muscles has been followed by a marked decrease 
in the temperature and pulse-rate. 

CONVALLARIA, — is the rhizome and roots of Convallaria majalis, 
Lily of the Valley, a stemless perennial of the nat. ord. Liliacese, indig- 
enous to Europe, Northern Asia and the Southeastern portion of the 
United States. The preparations in the market vary in action, according 
to the quantity of the resin present, it being emeto-cathartic. Conval- 
laria contains two glucosides, namely — Convallamarin, on which the car- 
diac action depends, and Convallarin, a crystalline, purgative principle, 
insoluble in water; also an acrid Resin which probably contains the 
latter glucoside. 

Preparations. 

Extractum Convallariae Fluidum, Fluid Extract of Convallaria, — is the only offi- 
cial preparation, and probably contains Convallarin, which is not present in aqueous 
preparations, being insoluble in water. Dose, TT\jj-x. 

Extractum Convallariae (Unofficial), — from the flowers and stalks with y^ of the 
leaves and root ; is freely soluble in water and in alcohol. Dose, gr. ij-x. 

Infusum Convallariae (Unofficial), — prepared from the flowers, leaves and stems 25 
parts, in water 75. Dose, ^ss-ij. 

Convallamarinum, Convallamarin, C 23 H 44 P 12 (Unofficial), — an amorphous, white, 
bitter powder, freely soluble in water and in alcohol. Dose, gr. %-i). • 

Physiological Action. 

Convallaria has long been known as a decided cathartic and a prompt 
and powerful diuretic, but its cardiac action has excited great atten- 
tion, and it is now considered a close analogue of Digitalis, while free 
from the so-called cumulative action which makes the latter drug so fre- 
quently a dangerous remedy. Preparations of the root have a powerful 
emeto-cathartic action, probably due to a preponderance of the resin. 
Those freed from this ingredient correspond in action to Convallam- 
arin, stimulate the appetite without impairing digestion, increase peri- 
stalsis without producing catharsis, slow the heart and raise the arterial 
tension, also slowing and deepening respiration. Lethal doses at first 
produce irregularity of the cardiac action and spasm of the respiratory 
muscles, high arterial tension and a very rapid pulse, — followed by low- 
ered blood-pressure, very slow and deep breathing, and finally arrest of 
the heart in systole. Its mode of action is by direct stimulation of the 
pneumogastric, the motor and sensory nerves retain their irritability, the 
muscles preserve their contractility, and the cerebral functions and the 
pupil are unaffected. 

Convallarin is a drastic purgative in 3-grain doses. Convallamarin is 
an emetic even in small quantity, and the powdered root is sternutatory. 



COPAIBA. 259 

Therapeutics. 
Convallaria is a heart-tonic like Digitalis, and is indicated in the same 
class of cases as is that drug, with the advantage that having no cumu- 
lative action it is not dangerous to the heart in medicinal doses, and does 
not disturb the stomach or the functions of the cerebro-spinal axis. In 
doses of gr. xv-xxv of the extract it slows the action of the heart and 
increases the force of its contractions, raises arterial tension, augments 
the force and volume of the respiration, and produces prompt diuresis 
without altering the composition of the urine. It is often a valuable 
remedy in mitral stenosis or insufficiency with venous stasis, dilatation of 
the heart, palpitation, vehement cardiac action or disordered rhythm, and 
in all valvular affections accompanied by dropsy and a weak heart. It 
has also been used with benefit in pneumonia, typhoid fever and renal 
dropsy. Its action is maintained for several days after its administration 
has been suspended. 

COPAIBA, Copaiba, Balsam of Copaiba, — is the oleoresin of 
Copaifera Langsdorffii, and other species of Copaifera, a S. American tree 
of the nat. ord. Leguminosae, growing chiefly in the valley of the Amazon. 
It is a translucent, viscid liquid, of yellow color, aromatic odor, acrid and 
bitter taste, not fluorescent, soluble in alcohol and in benzol. It is not a 
balsam as it contains no cinnamic acid. Its constituents are a Volatile 
Oil and a Resin in about equal proportions, the latter containing nearly 
99 per cent, of Copaibic Acid. Dose, tthx-3J. 

Preparations. 

Oleum Copaibas, Oil of Copaiba, C 10 H 16 , — a pale yellow liquid, of sp. gr. 0.890, 
bitter taste and neutral reaction, soluble in 10 volumes of alcohol. Dose, TTLx-xv. 

Resina Copaibse, Resin of Copaiba, — is the residue left after distilling off the vola- 
tile oil from Copaiba ; a yellowish, brittle body, of acid reaction, soluble in alcohol, 
benzol or amylic alcohol. Consists mainly of Copaibic Acid, which is crystallizable, also 
ij4. per cent, of a viscid resin. Dose, gr. j-v. 

Massa Copaibas, Mass of Copaiba, — consists of Copaiba 94, fresh Magnesia 6, tritu- 
rated with water and set aside to concrete into a pilular mass. Dose, TTLx-gj. 

Mistura Copaibas Composita, Compoitnd Copaiba Mixture, Lafayette Mixture 
(Unofficial). — & . Copaibse Jj, Spiritus jEtheris Nitrosi !|j, Liq. Potassae 5pj. Mix 
with constant stirring, then add: Tinct. Lavandulae Co. Jj,Syrupi ^ijss, Mucil. Dex- 
trini (N. F. ) q. s. ad ^viij. Mix the whole thoroughly by shaking. Of this each g 
contains rr\,vijss of Copaiba (National For?nulary). Dose, ^j-iv. 

Physiological Action and Therapeutics. 
Copaiba is a stimulant diuretic, diaphoretic, expectorant, and a gastro- 
intestinal irritant. Its taste is bitter and nauseous. In the stomach it 
causes heat, eructations, heaviness, frequently anorexia and diarrhea, and 
if continued for any length of time gastro-intestinal catarrh and desqua- 
19 



29O CORIANDRUM CORNUS COTO. 

mative nephritis may result. The oil and resin diffuse into the blood and 
are excreted by the bronchial mucous membrane, skin and kidneys, pro- 
ducing increased secretion at the points of elimination. The various 
secretions have the odor of the drug, especially the urine. In medium 
doses it increases the quantity of urine and its solid constituents, but 
large doses will cause scanty urine, containing albumin, casts and blood, 
with pain in the loins and other signs of renal congestion. On the skin 
it often produces itching and several forms of eruption. 

Copaiba has been largely used in gonorrhea after the acute symptoms 
have subsided, also in chronic cystitis, acute and chronic bronchitis, and 
in dropsies, particularly ascites. In all these affections it is a useful 
remedy, but its nauseous taste and irritant effects on the stomach are 
driving it out of fashion, especially in private practice. One eminent 
surgeon declares not only that it is useless in gonorrhea but that it does 
more harm than good, often prolonging the disease beyond its natural 
limit. In psoriasis and urticaria, and in cutaneous affections character- 
ized by torpid peripheral circulation, this drug has been administered 
internally with excellent results. In long-standing cystitis in the female 
Copaiba has been injected into the bladder with great benefit. The resin 
is the most active ingredient, especially for diuretic purposes. 

CORIANDRUM, Coriander, — is the fruit of Coi'iandrzim sativum, a plant of the 
nat. ord. Umbelliferse. It contains a volatile and a fixed oil. Dose, gr. x-xx. 

Oleum Coriandri, Oil of Coriander, — a volatile oil distilled from Coriander. A 
colorless liquid, of aromatic, bitter and pungent taste ; soluble in 10 volumes of alcohol, 
forming a slightly turbid liquid neutral to litmus paper. Dose, n\,ij-v. 

Coriander is stimulant, aromatic and carminative. It is used almost wholly as a 
flavoring to other remedies, or as a corrective against the griping effects of certain purga- 
tives. Its flavor covers the taste of Senna and Rhubarb, and it is an ingredient of the 
official Confectio Sennae. 

CORNUS, Dog-wood (Unofficial), — is the bark of the root of Cornus florida, a 
small tree of the nat. ord. Cornacese, indigenous to the U. S. It contains a bitter prin- 
ciple named Cornin, which is crystallizable and soluble in water and in alcohol ; also a 
resin and tannic acid. 

Cornus is a simple bitter, having stomachic and other qualities similar to those of 
Calumba (which see). In addition it is possessed of considerable antiperiodic power, 
and has a good deal of reputation in the Southern States as a remedy in malarial fever, 
the physicians of that section considering it as next to quinine in efficiency. Heat de- 
stroys its active principle, consequently a decoction is a useless preparation. A fluid 
extract is on the market, the dose of which is tthx-gj. 

COTO, Coto Bark (Unofficial), — is the bark of some unknown tree growing in 
Bolivia. It contains an acrid, bitter principle, of yellow color, crystalline and soluble in 
hot water and in alcohol, named Cotoin, C 22 H 18 6 ; also Piperony lie Acid, C 8 H 6 4 , and a 
volatile oil, resin, etc., but no tannin. Dose, gr. j-xv. 

Paracoto Bark, or False Coto. — Its principle, Paracotoin, C 19 H 12 6 , has a strong 
similarity to Cotoin therapeutically, but is less active. 

A fluid extract of the official strength is prepared, also a tincture (10 per cent.), which 
may be administered in doses of from mj-xx. Cotoin is used in doses of gr. j-iv, and 
Paracotoin in somewhat larger quantities. 



CREOSOTUM. 29I 

The physiological action of Cotohas not been studied, all that is known about it being 
that it is decidedly irritant to the skin and mucous membranes. After its internal admin- 
istration the urine takes a dark-red color with Nitric Acid. Ferric Chloride blackens a 
dilute solution of Cotoin, but has no reaction with Paracotoin. 

The bark and both principles are highly recommended in diarrheas of various forms, 
especially those of phthisis, typhoid fever, and cholera. In Asiatic cholera Paracotoin 
has been used hypodermically in 3-grain doses with success. When there is any ten- 
dency to acute inflammation of the gastro-intestinal tract this agent must be used with 
caution. Small doses of the tincture (TnJ-v) are said to be very effective in the diarrhea 
of children. 



CREOSOTUM, Creosote, — is a mixture of phenols, chiefly Guaia- 
col and Creosol, also Methylcreosol and Phlorol, obtained during the 
distillation of wood-tar, preferably of that derived from the Beech. It 
occurs as an almost colorless, or pinkish, inflammable, oily liquid, of 
smoky odor, caustic taste, and neutral reaction ; soluble in about 150 of 
water, and in all proportions in absolute alcohol, ether, chloroform, ben- 
zin, carbon disulphide, acetic acid, and fixed and volatile oils. It does 
not coagulate albumin (?) or collodion while Carbolic Acid does. It was 
named from its remarkable preservative power over meat {creas, flesh, 
sohzoh, preserve). Much of the commercial Creosote is an impure car- 
bolic acid, or a heavy oil distilled from coal-tar and containing carbolic 
and cresylic acids. Dose, mj-iij, well diluted, in wine or whiskey. 
Morson's beechwood creosote is the best for internal use. There is only 
one official preparation, viz. — 

Aqua Creosoti, Creosote Water, — is a 1 per cent, solution, containing nearly 5 minims 
of Creosote in each fluid-ounce. Dose, gj- Jj. 

Unofficial Derivatives. 

Guaiacolum, Guaiacol, Methyl Pyrocatechin, C 6 H 4 OHOCH g , — is the most active 
ingredient of Creosote, of which it constitutes from 60 to 90 per cent. It occurs as a 
colorless liquid, highly inflammable, of a powerfully aromatic odor, very slightly soluble 
in water, readily soluble in alcohol. Dose, TT\J-xv, in capsules, pills, or alcoholic solu- 
tion. 

Guaiacoli Carbonas, Guaiacol Carbonate, Duotal, — is a tasteless and odorless crys- 
talline powder, insoluble in water. Dose, gr. iij-v or more, gradually increased to a 
maximum of 90 grains per diem. 

Creosoti Carbonas, Creosote Carbonate, Creosotal, — is a patented product, prepared 
directly from beech-wood creosote instead of guaiacol, and is analogous to guaiacol car- 
bonate. It occurs as a thick, brownish, inodorous oil, insoluble in water. Dose, rryij-v 
or more, gradually increased to a maximum of 90 grains per diem. 

Benzosolum, Benzosol, Benzoyl Guaiacol, — is prepared by heating Guaiacol with 
Benzoic Acid, and occurs in small, colorless, odorless, and almost tasteless crystals, 
practically insoluble in water. Contains 54 per cent, of Guaiacol. Dose, gr. v-xv. 

Physiological Action. 
Creosote is expectorant, astringent, antiseptic, styptic, escharotic, an- 
esthetic and narcotic. Its action is practically the same as that of Car- 
bolic Acid (see ante, page 86), especially upon the heart, respiration and 
nervous system, but differs from that of the latter in not causing convul- 



292 CREOSOTUM 

sions, and in increasing the coagulability of the blood. It is eliminated 
by the kidneys and the bronchial mucous membrane, which it stimulates, 
being quite a good expectorant. In small doses it seems to have a selec- 
tive sedative influence on the terminal nerve-filaments in the gastric 
mucous membrane. In large doses it is a powerful poison, resembling 
Carbolic Acid in its symptoms, except that its nervous effects are even 
more marked. It explodes when combined with Oxide of Silver in pill, 
unless previously diluted with an inert powder. 

Guaiacol, locally applied, is rapidly absorbed by the skin, and appears 
in the urine fifteen minutes after its application. Applied by painting it 
over the skin of the thigh, abdomen or chest, in quantity of 20 to 50 
minims, it causes a rapid reduction of body-temperature, and thereby the 
temperature in malarial fever, typhoid fever and pneumonia falls as much 
as 7 in the course of an hour or two, but soon rises again (Da Costa). 
This rapid antipyretic action is not accompanied by any marked distur- 
bance of the nervous system or any signs of collapse, not even by a very 
profuse sweat, neither does there occur any active chill, though slight 
chilliness is sometimes experienced. Guaiacol is said to be a powerful 
local anesthetic, equal in this respect to cocaine and much safer, as it can 
be injected in ten times larger doses without producing ill effects. For 
this purpose it is used in sterilized olive oil (1 in 10 or 20) hypodermi- 
cally, and it is claimed that thereby perfect local anesthesia is obtained 
for the extraction of teeth, the removal of small tumors, and similar oper- 
ations. Internally administered, the action of Guaiacol is similar to that 
of Carbolic Acid, and overdoses may prove equally fatal. 

Wyss, of Zurich, reports the case of a girl nine years of age who had been accidentally 
given 75 drops of guaiacol. In a short time she became unconscious, the conjunctivae 
became injected, the corneal reflexes diminished, and the pupils no longer reacted to 
light ; there were frequent attempts at vomiting, and the saliva flowed from the mouth in 
large quantities. The pulse became rapid and the sensibility of the skin much diminished. 
Finally, the patient began to vomit, — the physician detecting the odor of guaiacol the 
stomach was washed out, but she did not rally. The cyanosis gradually diminished, and 
instead of it a deadly pallor was observed and the respiration became frequent. Three 
and a half hours after the guaiacol had been swallowed the patient passed one hundred 
cubic centimeters of brownish-red urine. The spleen and liver soon enlarged, the tem- 
perature fell to 96 F., and small hemorrhages were observed upon the skin of the arms 
and legs. The urine contained albumin, blood, and casts, and Ehrlich's carbolic-acid test 
was positive. Jaundice soon appeared, the stupor increased, and the patient died on the 
third day. The autopsy revealed an acute gastritis and enteritis, parenchymatous degen- 
eration of the liver, acute hemorrhagic nephritis, parenchymatous degeneration of the 
heart-muscle, and ecchymoses in the pluree, peritoneum, endocardium and pericardium ; 
the spleen was much enlarged. 

Therapeutics. 
Creosote, being a very complex substance of varying composition, has 
been almost entirely supplanted in therapeutics by Carbolic Acid for 
external use, and by Guaiacol for internal administration. As an astrin- 



CREOSOTUM. 293 

gent it has been employed in intestinal hemorrhage, gonorrhea and gleet, 
and generally in the same affections as Carbolic Acid. Externally it is 
a good application in eczema, pruritus, ulcers and scaly skin diseases, 
and it effectually relieves the pain of an exposed dental nerve if applied 
thereto. It is a good agent by inhalation in chronic bronchitis and 
gangrene of the lung, and it has been administered internally with 
decided benefit in abnormal fermentative processes in the stomach and 
intestines, in reflex nausea and vomiting, as from sea-sickness, pregnancy, 
etc. ; also as an aseptic expectorant in chronic basilar cavity, in which it 
seems to have greater efficacy than any other remedy, and in bronchitis, 
pulmonary gangrene, carcinoma of the stomach and diabetes. 

In pulmonary tuberculosis, when well borne by the stomach, and con- 
tinued over a long period of time, it has probably proved more efficient 
than any other remedy. Its employment in this disease is based on the 
statement of Guttmann, that tubercle bacilli are destroyed by blood 
which contains y 2 per 1000 of Creosote, while even one-half that pro- 
portion arrests their growth. The commencing daily dose of Creosote or 
Guaiacol is 2 or 3 minims, largely diluted to prevent irritation, taken 
after meals, and increased by the addition of one minim daily until a 
maximum daily dosage of 15 to 18 minims is reached, at which rate it 
should be continued for several months. Under this treatment cough is 
relieved, expectoration diminished, night-sweats are stopped, the fever 
is lowered, while body-weight and appetite are increased in most cases ; 
and in many even the local conditions are decidedly improved, as shown 
by the physical signs. Recent researches indicate that the good effects 
of this treatment are due to the formation of soluble compounds between 
the remedy and the toxic albuminous by-products of the tubercle bacillus, 
which are then eliminated from the blood. 

Creosote was advocated for phthisis by Reichenbach in 1833, and its use was revived 
by Bouchard and Gimbert in 1877, since which time it has been tried and approved by 
a long list of authorities, including Jaccoud, Dujardin-Beaumetz, Dieulafoy, Germain 
See, Sommerbrodt, Von Brun, Guttmann, Douglas Powell, Burney Yeo, J. Solis-Cohen 
and many others, who all agree as to its utility, though differing as to its mode of action, 
its dosage, and the methods of administration. The number of cases dealt with by some 
of these observers is so considerable that there is at least strong prim Q. facie evidence in 
favor of this drug and its derivatives. Bouchard reported on 93 cases at first, and on 
more subsequently; Sommerbrodt's report included over 5,000 cases, treated during 
more than nine years ; and Von Brun dealt with 1,700 cases. Professor Sommerbrodt 
contends that it is possible to administer the quantity necessary to inhibit the growth of the 
bacilli, and believes that he did so in many cases. He had the most gratifying success 
with this medication, and states that the more creosote the patient could bear the better 
was the result. Of late years the tendency has been to administer Creosote or Guaiacol 
by hypodermic injection. Lepine uses creosote dissolved in oil, and finds that a much 
larger quantity can be used hypodermically than the stomach will tolerate. Picot injects 
a mixture of sterilized olive oil containing I per cent, of Iodoform and 5 per cent, of 
Guaiacol, beginning with I cc. of the mixture and increasing the dose to 3 cc. He states 
that no swelling or other local reaction follows this injection. Burney Yeo has used the 
same method with a more concentrated formula for the injection. 



294 CROCUS. 

Guaiacol is preferred by many for internal administration instead of 
Creosote, being the principal ingredient of the latter, and of more definite 
chemical composition, though nearly or quite as irritant to the stomach. 
It may be given in mixture with wine or brandy, in capsules, or hypoder- 
mically in combination with cod-liver oil. When neither of these agents 
agree with the patient, useful and efficient substitutes therefor are their 
carbonates, known by the respective trade-names Duotal and Creosotal, 
in doses of 4 to 6 grains, gradually increased to gjss per diem. These 
preparations are well borne as they do not irritate the gastric mucous 
membrane or disturb the digestion. 

The antipyretic power of Guaiacol, when painted on the surface of the 
body, has recently been utilized in the treatment of several diseases ac- 
companied by hyperpyrexia. In typhoid fever Dr. Montagnon applied 
10 or 15 drops with a brush whenever the temperature exceeded 102 , 
the application being followed by a profuse perspiration, the tempera- 
ture fell, and in a few hours a large quantity of urine was passed. The 
action lasted about two hours, and the treatment was renewed about every 
three or four hours with excellent results, none of the patients suffering a 
relapse. Similar results have been obtained in the pyrexia of malarial 
fever and pneumonia, and this employment of the drug is claimed to pro- 
mote the absorption of pleuritic effusions in a remarkable manner. Only 
pure guaiacol should be used, as an inferior quality produces a very grave 
cutaneous irritation. By other clinicians it is mixed with glycerin before 
application, in the proportion of 1 part to 8 of the latter, or even in 
equal quantity, and it is claimed that thereby no inconvenience is expe- 
rienced. This application of Guaiacol is also decidedly anesthetic in 
effect, and has been utilized in orchitis, in the chest-pains of tuberculous 
subjects and in other painful affections, especially sciatica and rheumatism. 

Benzosol contains Guaiacol in the proportion of 54 per cent. In the 
intestinal canal the latter is probably set free by the action of the alkaline 
secretions, as benzosol is excreted by the urine in the form of guaiacol 
and benzoic acid combinations. Compared with guaiacol, this agent has 
the advantage of being almost tasteless; hence it can be given in large 
doses without the digestive disturbance and disagreeable eructations pro- 
duced by the parent substance when administered in liquids, and without 
the local irritant effect caused by the latter in capsules. In doses of 4 
grains, gradually increased to 12 grains thrice daily, results are said 
to have been obtained from this agent, in the treatment of phthisis, equal 
if not superior to those produced by Creosote. 



CROCUS, Saffron, — the stigmas of Crocus sativus, a plant of the nat. ord. Iridece, 
cultivated in Europe, containing a volatile oil and coloring matter. So-called American 
Saffron is not Crocus but the flowers of Carthamits tinctorhis. True Saffron is expen- 
sive, as it requires about 60,000 flowers to furnish one pound of the stigmas. Dose, 
pt. v-xx, in infusion. 



CUBEBA. 295 

Tinctura Croci, Tincture of Saffron, — 10 per cent. Dose, gj-ij. 

Saffron Tea, so much used in domestic practice, is an infusion of Carthamus tinc- 
torhts, the Saffiower. 

Crocus is a stimulant aromatic, having some antispasmodic and anodyne qualities. 
The hot infusion produces diaphoresis, probably by virtue of the hot water alone. It is 
said to have caused death with narcotic symptoms. On the continent of Europe it is 
employed as a stimulant and emmenagogue, but in this country its only use is as a color- 
ing agent. The miscalled Saffron Tea noted above is used in domestic practice for 
measles and other exanthemata. 



CUBEBA, Cubeb, — is the unripe fruit of Piper Cubeba, a plant of 
the nat. ord. Piperacese, cultivated in Java. It contains a Volatile Oil, 
which is official, an acrid resin composed in part of Cubebic Acid, also a 
fatty oil, gum, and Cubebin, which is an insoluble, neutral, odorless and 
tasteless body. The volatile oil may be separated into Cubebene a cam- 
phor, and Cubeben a liquid portion. The active principles are the vola- 
tile oil and cubebic acid, both of which are contained in the oleoresin. 
Cubeb should be kept whole and not pulverized until wanted for use. 
Dose of the powdered drug, gr. x-^ij. 

Preparations. 

Extractum Cubebae Fluidum, Fluid Extract of Cubeb. Dose, TTLv-xxx. 

Tinctura Cubebae, Tincture of Cubeb , — 20 per cent. Dose, n\x-£i\). 

Oleoresina Cubebae, Oleoresin of Cubeb,— extracted by ether. Dose, TT\v-xxx. 

Trochisci Cubebae, Troches of Cubeb, — each contains of the Oleoresin 4, Oil of Sas- 
safras I, Extract of Glycyrrhiza 25, Acacia 12, and Syrup of Tolu q. s. to form 100 
troches. Dose, j-iij. 

Oleum Cubebae, Oil of Cubeb, C 15 H 24 , — is the volatile oil, a colorless or pale green- 
ish-yellow liquid, of sp. gr. 0.920, warm, aromatic taste, odor of cubeb and neutral re- 
action. Is soluble in an equal volume of alcohol. Dose, rr^v-xx. 

Cubeb belongs to the pepper family, and like black pepper is an aro- 
matic stomachic and a stimulant diuretic in small or medium doses, but 
large doses derange digestion and may act as a gastro-intestinal irritant. 
Its constituents are eliminated by the bronchial mucous membrane, the 
skin and the kidneys, stimulating and disinfecting the genito-urinary 
passages, increasing the bronchial mucus, sweat and urine, and frequently 
causing an urticarial or vesicular eruption. It increases the action of the 
heart and of the vascular system, stimulates the venereal appetite, and 
promotes the menstrual discharge. 

Cubeb is particularly useful in affections of the bladder and urethra. 
It is used in the acute stage of gonorrhea, in chronic cystitis, prostator- 
rhea and chronic bronchitis with excellent results. The powder is a 
good application in hay-fever, chronic nasal catarrh and follicular pharyn- 
gitis, blown on to the mucous membrane by an insufflator. It may also 
be smoked in cigarettes with temporary relief in cases of acute nasal 
catarrh with "stuffed" nasal passages. In some subjects the continued 



296 CUPRUM. 

use of cubeb produces nausea, hemorrhoids, hematuria, and severe head- 
ache. The troches are a useful preparation in chronic irritability of the 
fauces, pharynx and air-passages, and are much employed by singers and 
public speakers for their tonic effect on these parts and for the relief or 
prevention of hoarseness. 

CUPRUM, Copper, Cu, — is not official, but one of its salts is, 
namely the Sulphate. The metal itself is inert, but in combination it is 
actively poisonous. Copper has been found in the normal human blood 
in very minute quantity. 

Salts and Preparations of Copper. 

Cupri Sulphas, Copper Stilphate, CuS0 4 + 5H 2 0, — blue, translucent crystals, efflor- 
escent, of nauseous, metallic taste and acid reaction, very soluble in water, insoluble in 
alcohol. Its solution is blue by transmitted light, green by reflected light. Dose, as an 
emetic, gr. ij-v, every 10 or 15 minutes, — as a tonic, gr. y^-Yz. 

Alkaline Cupric Tartrate Volumetric Solution, Fehling's Solution, — the official 
reagent for glucose, is prepared as follows. (1) Dissolve 34.64 grammes of pure Cupric 
Sulphate in water, to measure exactly 500 cubic centimeters. (2) Dissolve 173 grammes 
of Potassium and Sodium Tartrate and 125 grammes of Potassium Hydrate in water to 
measure exactly 500 cubic centimeters. Keep the two solutions in small, rubber-stop- 
pered bottles, separate ; and for use, mix exactly equal volumes of the two at the time 
required. One cubic centimeter of the mixed solution is the equivalent of — 

Cupric Sulphate, crystallized, CuS0 4 -\- 5H 2 0, Gramme, 0.03464 

Cupric Tartrate, CuC 4 H 4 6 + 3 H A " 0.03685 

Glucose, anhydrous, C 6 H 12 6 , " 0.00500 

Cuprum Ammoniatum, Ammoniated Copper (Unofficial), — is made by triturating 3 
parts of Ammonium Carbonate with 4 of Cupric Sulphate until effervescence has ceased, 
then drying. A deep azure blue powder, of ammoniacal odor, a styptic, metallic taste, 
and alkaline reaction, soluble in water. Dose gr. */£-j. 

Cupri Arsenis, Copper Arsenite, — is described under Arsenum, ante, page 199. 

PHYSIOLOGICAL ACTION. 

The salts of Copper are gastro-intestinal irritants, producing a metallic 
taste, nausea with greenish vomited matter, purging of blood and mucus, 
constricted fauces, depressed heart action, hurried respiration and fever. 
Or, as with Arsenic, gastro-enteritis may not occur, but instead profound 
nervous symptoms, as headache, defective coordination, coma and con- 
vulsions. The symptoms of chronic poisoning are bronchial irritation 
and catarrh, gastro-intestinal catarrh, colic with diarrhea [Lead produces 
colic with constipation], dysentery, nausea, emaciation, anemia, saliva- 
tion, and a green line (sulphide) along the margin of the gums in those 
who do not clean their teeth. The nervous symptoms above mentioned 
are also usually well marked. The liver becomes atrophied from irrita- 
tion of its connective tissue and fatty degeneration of the hepatic cells. 
The lungs are congested, even pneumonic consolidation may be set up, 
the metal seeming to have affinity for the pulmonary parenchyma. These 



CUPRUM. 297 

effects are often produced by the inhalation of cuprous fumes, and by 
eating acid fruits cooked in a copper vessel. Brass-founding is known 
to cause various forms of disease, as gout, chronic nephritis, progressive 
paresis of the legs, tremor, muscular wasting, and locomotor ataxia. A 
group of symptoms known as "brass founders' ague" has also been 
noticed. The fit of ague is ushered in by languor and depression, then 
follow prostration with pallor, cold sweats, and chills, which may even 
amount to rigors, with chattering of the teeth, precordial anxiety, head- 
ache, nausea and muscular pains. The onset of vomiting arrests the 
symptoms and usually is followed by sleep, from which the patient awakens 
almost well. It is not clear whether these symptoms are due to copper or 
to zinc, both of which enter into the composition of brass. 

Copper Sulphate is a simple, irritant emetic, producing prompt and 
continued vomiting with but little nausea or depression. In small doses 
it is a nerve-tonic, and is astringent to the gastro-intestinal tract. Exter- 
nally applied in solution it is a useful stimulant and astringent to diseased 
mucous surfaces, and is mildly caustic if used in substance. The Acetate 
is possessed of the same general action as the sulphate. Its local action 
is stimulant and escharotic. The impure acetate (verdigris) is a violently 
irritant poison. Ammoniated Copper has no special action other than 
that of the sulphate. 

Antidotes, Antagonists and Inco?npatibles. 
Potassium Ferrocyanide is the antidote in poisoning by the Copper Salts, but Albumin 
or Magnesia may be used. Any chemical antidote should be followed by prompt evacua- 
tion of the stomach, then Ophtm and demulcents for gastro-enteritis, and Potassium 
Iodide even to saturation of the system. Alkalies and their Carbonates, Lime-water, 
Iodides, and Mineral Salts (except the sulphates), are all incompatible. 

Therapeutics. 

The Sulphate is a prompt and efficient emetic, and is so used in croup 
and narcotic poisoning. In phosphorus poisoning it forms a compara- 
tively insoluble phosphide of copper besides producing emesis. Fifteen 
or twenty grains may be dissolved in §iv of water, and a teaspoonful or 
more, according to age, given every ten minutes until vomiting is pro- 
duced. In acute diarrhea and chronic dysentery it is the best metallic 
astringent in doses of gr. -^ to -^ with Opium, and in gastro-intestinal 
catarrh it is equally efficient. Locally, it is used with benefit in throat 
affections, gonorrhea, granular lids and corneal ulcers, indolent granu- 
lations and chronic inflammations of mucous membranes. In most of 
these affections weak solutions (gr. yi to ^ to the 3) are best, but in 
granular conjunctivitis the smooth crystal may be rubbed quickly over 
the surface once daily. 

In various nervous diseases, as epilepsy, chorea, hysteria, etc., the salts 
of copper are sometimes beneficial, the Ammoniated Copper being con- 



298 CURARE. 

sidered the most efficient preparation in these cases. In Germany a 
tincture of the Acetate was formerly official, and has been used success- 
fully in the treatment of pneumonia. Ammoniated copper has been 
highly recommended for facial neuralgia, but requires pushing to the pro- 
duction of some physiological action. Ointments or lotions of the Ace- 
tate are useful applications in eczema, herpes, tinea sycosis, mentagra and 
herpes circinatus. 

Vitiate* 's Solution has been successfully used as a local injection for the 
cure of caries. It is composed of Copper Sulphate, Zinc Sulphate, of 
each 15 parts, Liquor Plumbi Subacetatis 30, Vinegar 200. The solution 
is thoroughly injected into the sinuses leading to the carious bone. 

CURARE, Woorara (Unofficial), — is a vegetable extract obtained 
from various members of the Strychnos family, also from Paullinia curare 
and other plants. It is used in S. America as an arrow-poison under 
various names, as Caroval, Vao, etc. Its active principle is the crystal- 
lizable alkaloid Curarine, which contains no oxygen. 

The dose of Curare is gr. ^- Q -\ hypodermically, — of Curarine, gr. 2Fo - i7TT hypoder- 
mically, or gr. x\o~T§ by the stomach, but as the samples vary greatly in activity they 
should first be tried on some inferior animal before being administered to man. 

Physiological Action and Therapeutics. 
Curare is a paralyzer of the voluntary muscles, affecting them through 
the end-organs of the motor nerves. It does not at first act upon the 
brain or spinal cord, but if life be prolonged by artificial respiration the 
cord, sensory nerves and even the muscular tissue become affected. 
The heart, at first quickened, becomes depressed, the blood-pressure 
is lowered, the eyelids droop, the eye-balls protrude, vision is disordered, 
intestinal peristalsis and sensibility to stimuli are greatly increased, and 
an artificial glycosuria (curare-diabetes) is set up. The limbs are para- 
lyzed first, death occurring by paralysis of respiration. The absorption 
of the drug by the stomach is very slow, as its active principle passes 
with difficulty through animal membranes, and its elimination, which 
takes place by the kidneys, being more rapid and complete than that of 
any other agent, no marked effect may be produced when it is adminis- 
tered internally. When hypodermically injected its action is very prompt. 
The urine of a curarized animal will poison another, and that of the second 
animal will paralyze a third. As compared with other motor depressants 
Curarine and Conime paralyze the end-organs of the motor nerves, Gel- 
semine paralyzing the motor centres. 

Antagonists and Incompatibles. 

Strychnine, though from a member of the same family, is antagonistic as to the action 
on the heart and respiration. So also is Atropine. Artificial Respiration is the most 



CUSSO DAMIANA. 299 

efficient antagonist, maintaining life until elimination occurs. Evacuation of the bladder 
repeatedly is important to prevent reabsorption. The caustic alkalies destroy Curarine 
as they do all other alkaloids. 

Curare is chiefly used for experimental purposes on the lower animals. 
It has an historical interest from its having been the means by which 
Bernard demonstrated the existence of muscular contractility as an essen- 
tial endowment of that tissue. It has been used with some success in 
spasmodic nervous affections, particularly in tetanus, both idiopathic and 
traumatic, in hydrophobia, chorea and epilepsy. It does not promise 
well as a therapeutic agent, but undoubted cases of hydrophobia are 
reported by high authority as cured by this drug. 

CUSSO, Kousso, Bray era, — is the female inflorescence of Hagenia abyssinica, an 
Abyssinian tree of the nat. ord. Rosaceae. It contains tannic acid, a volatile oil, and a 
crystalline principle named Koussin. Dose, of Cusso, gij-^j. 

Extractum Cusso Fluidum, Fluid Extract of Kousso. — Dose, %i}-%]- 
Cusso has little or no effect except the nausea, vomiting, colic and slight diarrhea pro- 
duced by large doses. Its chief action is anthelmintic against both varieties of tape- 
worm, but it rarely expels the head of the parasite, and is very nauseous to the taste and 
difficult of retention by the stomach in the large doses necessary to efficiency. From gij 
to fy j of the flowers infused in 3 iv of boiling water is the usual dose, which should be 
taken on an empty stomach and followed by a castor-oil or saline purge after 3 or 4 
hours. An emulsion of a 6 per cent, infusion with castor-oil, yolk of egg, a few drops 
of ether and oil of anise with 10 to 20 drops of the Oleoresin of Male-fern, is more agree- 
able and efficient than the infusion alone. 

CYDONIUM, Quince Seed (Unofficial), — is the seed of Cydonia vulgaris, a tree 
of the nat. ord. Rosaceae, native in Crete and Austria, and cultivated elsewhere. The 
seeds placed in water swell up, forming a mucilaginous mass. The mucilage is the only 
constituent of importance and is contained in the epithelial cells. It has been named 
Cydonin, and is considered to be a compound of gum and cellulose. 

Mucilago Cydonii, Mucilage of Cvdonium (Unofficial), — is prepared by macerating 
2 parts of Cydonium in 100 of Distilled Water. Dose, indefinite. 

Cydonium is of value for its mucilage, which is used as a bland, demulcent application 
in conjunctivitis, abrasions of the skin, and fissures of the mucous membranes, and as a 
vehicle for injections in gonorrhea. Internally it may be used as a soothing remedy for 
the throat, stomach, or intestines. The preparation known as Bandoline, used as a hair- 
dressing, is identical with mucilage of Cydonium. 

CYPRIPEDIUM, Ladies' Slipper, — is the rhizome and roots of Cypripedhtm 
pubescens, and of C. parviplorum, the Moccasin-plant, or American Valerian (nat. ord. 
Orchideae). It contains a volatile oil, a volatile acid, resins, and tannin. 

Extractum Cypripedii Fluidum, Fluid Extract of Cypripedium. — Dose, rr^x-xxx. 

Cypripedin (Unofficial), — is an impure alcoholic extract. Dose, gr. ss-iij. 

Cypripedium is antispasmodic, tonic, stimulant and diaphoretic, possessing the same 
general properties as Valerian, whence one of its common names, American Valerian. 
It is a popular remedy in some parts of the U. S. for nervous hyperesthesia unaccom- 
panied by organic lesions, and especially in morbid sensibility of the eye. It is reported 
to have even cured epilepsy, and is said to be highly useful in neuralgia, hysteria, nervous 
headache and insomnia. 

DAMIANA (Unofficial),- — the leaves of Turnera aphrodisiaca, a plant of the nat. 
ord. Turneraceae, growing in Mexico and Lower California. Several varieties of so-called 
Damiana are in the market, but the true leaf is of a light-green color, small, lanceolate, 
and dentate along the margin. It contains a volatile oil and a resin. Dose, 3J daily. 



300 DATURA TATULA DIGITALIS. 

Extractum Damianae, Extract of Damiana (Unofficial). — Dose, gr. ij-x. 

Extractum Damianae Fluidum, Fl. Ext. of Damiana (Unof.). — Dose, TT^x-gj. 

Damiana is said to be a powerful aphrodisiac in cases of sexual atony, but the pub- 
lished reports of its use since its introduction vary greatly as to its efficacy. It is probably 
a stimulant diuretic, a bitter tonic, and a purgative in sufficient doses. Besides its use as 
an aphrodisiac Damiana has been administered with benefit in some forms of cerebral 
exhaustion and general atony of the nervous system, also in sick headaches and in some 
few cases of paralysis. It forms the chief stock in trade of the numerous charlatans who 
fill the daily papers with advertisements of " manhood-restorers." 

DATURA TATULA (Unofficial), — is an indigenous plant of the nat. ord. Solana- 
ceae, resembling Stramonium very closely, with which it generally agrees in its physio- 
logical action and therapeutics. It is distinguished by its purple stem, purple flowers and 
anthers, and the darker green of its leaves. It probably contains the alkaloid Daturine 
(see Stramonium), — and has been smoked in asthma, in a few cases giving continued 
relief when Stramonium had failed to render any service. 



DIGITALIS, Foxglove, — Digitalis consists of the leaves, col- 
lected from plants of the second year's growth, of Digitalis purpurea, 
the Purple Foxglove, a plant of the nat. ord. Scrophularineae, which 
grows wild in Europe, and is cultivated in this country, often in private 
gardens for its beautiful spike of purple flowers, and largely by the Shakers 
for the drug market. 

The British Phar. directs that the official drug shall consist of " the dried leaf, collected 
from the wild, indigenous plant, when about two-thirds of the flowers are expanded." 
Much of the leaf found in our shops is of very poor quality, a large proportion being 
inert ; but whether this is due to our Pharmacopoeia not restricting the official drug to the 
wild plant, or to careless treatment in gathering and drying, is not definitely known. 
When, however, the leaves are imperfectly dried, a process of decomposition sets in, 
which destroys the active principles, and may produce new and poisonous ones. A 
similar decomposition is said to occur whenever the tincture of Digitalis is mixed with 
watery or syrupy solutions. Certain it is, at any rate, that Digitalis is one of the most 
unreliable drugs, in respect to the physiological activity of any particular sample or 
preparation. The seeds are known to contain the active principles in much greater pro- 
portion than the leaves, but they are never used. 

Constituents of Digitalis. 
The supposed active principle of Digitalis was first designated by the 
term Digitalinum (Digitalin), under which name a substance was official 
in the U. S. Phar. and a process was given therein for its extraction, until 
the revision of 1880, when it was omitted. It was an amorphous product, 
of complex composition, and did not represent Digitalis. In 1871 Nati- 
velle received the Orfila prize from the French Academy for the discovery 
of a crystalline principle in Digitalis, which he named Digitaline. This 
was supposed to be the active principle of the plant, until Roucher 
(1872) and Schmiedeberg (1875) f° un d it to be a complex body consist- 
ing of a mixture of Digitalin and Digitoxin. 

Schmiedeberg's latest analysis is now accepted as the most accurate determination 
yet obtained of this vexed question. He enumerates five principles as contained in 
Digitalis, namely — 



DIGITALIS. 30I 

(1) Digitalin, a granular glucoside, soluble in alcohol, almost insoluble in water, 
sparingly soluble in ether or chloroform ; possesses in a high degree the medicinal action 
of digitalis ; the active ingredient of Homolle's French Digitaline and the Digitalin of 
the U. S. and Br. Pharmacopoeias. 

(2) Digitoxin, a crystalline glucoside, soluble in alcohol, slowly in chloroform, 
sparingly in ether, quite insoluble in water ; the most toxic of all the constituents, but 
uncertain, cumulative and dangerous in its action ; the principal constituent of Nativelle's 
prize Digitaline. 

(3) Digitalein, an amorphous glucoside, soluble in both water and alcohol, insoluble 
in ether or chloroform. Its action on the heart is non-cumulative and it causes no 
irritation when subcutaneously injected. 

(4) Digitonin, a crystallisable glucoside resembling Saponin, soluble in water, 
insoluble in cold alcohol, ether or chloroform. It is perhaps the diuretic agent. 

(5) Digitin, a crystalline body, insoluble in ether or chloroform, scarcely soluble in 
water, more readily in alcohol. It is physiologically inert. 

The first three are cardiac stimulants and are highly poisonous. Digitonin is a direct 
depressant of the heart and antagonizes the stimulant action of the others. All five are 
non-nitrogenous, and except Digilin are glucosides. Digitalis contains no alkaloid. 

Official Preparations. 

Digitalis, Digitalis, — the powdered leaves. Dose, gr. ss-iij. 

Extractum Digitalis, Extract of Digitalis, — By maceration and percolation in Alco- 
hol 2, Water I, distilling off the alcohol, and evaporating the residue. Dose, gr. }(.—). 

Extractum Digitalis Fluidum, Fluid Extract of Digitalis, — By maceration and 
percolation in Alcohol 2, Water I, and evaporation. Dose. TT^ss-iij. 

Tinctura Digitalis, Tincture of Digitalis, — Digitalis 15, Diluted Alcohol to 100. 
By maceration and percolation. Dose, TT\v— xx. 

The Tincture and Fluid Extract, being alcoholic preparations, contain Digitalin, 
Digitoxin and Digitalein, which are soluble in alcohol and represent the cardiac action 
of the drug itself. On the addition of water to these preparations, the Digitoxin is 
precipitated. The Infusion contains Digitonin and Digitalein but practically no Digitalin 
or Digitoxin, and is the best preparation for diuretic purpose. The Tincture is the best 
for the cardiac action ; but to obtain the action of. the plant itself the powdered leaves 
must be used in pill or capsule. To obtain the best action of the Tincture on the heart, 
it should be administered without admixture, or at least, with water alone, the latter 
being added immediately before ingestion and any precipitate being also swallowed. 

Infusum Digitalis, Infusion of Digitalis, — Digitalis 1%, Alcohol 10, Cinnamon 
Water 15, Boiling Water 50, Water to 100. By maceration in boiling water. Dose, 
gj-iv. Notice that the dose is in drachms, not in ounces. The British Infusion has 
only l / z the strength of the above and is given in doses of g ij-iv. In France a cold 
infusion is preferred, 5 grains of the powdered drug being macerated in 4 ounces of cold 
water for 8 to 12 hours and then filtered. The dose is ^ ss every two hours. 

Unofficial Preparations . 

Digitalinum, Digitalin, — is the complex product of the process formerly official in 
the U. S. and Br. Phar. Dose, gr. -%-$—%■$. 

Homolle's (or Quevenne's) Digitalin, — is much used in France in form of granules. 
Consists chiefly of Digitalin with a little Digitoxin, and possesses the action of the 
leaves. An amorphous, yellowish-white powder or small scales, intensely bitter, 
inodorous, but irritant to the nostrils. Dose, gr. '^, equal to about gr. jss. of the 
powdered leaves. 

Nativelle's Digitaline, — consists largely of Digitoxin, and is cumulative in action. 
Light, white, crystalline tufts of needles, of very bitter taste ; soluble in alcohol, insoluble 
in water. Dose, gr. ^~To m P^ 1 - 

Digitalinum Verum, is the distinguishing name given by Kiliani to Schmiede- 
berg's Digitalin, which he believes to be the best form in which to prescribe Digitalis." 
Its composition is definite, it is obtainable commercially in a sufficiently pure condition, 



302 DIGITALIS. 

it possesses all the medicinal action of Digitalis on the heart, and it is non-cumulative. 
It is soluble in loo of 50 per cent, alcohol and in 1000 of water. Dose, gr. 3 ^ every 2 
or 3 hours. 

Physiological Action. 

Digitalis is a cardiac and vascular stimulant, a diuretic in certain con- 
ditions, an emetic to some persons, hemostatic, anaphrodisiac, excito- 
motor and at last a paralyzant. In over-doses it irritates the mucous 
membranes, causing sneezing, severe gastric disturbance, nausea, vomit- 
ing, colic and purging, the discharges being of a grass-green color. In 
such doses it lowers temperature, probably by lessening the blood - 
supply to the tissues, produces headache, irregularity of the heart's 
action, vertigo and an appearance of vibratory fringes of color around 
objects. 

Digitalis slows the action of the heart but increases its force at the same 
time. It stimulates the cardiac muscle and its inhibitory apparatus, and 
also stimulates the vaso-motor centres, contracting the arterioles and 
thereby greatly raising arterial tension. The continued use of full doses 
dilates the blood-vessels, exhausts the irritability of the cardiac motor 
ganglia, and finally paralyzes the cardiac muscle itself. The recumbent 
posture must be maintained when Digitalis is given for its full cardiac 
effects. Its final effect on striped muscular tissue is to lessen the con- 
tractile power, causing great weakness and languor. Under its influence 
the excretion of urea is at first increased, but soon decidedly diminished. 
It lessens the sexual appetite and impairs the venereal function. Lethal 
doses lessen the reflexes by stimulation of Setschenow's centre, and para- 
lyze the muscles and the peripheral nerves, motor and sensory. Respira- 
tion, at first slowed, becomes rapid and feeble; cyanosis, coma and con- 
vulsions follow, also death by sudden paralysis of the heart, which is 
arrested in systole. 

It has been conclusively shown that in many cases of pneumonia 
Digitalis failed to influence the pulse, the result probably of the partial 
paralyzant influence of high body-temperature upon the vagus centre and 
endings in the heart, thus weakening the inhibitory apparatus to such a 
degree that the drug awakens no responsive increase of inhibition. In 
cases with but moderately .high pyrexia the characteristic action of the 
drug is not interfered with. 

Compared with Aconite, both this drug and Digitalis slow the heart, 
but otherwise their actions are antagonistic. Aconite at first stimulates 
and soon relaxes inhibition and depresses the cardiac motor ganglia, — 
Digitalis increases inhibition and stimulates the cardiac muscle. Both 
drugs finally paralyze the heart, Aconite by direct depression of its motor 
ganglia, Digitalis by over-stimulation of the cardiac muscle. Under 
Aconite the heart is arrested in diastole, under Digitalis in systole. The 



DIGITALIS. 3O3 

arterial tension is lowered by Aconite but is raised (at first) by Digitalis. 
Aconite acts quickly, Digitalis very slowly, — a fact which makes the 
latter drug of little value in poisoning by the former. 

During the use of this drug for any length of time the muscle of the 
heart is so strained by over-stimulation that on suddenly assuming the 
erect position the cardiac energy may fail, more especially if the doses are 
administered too close together to admit of the elimination of one before 
the ingestion of the next. This is the explanation of the so-called cumu- 
lative action of Digitalis, which is not now generally recognized in the 
sense in which the term was formerly applied. Another explanation is 
that it may stop its own excretion, by arresting the renal circulation and 
the secretion of urine through extreme contraction of the renal vessels, 
and thus may really accumulate in the blood. 

The diuretic action of Digitalis is not yet fully understood. All authori- 
ties agree that this action is exercised indirectly through the circulation, 
but many differ in regard to its details. One theory is that the constit- 
uent principle Digitalin contracts the bloodvessels all over the body, while 
others (Digitoxin and Digitalein or perhaps Digitonin) dilate the renal arte- 
ries. The effect of this, together with the increased force of the ventric- 
ular contractions caused by the drug, is to greatly raise the general arterial 
tension and consequently to increase the bloodpressure in the glomeruli ; 
while the rapidity of the renal circulation is 'increased and its volume 
augmented by the strengthening of the cardiac contractions and the dila- 
tation of the afferent renal vessels. If this explanation be true, no other 
drug possesses such double power, and so far as vascular action is con- 
cerned Digitalis is the ideal diuretic. Another theory is that when a 
small dose is given, or during the first stage of a large dose, the renal 
arteries contract as do the other arteries of the body, but they are the first 
to dilate under the continued influence of the drug, which then acts as a 
diuretic. 

It is generally conceded that Digitalis has some diuretic power in 
health, but that this is slight compared with the diuresis produced by it 
in cases of dropsy, especially when due to cardiac disease. Much un- 
certainty exists as to its effect upon the constituents of the urine, some 
maintaining that it increases the elimination of urea, others that this is 
diminished, and still others that it is at first increased and afterwards 
diminished. 

Antidotes, Antagonists and Incompatibles. 

Tannic Acid is the chemical antidote, but as the tannate is not inert the stomach 
should be evacuated. Aconite is the best antagonist to the effects of large doses, Opin?n 
to those of its long-continued use. Saponin and Senegin are considered to be its most 
complete physiological antagonists. Incompatibles are Cinchona, Iron Sulphate, Tinc- 
ture of Ferric Chloride, and Lead Acetate ; also syrupy and watery solutions, which may 
precipitate and decompose the active principles of the plant. 



304 digitalis. 

Therapeutics. 

The employment of Digitalis in disease is chiefly based on its action as 
a cardiac tonic and a diuretic. The forms of heart disease in which it is 
indicated are the affections of the auriculo-ventricular orifices, namely, 
mitral and tricuspid disease, whether regurgitant or obstructive in char- 
acter. It is contra-indicated in aortic disease, except for special symp- 
toms, and especially in fatty degeneration of the cardiac muscle. Its 
particular sphere of usefulness is Mitral Regurgitation, especially when 
accompanied by venous engorgement and edema of the lungs, the right 
heart, the liver, kidneys and subcutaneous tissues. In such cases its action 
is shown to striking advantage, ameliorating all the symptoms by assisting 
the flow of blood in the veins. By prolonging the diastole, it gives time 
for the dilated auricle to empty itself through the incompetent orifice ; 
and by strengthening the contraction of the left ventricle, it causes the 
better approximation of the mitral flaps, consequently less regurgitation 
occurs, less venous engorgement, and the propulsion of more blood into 
the arterial system. If it also acts as a diuretic, as it usually does in these 
cases, the diuresis will tend to remove the edema; and the general im- 
provement in the circulation produced by it will relieve the cardiac pain 
and distress, the dyspnea and cyanosis. The less a case of mitral regurgi- 
tation approaches the edematous type, the less good will Digitalis do as a 
rule. 

In Mitral Constriction, Digitalis is usually of great assistance, the 
lengthened diastole giving more time for the blood to pass through the 
narrowed orifice, and the increased force of the auricular contraction 
helping in the same direction. 

In Tricuspid Regurgitation or Constriction, Digitalis is beneficial in the 
same manner as in disease of the mitral valve. It is particularly useful 
in dilatation of the right side of the heart with incompetence of the tri- 
cuspid. The rational symptoms which indicate its use are — rapid and 
feeble cardiac action, low arterial tension, cough, dyspnea, pulsating 
jugulars, a dusky face, scanty and high-colored urine and general dropsy. 

In Aortic Regurgitation, Digitalis is generally injurious; the prolonged 
diastole caused by it giving more time for the blood to regurgitate through 
the imperfectly closed orifice, and thus increasing the danger of fatal 
syncope. It may do good if compensatory hypertrophy has not set in, if 
the heart is feeble and its action rapid, or when there is but little blood 
regurgitating, or when there are reasons, such as the coincident presence 
of aortic obstruction, for wishing to strengthen and regulate the contrac- 
tion. In any case, the dose administered should be a small one, and its 
effects should be carefully watched. 

In Aortic Constriction, Digitalis is generally contra-indicated, especially 



DIGITALIS. 305 

when,' as is usually the case, this lesion is accompanied by aortic regurgi- 
tation. It may be of service, however, when the force of the heart-beat 
requires strengthening ; or when, as a result of the obstruction, mitral 
dilatation has set in, with much regurgitation and the consequent venous 
and pulmonary engorgement. It should not be used in aortic stenosis 
with compensatory hypertrophy, in simple hypertrophy when compen- 
sated, in pericarditis or in fatty degeneration of the heart, except tem- 
porarily for some special indication. 

In the irritable heart of soldiers Digitalis is often curative, and palpita- 
tion, cardiac failure and venous engorgement are well treated by it. In 
exophthalmic goitre it has apparently benefited some cases, when used 
over a long course of treatment ; but, as a rule, this affection is not 
amenable to its influence. 

Digitalis is not a suitable diuretic in Bright's disease, though it has 
been used with benefit in the early stage of the acute form. If its action 
produces dilatation of the renal arteries it is questionable practice to in- 
crease the circulation in any acutely inflamed organ; while on the other 
hand the arterial tension is always raised in such cases, and this drug only 
aggravates that condition. In chronic Bright's disease it is still more 
injurious, for the same reason, the arterial tension being already very high 
therein. It may be of service, however, in cases of renal cirrhosis, when 
the cardiac hypertrophy has failed to overcome the peripheral resistance, 
and consequently there is dilatation of the left ventricle and the left 
auriculo-ventricular orifice, with the resulting mitral regurgitation. In 
such cases, a diuretic pill is frequently of service, consisting of Digitalis 
leaves in powder, Calomel and Squill, a grain of each, made into pill with 
extract of Hyoscyamus. 

Digitalis is always an uncertain diuretic unless the heart is diseased ; 
yet it has rendered good service in renal dropsy as well as in the cardiac 
form. Its contractile power over the arteries may so predominate as to 
arrest the renal circulation completely, and stop the secretion of urine 
(Brunton). On this account it is well to administer at the same time an 
agent which causes dilatation of the renal vessels, as Sodium Nitrite. Con- 
trary to theory it has been employed with benefit in the early stage of 
scarlet fever, and when the kidneys strike work in that disease. As a 
hemostatic it may be used in hemorrhage from a large surface, in the 
hemorrhagic diathesis, hemoptysis, and menorrhagia. As an antipyretic 
it has been much used in fevers, in the first stage of pneumonia, and in 
other inflammations, but a reaction is setting in against this employment 
of so powerful an agent, which by over-stimulation may act as a heart- 
depressant. In rheumatic fever it lowers the temperature, shortens the 
duration of the disease, and is particularly indicated for any cardiac 
complications. It was formerly much used in delirium tremens, in con- 
20 



306 DIOSCOREA DITA BARK DROSERA. 

gestive headaches, acute mania and other congestive conditions of the 
brain, but generally without much benefit. In spermatorrhea of the 
plethoric it may be well combined with Potassium Bromide, and when 
this affection is complicated with an atonic condition, shown by feeble 
erections, frequent emissions, and cold feet and hands, it is a serviceable 
anaphrodisiac. Finally, Digitalis is said by high authority to be particu- 
larly adapted to blondes and persons of sanguine and indolent tempera- 
ment. Sometimes the vomiting caused by it is so severe as to prevent its 
use. 

Of the four active principles contained in this plant, namely — Digita- 
lin, Digitoxin, Digitale'in and Digitonin, the first two are soluble in alco- 
hol and practically insoluble in water, the third is soluble in both men- 
strua and the fourth is insoluble in alcohol but is freely soluble in water. 
Consequently all alcoholic preparations of Digitalis contain the first 
three principles and all aqueous ones contain the last two. In action 
the first three are very similar, producing the characteristic effects of the 
plant, while Digitonin is directly poisonous to the cardiac muscle, 
decreasing its contractile power. This principle produces dilatation of the 
arteries, generally antagonizes the action of the other constituents, and 
perhaps irritates the renal epithelium. When, therefore, the cardiac action 
of Digitalis is desired, the tincture should be employed, given on sugar 
or bread, prohibiting the ingestion of any aqueous fluid within 20 min- 
utes, either before or after swallowing it. If the diuretic action is required, 
the proper preparation is the infusion. The latter preparation may be 
employed hypodermically, and very small doses so administered have 
been found efficient when larger ones given by the stomach have failed to 
act. An infusion for this purpose is of the strength of 3 parts of the 
leaf in 100 of water, and the hypodermic dose thereof is 15 minims 
twice or thrice daily. 

DIOSCOREA, Wild Yam, Colic-root (Unofficial),— is the rhizome of Dioscorea 
villosa, a creeping plant of the nat. ord. Dioscoracese, indigenous to the eastern U. S. 
It contains an acrid resin, and is reported to be expectorant and diaphoretic in action, as 
well as stimulating to the intestinal canal, and in large doses to cause general neuralgic 
pains with erotic excitement. It is used with great success in bilious colic ; and in the 
cramps of cholera morbus, spasmodic hiccough, dysmenorrhea and nocturnal emissions 
of sthenic type it is said to be very efficient. A powdered extract named Dioscorein is 
on the market, of which the dose is gr. j-iv. A fluid extract made according to the 
pharmacopceial rule may be administered in doses of n\xv-xxx. 

DITA BARK (Unofficial), — is the bark of Alstonia scholaris, a tree of the nat. ord. 
Apocynaceee, growing in the Philippine Islands. It contains two active alkaloids, 
Ditaine and Ditamine, the former of which has an action identical with that of Curare. 
The bark is considered tonic and antiperiodic, and is used in the East as a remedy for 
intermittents. It may be given in doses of 5 j-iv, in powder or as a fluid extract. 

DROSERA, Sundew (Unofficial), — A fluid extract of Drosera rotundifolia, the 
round-leaved Sundew, is said to have been successfully used in phthisis pulmonalis. It 






DUBOISIA. 307 

is certainly a most useful agent in whooping-cough and other spasmodic coughs ; espe- 
cially when marked by violent paroxysms, the cough being loud and harsh, and followed 
by bleeding from the nose or mouth, and perhaps by vomiting of the contents of the 
stomach. The expressed juice has been applied to warts and corns, for the purpose of 
curing them. Dose of the fluid extract, n\,v-xx. 



DUBOISIA (Unofficial), — is the leaf of Duboisia myoporoides, an 
Australian tree of the order Solanaceae. It contains a poisonous alkaloid, 
Duboisine, which is believed to be identical with Hyoscyamine, and 
strongly resembles Atropine. 

Unofficial Preparations. 
Extractum Duboisiae, Extract of Duboisia, — Dose, gr. )/(>-}£. 
Tinctura Duboisiae, Tincture of Duboisia, — Dose, TT\v-xx. 
Duboisinae Sulphas, Duboisine Sulphate (Langenberg's), — Dose, gr. 1 * - ^ . 

Physiological Action and Therapeutics. 

The actions of Duboisia are in all respects similar to those of its con- 
gener, Belladonna, except that Duboisine is more soluble in water than 
Atropine, is less irritating to mucous membranes, and more prompt in 
mydriatic action, but its effects are of shorter duration. It is also less of 
a cerebral excitant and more of a calmative and hypnotic. On man its 
action is said by some authorities to be more powerful than that of Atro- 
pine, but less powerful on frogs. If administered in the intervals between 
meals it disorders the ensuing digestion, but does not so act if given 
while digestion is in progress. 

Duboisine is highly praised for its sedative action in the mental exci- 
tability of the insane, in the treatment of the morphine habit and in 
paralysis agitans. In doses of gr. yi-g- to y 1 - of the sulphate, administered 
hypodermically twice daily, it induces quiet and refreshing sleep and is 
not dangerous. When given in larger doses it may produce vertigo, 
nausea or even syncope, but no fatal cases from its moderate use have 
been reported (Massant). Its sedative effect is at the same time the most 
persistent and also that of which the patient first acquires a tolerance. 
Of 22 cases in which the calmative effect was at first decided, a tolerance 
was acquired in eight. In such cases the sedative action of the drug may 
be restored by ceasing its continuous administration and lengthening the 
interval between the doses (De Montyel). It has been well employed in 
puerperal mania, and may be used instead of Atropine in many conditions, 
especially in the night-sweats of phthisis, respiratory neuroses and cardiac 
failure. It is employed as a mild mydriatic by eye surgeons, its advan- 
tages for them over Atropine being its more rapid action in paralyzing 
accommodation and effecting mydriasis, the shorter duration of its effects* 
and the slight degree of conjunctival irritation produced by it. Dubois- 



308 DULCAMARA — ELASTICA. 

ine is an efficient antagonist to Morphine. Its own antagonists and 
incompatibles are the same as for Atropine, and are given under Bella- 
donna, ante, page 215. 

DULCAMARA, Bittersweet, — the young branches of Solatium 
Dulcamara, or Woody Night-shade, a shrub of the nat. ord. Solanaceae, 
growing in Europe and N. America. It contains the glucoside Dulcam- 
arin, a peculiar principle named Picroglycion, and the alkaloid Solanine, 
which exists in the stems of other species of Solanum, namely, S. tube- 
rosum (potato), S. Lycopersicum (tomato), and S. nigrum (black night- 
shade). Solanine is of bitter taste and alkaline reaction, crystallizing in 
minute prisms which are soluble in 125 of boiling alcohol but very in- 
soluble in water. It is a narcotic poison, but exists in very small quantity 
in the plant. 

Preparations. 

Extractum Dulcamarse Fluidum, Fluid Extract of Dulcamara , — Dose, ^ss-jss. 

Decoctum Dulcamara?, Decoction of Dulcamara (Unofficial), — may be made of 
10 per cent, strength and given in doses of ^j-ij. 

Physiological Action and Therapeutics. 

Dulcamara is but imperfectly understood. In overdoses it has pro- 
duced nausea and vomiting, vertigo, convulsive muscular movements, 
pruritus, erythematous eruptions on the skin, and languid circulation with 
a dusky color of the face and hands. In children who have eaten the 
berries there have been observed signs of severe enteralgia, abdominal 
tenderness, nausea, thirst, heat in the throat and chest, great prostration, 
rapid pulse, quick and painful respiration. In very large doses it is a nar- 
cotic poison, causing paralysis by depression of the central nervous system, 
with lowered activity of the heart and respiration. It is believed by 
some authorities to be anaphrodisiac, diaphoretic and diuretic. 

Dulcamara was formerly used in a variety of affections, as herpetic dis- 
eases, chronic rheumatism, gout, jaundice, etc. It is now chiefly em- 
ployed in obstinate scaly skin diseases, as psoriasis and pityriasis, in 
which it is unquestionably serviceable. It is also serviceable in the diar- 
rhea of children when produced by exposure to cold and damp, in mania 
with strong venereal propensities, in chronic bronchitis and in whooping- 
cough. As a diaphoretic it has been used with benefit in rheumatic and 
venereal disorders, and is often beneficial in nasal, pulmonary and vesical 
catarrhs. It is said to be particularly useful in affections of a rheumatic 
or catarrhal nature when caused by exposure to damp weather. 

ELASTICA, India-rubber, Caoutchouc, — is the prepared milk- 
juice of various species of Hevea (nat. ord. Euphorbiaceae), growing in 



ELATERINUM. 3O9 

S. America, and being known in commerce as Para Rubber. It is very 
elastic, insoluble in water, diluted acids, or diluted solutions of alkalies, 
soluble in chloroform, carbon disulphide, oil of turpentine, benzin and 
benzol. When pure, or nearly pure, it floats on water. 

India-rubber is a hydrocarbon, and may be combined with sulphur 
by the aid of heat (vulcanized), which process, long continued, converts 
it into hard rubber. It is used in the fabrication of catheters, bougies, 
pessaries, court plaster, bandages, elastic stockings, tubing, etc. An 
analogous substance is Gutta-percha, which was official in the U. S. 
Phar., 1880. 

Gutta-percha (Unofficial), — is the concrete exudation of Isonandra gutta, a large 
tree of the nat. ord. Sapotacese, growing in the Malay peninsula and adjoining islands. 
It occurs in tough but somewhat flexible pieces, of grayish or yellowish color, plastic 
above 140 F., soft at 212° F., insoluble in water or alcohol, soluble in chloroform, 
oil of turpentine, carbon disulphide, benzin and benzol. It contains a hydrocarbon, 
Gutta, C ]0 H 16 (80 per cent.), two resins named Fluavil and Albau, also a volatile oil, 
salts, fat and coloring matter. 

Preparations of Gutta-percha. 

Liquor Gutta-perchae, Solution of Gutta-percha (Unofficial), — Gutta-percha 9, Car- 
bonate of Lead 10, in Chloroform 91. Used as a protective application to eruptions and 
slight wounds, the evaporation of the menstruum leaving behind a thin adhesive and non- 
irritating pellicle. 

Traumaticin (Unofficial), — is the name given to a 10 per cent, solution of Gutta- 
percha in Chloroform, which forms on drying a permanent, unirritating, adhesive, flexible 
and non-contractile skin for the treatment of skin affections and slight wounds. It forms 
an excellent basis for the application of Chrysarobin to psoriasis. 

Gutta-percha has neither physiological action nor therapeutics, being used for its 
physical qualities alone. In surgical practice it has several applications, making a good 
material for splints, as it can be softened in hot water and adapted to any surface while 
pliable. From it are manufactured pessaries, specula, stethoscopes and other instruments. 
The solution may be used as a protective covering for excoriations and slight wounds, to 
prevent pitting in small-pox, and to paint over the line of suture after post-mortem 
examinations. 



ELATERINUM, Elaterin, C 20 H 28 O 5 ,— is a neutral principle ex- 
tracted from Elaterium, a substance deposited by the juice of the fruit of 
Ecballium Elaterium, or Squirting Cucumber, a cultivated European 
plant of the nat. ord. Cucurbitacese. Elaterium is no longer official by 
reason of its variable quality. Elaterin occurs in small, colorless scales 
or prisms, of bitter taste and neutral reaction, insoluble in water, soluble 
in 337 of alcohol and in solutions of the alkalies. Dose, gr.-^Q-^. 

Preparation. • 

Trituratio Elaterini, Trituration of 'Elaterin,— Elaterin 10, Sugar of Milk 90, thor- 
oughly mixed by trituration. Dose, gr. ss-j. 

Elaterin is the most powerful of the hydragogue cathartics, causing 
profuse, watery stools, and when given in large doses great prostration 
and gastro-intestinal irritation, nausea and vomiting. In the lower ani- 



3IO ERGOTA. 

mals it does not produce purgation, but profoundly impresses the nervous 
system, causing irregular breathing, convulsions and death. 

Its chief use is to produce free watery discharges in ascites, anasarca, 
uremia and cerebral disorders, but while the most efficient agent we 
possess for this purpose it must be used with great caution in the aged 
and feeble, as its action is very depressant. 

ERGOTA, Ergot, Ergot of Rye, — is the sclerotium (compact myce- 
lium or spawn, intermediate fibrous stage) of Claviceps purpurea (class 
Fungi), growing within the flower and replacing the grain of Rye, Secale 
cereale (nat. ord. Graminese). It occurs in fusiform, curved, grain-like 
bodies, of purplish-black color, peculiar, heavy odor, and oily, disagree- 
able taste. It should be only moderately dried, preserved in a close 
vessel, and have a few drops of chloroform dropped upon it from time to 
time, to prevent the development of insects. When more than one year 
old it is unfit for use. Dose, gr. x-3j- 

Composition of Ergot. 
The composition of Ergot and the nomenclature of its supposed con- 
stituents are subjects upon which there exist a great diversity of opinions, 
and about which there is nothing settled. The following synopsis gives 
the views of the different persons who have examined into the matter. 

Wenzell (1864) named two alkaloids, Ecboline and Ergotine, which he claimed to be 
the active principles, and to be combined with Ergotic Acid, a volatile body yielding 
crystallizable salts. He also claimed the presence of Trimethylamine as a Phosphate. 

. Tanret (1877) isolated a crystallized alkaloid, which he named Ergotinine (dose, gr. 
-^q-jo) ; also a volatile camphoraceous substance. 

Dragendorf and his pupils (1875-187 9) stated the active principles to be two in num- 
ber, Sclerotic or Sclerotinic Acid, a very powerful body, yellow-brown, amorphous, taste- 
less and well adapted for hypodermic use in doses of gr. ^"tV anc ^ Scleromucin, a colloid 
substance, also quite active. Besides these they found various coloring matters (Scler- 
erythrin, Scleroxanthin, etc.), also a non-drying Oil, a peculiar sugar (Mykose), a number 
of alkaloids (Trimethylamine, etc.), and other inert principles. 

Kobert (1885) announced that Ergot contains three active principles, (1) Ergotinic 
Acid, a glucoside, and the chief constituent of Sclerotinic Acid ; having no ecbolic action, 
but affecting the nervous system, the heart and the respiration; — (2) Sphacelinic Acid, 
non-nitrogenous, unstable, soluble in alcohol, insoluble in water, stimulates the vaso-motor 
centre, and believed to be the active agent in contracting the blood-vessels and producing 
gangrenous ergotism ; — (3) Coroutine, an alkaloid, believed to be the agent which con- 
tracts the uterus. It produces convulsions and peristaltic contractions of the uterus, and 
is the active agent in convulsive ergotism. 

Jacobj (1898) finds in Sphacelinic Acid a toxic resin named Sphacelotoxin, which differs 
from all other poisons in producing gangrene of various organs, especially in fowls and 
pigs. It induced abortion in pregnant animals and caused ataxia and other nervous 
symptoms in fowls. 

Tanret's Ergotinine has been proved to have no action on the uterus. The Ergotin 
of Bonjean, Wiggers and Tanret is not a fixed compound, but a mixture. The Ecboline 
of Wiggers is also a mixture. Sclerotinic Acid is said by many authorities to act on the 
uterus, but this is positively denied by many others. It is probably a very uncertain 
preparation, and is said to be really a mixture of sphacelinic acid and cornutine. Ergot 



ERGOTA. 311 

also contains Trimethylamine, to which its odor is due, a fixed oil, (30 per cent.) and 
Tannin. For the Ergotin of commerce see below. 

Preparations. 

Extractum Ergotae Fluidum, Fluid Extract of Ergot, — prepared with Acetic Acid 
and Diluted Alcohol. Dose, gss-ij. 

Extractum Ergotae, Extract of Ergot, commonly called Ergotin, — is prepared by 
evaporating the fluid extract at a temperature not above 122 F. , until reduced to a pilu- 
lar consistence. Dose, gr. ij-xx. 

Vinum Ergotae, Wine of Ergot, — strength 15 per cent. Dose, ,^j-^j. Is now 
made by an improved method and is more reliable than that formerly official. 

Ergotin (Unofficial) , — is the name of several watery extracts found on the market, and 
varying much in action both from each other and from the parent drug. That made by 
Squibb has about the same strength as the official extract, and represents the general 
powers of Ergot. It may be used hypodermically in doses of gr. %-gr. v. The Ergotin 
of Bonjean is also an aqueous extract, but is very variable in quality and frequently inert. 
Wiggers' Ergotin is insoluble in the ordinary menstrua, and inert on the vascular appa- 
ratus, but causes colic and gastro-enteritis. 

Physiological Action. 

Ergot is a motor-excitant and a vascular contractor, also hemostatic, 
anhidrotic, emmenagogue and oxytocic. It exalts the functional activity 
of the spinal cord ; stimulates the vaso-motor centre, raising the blood- 
pressure ; produces tetanic contraction of unstriped muscular fibre, dimin- 
ishing the calibre of the arterioles ; depresses the motor ganglia of the 
heart, causing a slower and weaker pulsation ; is directly emmenagogue 
and oxytocic, and markedly increases intestinal peristalsis. Whether the 
admitted increase of blood-pressure is due to the action of the drug on 
the unstriped muscle of the arterioles or is indirectly caused by stimula- 
tion of the vaso-motor centre is a disputed question. Its action upon the 
circulation results in the production of an artificial anemia of the arterial 
system, and its phenomena are divided into two sets, named respectively 
Acute and Chronic Ergotism, according as the drug is administered in large 
doses or in small quantity for a considerable length of time. 

Acute Ergotism, In large doses Ergot acts as a gastro-intestinal irri- 
tant, causing nausea and vomiting, gastralgia, colic, thirst, difficult mictu- 
rition and purging. It slows the heart, raises the arterial tension greatly, 
dilates the pupils and produces pallor, vertigo and frontal headache. It 
stimulates the contraction of unstriped muscular fibre, especially affecting 
the sphincters and the uterus, causing continuous labor pains and tonic 
contraction of the sphincter vesicae, making micturition difficult if not 
impossible. It also produces cerebral and spinal anemia, coldness of the 
surface, tetanic spasms and violent convulsions, but very large doses 
(several ounces) are necessary to cause such results. As much as giij of 
the fluid extract has been given daily for a week or more, without pro- 
ducing any marked effect. 

Chronic Ergotism occurs in two forms, the convulsive and the gah- 



312 ERGOTA. 

grenous, — either usually excluding the other. The convulsions are 
tetanoid spasms of the flexor muscles, the uterus, the intestinal fibres, 
and the muscles of respiration, ending in coma and death by asphyxia. 
The gangrenous form begins with coldness and numbness of the limbs, 
formication of the skin all over the body, loss of sensibility and abolish- 
ment of the special senses, bullae of blood and ichor, followed by dry or 
moist gangrene of the lower extremities, buttocks and other parts, epi- 
leptiform convulsions, coma and death. Autopsies show changes in the 
posterior columns of the cord, resulting probably from spinal anemia. 

Experiments with the various derivatives of Ergot show that no one 
of its constituents represents the power of the drug itself. Those which 
probably come nearest to it in action are the Ergotinine of Tanret and 
Sclerotinic Acid. Cornutine stimulates the central nervous system 
strongly and produces convulsions. 

Analogues of Ergot are Ustilago (see under Zea), Gossypii Radicis 
Cortex (Cotton-root Bark), and Caulophyllum (Blue Cohosh). They are 
each described under their respective titles. 

Antagonists and Inco7)ipatibles. 

Amyl Nitrite, Aconite, Veratrura Viride, Tobacco and Lobelia antagonize its action 
on the circulation. Caustic alkalies and metallic salts are chemically incompatible. 

Therapeutics. 
Ergot has a wide field of application. Its most familiar use is to pro- 
mote uterine contraction in labor, but as the contractions produced by 
it are continuous instead of the natural intermittent ones, it is highly 
dangerous when there is any obstacle in front of the child, the probable 
results being rupture of the uterus, paralysis of the fetal heart and severe 
laceration of the perineum. At the end of the second stage, when the 
head is born, is the best time for its use (if employed in labor at all) in 
order to promote firm uterine contraction, thereby guarding against post- 
partum hemorrhage. and promoting the expulsion of the placenta. The 
tendency, however, of obstetrical teaching, is against its employment at 
all in labor; while in practice the teaspoonful of Ergot is almost in- 
variably administered as soon as possible after the child is born. In 
many uterine affections, as chronic metritis, subinvolution, congestive 
dysmenorrhea, menorrhagia, fibroids and polypi, Ergot is well employed, 
producing firm contraction of the womb and promoting absorption* of 
inflammatory products. It is extremely useful in amenorrhea due to 
plethora, and in the atonic form of spermatorrhea. In conjunctivitis, 
gonorrhea, and inflammations of mucous membranes generally, it is of 
striking benefit, if used both locally and internally. It is also an excel- 
lent remedy in acute and chronic dysentery, chronic diarrhea, atonic 



ERIGERON — ERIODICTYON EUCALYPTUS. 3 I 3 

hemorrhages of arterial type, mania due to cerebral hyperemia, headache 
and migraine of congestive form, myelitis, spinal congestion, cerebro- 
spinal meningitis, splenic enlargement, lax sphincters of the rectum and 
bladder, and in incontinence of urine from paralysis of the sphincter 
vesicae. Hemorrhoids are well treated by its local application, but in 
this affection it should not be used internally as it promotes venous con- 
gestion. In aneurism it aids coagulation by slowing the blood current, 
and in cardiac hypertrophy without valvular lesion it acts well by slowing 
the heart. In diabetes insipidus full doses of Ergot are often curative, 
and it has been used with benefit in diabetes mellitus. 

Hypodermically, the aqueous extract dissolved in water and free from 
alcohol or any other irritating substance is in many cases much more 
prompt m action than when given internally, especially if injected near 
the seat of the affection. This is particularly true in post-partum and 
other hemorrhages, prolapse of the rectum, chronic metritis and subin- 
volution of the womb, uterine fibroids, varicocele and varicose veins. 
When so administered it will frequently contract the sphincter of the 
bladder so as to produce retention of urine and necessitate the use of the 
catheter. 

ERIGERON, Fleabane (Unofficial), — is the flowering plant Erigeron canadense, a. 
plant of the nat. ord. Composite, growing in N. America. It contains a Volatile Oil, 
which is official, also tannic acid and a bitter extractive. 

Oleum Erigerontis, Oil of Fleabane, — a pale yellow liquid, of sp. gr. about 0.850, 
becoming darker by age and exposure to air, of peculiar and persistent odor, pungent 
taste and neutral reaction, readily soluble in alcohol. Dose, TT^x-^ss. 

Oil of Erigeron has the same action as Oil of Turpentine but is less irritant and less 
efficient. It has considerable reputation as a hemostatic, especially in menorrhagia and 
intestinal hemorrhage of passive form, as in typhoid fever. It is also used with benefit 
in diarrhea and dysentery, and in hemoptysis without fever or other evidence of irritation 
it is a very valuable remedy. 

ERIODICTYON, — the leaves of Eriodictyon glutinosum, or Yerba Santa, a Cali- 
fornia shrub of the nat. ord. Hydrophyllaceae. They contain an acrid Resin and an 
aromatic Volatile Oil. 

Extractum Eriodictyi Fluidum, Fluid Extract of Eriodictyon, — Dose, TT^xv-^j. 

Extractum Eriodictyi, Extract of Eriodictyon (Unofficial), — Dose, gr. ij-x. 

Eriodictyon is expectorant, and covers the taste of Quinine in a remarkable manner, 
for which purpose it is combined in mixture with Glycyrrhizin, under the title Velatine, a 
proprietary preparation (see ante, page 276). It is used with fair success in bronchial 
and laryngeal affections, also in asthma. Combined in syrup with Grindelia it is very 
efficient for coughs. 

EUCALYPTUS,— the leaves, collected from the older parts of the 
tree, of Eucalyptus globulus or Blue Gum-tree (nat. ord. Myrtacese), a 
native of Australia, now grown in California, Italy, etc. They contain 
tannic acid, a resin, a fatty acid and a Volatile Oil. The latter consists 
of three different oils which distil over at various temperatures, the first, 
product being the official substance named Eucalyptol, C 10 H 18 O, which 



3H EUCALYPTUS. 

by the action of phosphoric acid is converted into Eucalyptene, a sub- 
stance allied to Cymene, and Eucalyptolen. 

Preparations. 

Extractum Eucalypti Fluidum, Fluid Extract of Eucalyptus, — is three-fourths 
alcohol. Dose, TTVx-^j. 

Oleum Eucalypti, Oil of Eucalyptus, — the volatile oil, is distilled from the fresh 
leaves of various species of Eucalyptus, that from E. amygdalina being considered 
wanting in Eucalyptol. Is soluble, in all proportions, in alcohol, carbon disulphide, or 
glacial acetic acid. Dose, tt\v-xxx, in emulsion or capsules. 

Eucalyptol, C 10 H 18 O, — is a neutral body obtained from the volatile oil ; a colorless 
liquid, of aromatic, camphoraceous odor, and pungent, cooling taste ; soluble in all pro- 
portions in alcohol, carbon disulphide and glacial acetic acid. Dose, rryij-x. 

Physiological Action. 

The taste of Eucalyptus is warm, aromatic, bitter and camphoraceous. 
It increases the flow of saliva, the gastric juice and the intestinal secre- 
tions, and in small doses promotes appetite and digestion, increases the 
heart's action and lowers arterial tension. In large doses it produces 
eructations, indigestion, diarrhea, nausea and vomiting, lowered temper- 
ature, great muscular weakness, and if continued will irritate and congest 
the kidneys, and induce a feverish state with symptoms of cerebral con- 
gestion and great constitutional disturbance. In toxic doses it is a nar- 
cotic poison, and a fatal dose causes paralysis of respiration by direct 
action on the respiratory centre in the medulla, 

Eucalyptus is powerfully antiseptic and destructive to low forms of 
life, a stimulating expectorant and an efficient diaphoretic. By some 
authorities it is believed to reduce the size of an enlarged spleen and to 
possess anti-malarial properties by absorbing noxious germs as well as by 
draining the soil of its water, and by its aseptic emanations purifying the 
atmosphere in its vicinity. It is largely cultivated in malarial districts 
for these properties, and is reported to have rendered habitable a portion 
of the deadly Roman Campagna. 

Eucalyptus is eliminated by the skin, the bronchial mucous membrane 
and the kidneys. It imparts its odor to the breath and the urine and is 
more or less irritant at the points of its elimination. 

Therapeutics. 
Eucalyptus is an efficient stomachic in atonic dyspepsia, chronic gastric 
and intestinal catarrh, and in conditions of the intestinal canal which 
favor the development of worms. In chronic catarrhal conditions of the 
genito-urinary organs, the broncho-pulmonary mucous membrane and 
especially the bladder, it is very useful, acting as a stimulant and disinfec- 
tant to the mucous membranes. It is equally beneficial in chronic bron- 
chitis and bronchorrhea, in cachectic states generally and in convales- 



EUONYMUS EUPATORIUM EUPHRASIA. 3 I 5 

cence from acute diseases. In epidemic influenza (grippe) the oil has 
been used internally with good results, and sprinkled on blotting-paper 
placed in offices and stores has seemed to act as a prophylactic on persons 
employed therein. In hysteria, chorea and asthma it is beneficial, in the 
latter affection being advantageously smoked in cigarettes with Stramo- 
nium or Belladonna leaves. In malaria as a reconstructant it is better 
than Quinine, and it has considerable utility in obstinate intermittents 
where it is desirable to stop the use of Cinchona preparations. As an 
antiseptic it is highly valuable in dilute solution for application to ulcers 
and as a substitute for Carbolic Acid on gauze in the antiseptic treatment 
of wounds. It is also used in dilute solution locally, as a stimulating dis- 
infectant in stomatitis, and in the subacute stages of pharyngitis and ton- 
sillitis. An aqueous preparation is highly recommended as a vehicle for 
alkaloids in solution for hypodermic use, to prevent the development of 
the penicillium which rapidly destroys the alkaloid present. 



EUONYMUS, Wahoo, — is the bark of Euonymus atropurpuretis , a shrub of the 
nat. ord. Celastrinese, growing in the U. S. It contains an amorphous, bitter principle 
named Euonymin, also Resins, Euonic Acid, and Asparagin, fixed oil, etc. 

Extractum Euonymi, Extract of Etionymus, — Dose, gr. j-v. 

Euonymin (Unofficial), — the eclectic preparation, consists of the fixed oil and resin, 
and is given in doses of gr. ss-v. 

Euonymus is classed with Rhubarb, Jalap, Aloes, etc. , as a tonic-astringent and resin- 
bearing purgative. It is said to be also diuretic and expectorant and a very efficient 
cholagogue. Its cathartic action is similar to that of Rhubarb, but milder. It has been 
employed with benefit in some cases of dropsy, also in habitual constipation, torpid liver, 
and pulmonary affections. In overdoses it will set up considerable gastro-intestinal 
irritation. 



EUPATORIUM, Thorough-wort, Boneset, — the leaves and flowering tops of 
Eupatorium perfoliatum, an American plant of the nat. ord. Compositae. It contains a 
neutral, bitter principle, named Eupatorin, tannic acid, a volatile oil, etc. 

Extractum Eupatorii Fluidum, Fluid Extract of Eupatorium, — Dose, tr^x-^.). 

Eupatorium is a bitter tonic and efficient diaphoretic, also in full doses emetic and 
aperient. It has been supposed to have antiperiodic and teniafuge powers. A warm 
infusion (Boneset tea) is a popular diaphoretic in remittent and typhoid fevers, also at the 
onset of an attack of acute catarrh or general cold. Asa bitter tonic it may be used with 
advantage in dyspepsia and general debility. Its common name is derived from its sup- 
posed power to relieve the bone pains of dengue, the " break-bone fever. " 

Another variety of Eupatorium, E. purpureum, or Gravel-root, is reputed to have de- 
cided power over the uric acid diathesis. 



EUPHRASIA, Eye-bright (Unofficial),— is a plant of the nat. ord. Strophulari- 
aceae, growing in Europe and the U. S., containing Euphrastic Acid, tannin, etc. It 
was formerly of great repute in various eye-affections, and may be of utility as a mild 
astringent in catarrhal conjunctivitis. Its chief value, however, is to abort an attack of 
acute nasal catarrh with lachrymation, for which purpose a few drops of the tincture 
every two hours is remarkably efficient. In hay-fever also it is of decided utility in miti- 
gating the catarrhal symptoms, and in the acute coryza of measles it will be found an ex- 
cellent remedy. A tincture (1 to 9) of the fresh plant should be used, and given in doses 
ofTry-v. 



3l6 FEL BOVIS FERRUM. 

FEL BOVIS, Ox-gall, Fel Tauri, the fresh bile of Bos Taurus, is a dark-green, 
viscid liquid, of peculiar odor, bitter taste, and neutral or faintly alkaline reaction. It 
contains Sodium Glycocholate, Sodium Taurocholate, Cholesterin and coloring matter. 

Fel Bovis Purificatum, Purified Ox-gall, — 3 of Ox-gall and I of Alcohol evaporated 
to pilular consistence after standing 24 hours. Dose, gr. v-xv. 

Bile is tonic, antiseptic and purgative. It assists in the emulsification of fats, and 
stimulates the absorbent powers of the mucous membrane. In the stomach it neutralizes 
the gastric juice, precipitates the pepsin, and is apt to cause nausea and vomiting. It is 
found to act well in stimulating the resolution of hypertrophies when locally applied to the 
part, as the mammae, tonsils, pannus, etc. It is used as a laxative in constipation when 
the secretion of bile is deficient, but has no advantage over other purgatives. 



FERRUM, Iron, Fe, — is metallic Iron in the form of fine, bright, 
and non-elastic wire. 

Ferrum Reductum, Reduced Iron, — is metallic Iron in fine powder, 
obtained by reducing the Sesquioxide by hydrogen at a dull red heat. It 
is a fine, gray-black, lustreless powder, odorless, tasteless, and insoluble 
in water or alcohol, but soluble in dilute sulphuric acid with evolution of 
nearly odorless hydrogen gas. Dose, gr. j-v, after meals. 

Salts of Iron and their Preparations. 

Liquor Ferri Acetatis, Solution of Ferric Acetate, — is an aqueous solution, contain- 
ing about 31 per cent, of the anhydrous salt, and corresponding to about 7^ per cent, of 
metallic iron. Dose, rr\^ij— x. Used chiefly in pharmacy. 

Ferri Carbonas Saccharatus, Saccharated Ferrous Carbonate, — has at least 15 per 
cent, of ferrous carbonate. A greenish-gray powder, of sweetish taste at first, changing 
to ferruginous. Partially soluble in water, but soluble in dilute hydrochloric acid with 
evolution of C0 2 . Action, — slightly stimulant to digestive tract. Dose, gr. ij-x. 

Massa Ferri Carbonatis, Mass of Ferrous Carbonate, ( Vallef s Mass), — Ferrous 
Sulphate 100, Sodium Carbonate 100, Honey 38, Sugar 25, Syrup and Distilled Water 
each, to make 100. Has 42 per cent, of Ferrous Carbonate. An astringent, non-irritant, 
ferruginous tonic. Dose, gr. j-v, after food. 

Pilulae Ferri Carbonatis, Pills of Carbonate of Iron, [Ferruginous Pills, Chalybeate 
Pills, Blaud's Pills), — made by mixing Ferrous Sulphate, about 2)4, grains for each pill, 
with Potassium Carbonate, Sugar, Tragacanth, Althaea, Glycerin and Water. Dose, j-ij. 

Mistura Ferri Composita, Compound Iron Mixtzire, [Griffith's Mixture), — has of 
Ferrous Sulphate 6, Myrrh 18, Sugar 18, Potassium Carbonate 8, Spirit of Lavender 60, 
Rosewater to 1000. Is really a solution of the Carbonate formed by reaction between 
the two principal constituents. An excellent chalybeate. Dose, 3 ij-iv. 

Ferri Chloridum, Ferric Chloi'ide, (Perchloride of Iron), Fe 2 G 6 -f-l2H 2 0, — orange- 
yellow, deliquescent pieces, of styptic taste and acid reaction, freely soluble in water, 
alcohol or ether. Action, — strongly astringent, hemostatic. Never used internally. 

Liquor Ferri Chloridi, Solution of Ferric Chloride, — an aqueous solution of the pre- 
ceding, containing 37.8 per cent, of the anhydrous salt, with some free HC1 acid. Action, 
strongly astringent and styptic. Dose, rryj-x, well diluted. Creuse' 's Tasteless Solution, 
is an agreeable preparation ; it has Liquor. Ferri Chloridi j|j, Acidi Citrici gr. 544, Sodii 
Carb. gr. 1000 or q. s., Aquas Destil. ^j, Alcoholis q. s. Dissolve the citric acid in the 
water, heat to the boiling point, gradually adding the sodium carbonate until the acid is 
neutralized ; mix with the iron solution and add alcohol up to a total of ^ iv. Dose, 
TTLxx-xxx, diluted. 

Tinctura Ferri Chloridi, Tincture of Ferric Chloride, — a hydro-alcoholic solution 
of Ferric Chloride, containing about 13.6 per cent, of the anhydrous salt, corresponding 
to about 4.7 per cent, of metallic iron. Has of the preceding solution 25 in Alcohol to 
make 100. A bright, brownish liquid, of ethereal odor, styptic taste and acid reaction. 



FERRUM. 3 I / 

Is used in Mistura Ferri et Ammonii Acetatis. One of the best preparations of Iron. 
Action, — ferruginous tonic. Dose, rr\v-xx, in water, syrup or glycerin. 

Ferri Citras, Ferric Citrate, Fe 2 (C 6 H 5 7 ) 2 + 6H 2 0, — garnet-red, transparent scales, 
slowly soluble in water, not in alcohol. Action, — mildly stimulant. Dose, gr. ij-v. 
Formed by evaporating the following : — 

Liquor Ferri Citratis, Solution of Ferric Citrate, — an aqueous solution, containing 
about 2>S l /z P er cent, of the anhydrous salt, corresponding to about 7^ per cent, of 
metallic iron. Solution of Ferric Sulphate 105, Citric Acid 30, Ammonia Water 88, 
Water q. s. evaporated to 100. A dark-brown liquid, of acid reaction. Dose, TH v-xv. 

Vinum Ferri Citratis, Wine of Ferric Citrate, — Iron and Ammonium Citrate 4, 
Tincture of Sweet Orange Peel 15, Syrup 10, White Wine to 100. Dose, 3 j-ij. 

Ferri Hypophosphis, Ferric Hypophosphite, Fe 2 (H 2 P0 2 ) 6 , — a white or grayish-white 
powder, odorless, tasteless, slightly soluble in water, freely so in HC1 or in a solution 
of sodium citrate. Action, ferruginous tonic. Dose, gr. v-x. 

Ferri lodidum Saccharatum, Saccharated Ferrous Iodide, — a yellowish-white 
powder, very hygroscopic, odorless, of slightly acid reaction, soluble in 7 of water, 
insoluble in alcohol. Action, — ferruginous tonic. Dose, gr. v-xxv in pill or elixir. 

Pilulae Ferri Iodidi, Fills of Ferrous Iodide, — made with Reduced Iron, Iodine, 
Licorice, Sugar, Acacia and Water, covered with a coating of Balsam of Tolu in Ether. 
" Blancard's Pills" differ from these only in being covered with a coating of reduced 
iron to protect the interior from oxidation, but it also protects them from the solvent action 
of the gastric juice. Dose, I or 2 pills ter in die. 

Syrupus Ferri Iodidi, Syrup of Ferrous Iodide, — is a syrupy liquid containing 10 
per cent, of ferrous iodide. Action, — ferruginous tonic. Dose, TT^v-xxx. 

Ferri Lactas, Ferrous Lactate, Fe(C 3 H 5 3 ) 2 + 3H 2 0, — pale, greenish- white, crystal- 
line grains, soluble in 40 of water, freely in solution of an alkaline citrate yielding a 
green solution, almost insoluble in alcohol. Action that of a feeble ferruginous tonic. 
Is a constituent of Syrupus Hypophosphitum cum Ferro. Dose, gr. j-iij, in pill or syrup. 

Liquor Ferri Nitratis, Solution of Ferric Nitrate, — an aqueous solution of Fe 2 - 
(N0 3 ) 6 , containing about 6.2 per cent, of the anhydrous salt, corresponding to about 1. 4 
per cent, of metallic iron. A transparent, amber-colored liquid, of acid, styptic taste and 
acid reaction. Action, — medium as to irritation, astringent' and hemostatic. Dose, 
TT\v-xv, well diluted. 

Ferri Oxidum Hydratum, Ferric Hydrate {Ferric Hydroxide, Hydrated Oxide of 
Iron), Fe 2 (0H) 6 , a brown-red magma, wholly soluble in HC1 without effervescence. 
Should be freshly prepared by mixing together Solution of Ferric Sulphate 1 00, Ammonia 
Water no, and Water to 250. It is the chemical antidote for Arsenic. Dose, gj in 
water, frequently repeated. 

Ferri Oxidum Hydratum cum Magnesia, Ferric Hydrate with Magnesia {Arsenic 
Antidote), — is a more convenient and more efficient antidote for Arsenic than the preced- 
ing, as the excess of the alkaline precipitant is non-irritant, and is itself an Arsenic anti- 
dote. The two following solutions should be kept ready : (1) Solution of Ferric Sulphate 
50 cc. in Water 100 cc. (2) Magnesia, 10 grammes rubbed up with Water 750 cc. in 
a bottle of 1000 cc. capacity. When wanted, shake the latter to a homogeneous magma, 
add it gradually to the former, and shake them together to a uniform, smooth mixture. 
Should be given in large doses (,^j) and frequently repeated. 

Emplastrum Ferri, Iron Plaster {Strengthening Plaster), — has of Ferric Hydrate, 
dried, 9, Olive Oil 5, Burgundy Pitch 14, Lead Plaster 72. 

Trochisci Ferri, Troches of Iron, — each troche has of Ferric Hydrate gr. v, with 
Vanilla, Sugar and Tragacanth. Dose, j-iij troches, thrice daily. 

Ferri Phosphas Solubilis, Soluble Ferric Phosphate, — bright-green, transparent 
scales, of acidulous, saline taste, soluble in water, not in alcohol. Used as an adjuvant 
to laxative pills to prevent the after reactionary constipation. Dose, gr. v-x. 

Ferri Pyrophosphas . Solubilis, Soluble Ferric Pyrophosphate , — green, transparent 
scales, of acidulous taste, soluble in water but not in alcohol. Is almost tasteless and 
unirritating, and non-constipative. Dose, gr. ij-v. 

Ferri Sulphas, Ferrous Sulphate, FeS0 4 -f- 7H 2 0, — large, pale, bluish-green prisms", 



3l8 FERRUM. 

efflorescent, of saline, styptic taste, and acid reaction, soluble in 1.8 of water at 59 F. , 
insoluble in alcohol. Is chiefly used to make the Dried Sulphate and other preparations. 

Ferri Sulphas Exsiccatus, Dried Ferrous Sulphate, 2FeS0 4 + 3H 2 0, — a grayish- 
white powder, nearly soluble in water, consisting of the preceding salt, heated gradually 
until it ceases to lose weight. The most astringent and irritating ferrous salt, but an 
excellent one in small doses. Dose, gr. ss-ij, in pill. 

Ferri Sulphas Granulatus, Granulated Ferrous Sulphate, — is the same salt as 
above, precipitated by alcohol from solution in dilute sulphuric acid. Dose, gr. ss-ij. 

Liquor Ferri Subsulphatis, Solution of Ferric Subsulphale (MonseV s Solution), — 
is an aqueous solution of Basic Ferric Sulphate, containing 43.7 per cent, of the salt. A 
dark, reddish-brown, almost syrupy liquid, of very astringent but not caustic taste, and 
acid reaction, mixing with water or alcohol in all proportions without decomposition. Is 
but slightly irritating and powerfully astringent, chiefly used locally as an astringent and 
hemostatic, but may be given internally in doses of ff\hj-x, well diluted. 

Liquor Ferri Tersulphatis, Solution of Ferric Sulphate, — is an aqueous solution of 
Normal Ferric Sulphate, Fe 2 (S0 4 ) 3 , containing 28.7 per cent, of the salt. Has the same 
properties as described for the preceding. Used to make other preparations of Iron. 

Ferri Valerianas, Ferric Valerianate, Fe 2 (C 5 H 9 2 ) 6 , — a dark, tile-red, amorphous 
powder, of faint, valerianic odor, and mildly styptic taste, insoluble in cold water, de- 
composed by hot water, readily soluble in alcohol. Dose, gr. j-iij, in pill. 

Compound Iron Salts and their Preparations. 

Liquor Ferri et Ammonii Acetatis, Solution of Iron and Ammonium Acetate 
(Bashaw' s Mixture), — prepared from Tincture of Ferric Chloride 2, Diluted Acetic 
Acid 3, Solution of Ammonium Acetate 20, Aromatic Elixir 10, Glycerin 12, Water to 
100. An excellent and very pleasant preparation, having some diuretic and diaphoretic 
powers. Dose, gij-v, well diluted. 

Ferri et Ammonii Citras, Iron and Ammonium Citrate, — prepared from Solution 
of Ferric Citrate 10, Ammonia Water 4, mixed and evaporated. Transparent, garnet- 
red scales, deliquescent, readily soluble in water, insoluble in alcohol. Dose, gr. ij-v. 

Ferri et Ammonii Sulphas, Ferric Ammonutm Sulphate (Ammonio- ferric Alum), — 
pale, violet crystals, efflorescent, of styptic taste and slightly acid reaction, soluble in 3 
of water, insoluble in alcohol. Is the least astringent of the sulphates of iron, but more 
so than any of the salts formed by vegetable acids. Dose, gr. iij-xv. 

Ferri et Ammonii Tartras, Iron and Ammonium Tartrate (Ammonio -ferric Tar- 
trate), — transparent, reddish-brown scales, slightly deliquescent, of sweetish and slightly 
ferruginous taste, very soluble in water, insoluble in alcohol. Contains an equivalent of 
about 25 per cent, of Ferric Oxide, and has but slight irritant qualities. Dose, gr. v-xx. 

Ferri et Potassii Tartras, Potassio-ferric Tartrate, — transparent, garnet-red scales, 
slightly deliquescent, of sweetish and slightly ferruginous taste, very soluble in water, 
insoluble in alcohol. Is the least disagreeable in taste of all the iron preparations, and 
but slightly astringent and not constipating. Dose, gr. v-x. 

Ferri et Quininae Citras, Iron and Quinine Citrate, — prepared from Ferric Citrate 
85, Quinine, dried, 12, Citric Acid 3, Aq. Destil. q. s. ad. 100, mixed and evaporated. 
Thin, transparent, yellowish-brown scales, slowly deliquescent, of bitter taste, slowly sol- 
uble in water, slightly soluble in alcohol. Contains 1 1^ per cent, of dry quinine. Action, 
astringent and stimulant to the digestive tract. Dose, gr. iij-v. 

Ferri et Quininae Citras Solubilis, Soluble Iron and Quinine Citrate, — Ferric 
Citrate 85, Quinine, dried, 12, Citric Acid 3, Ammonia Water, Distilled Water, to 100. 
Thin, transparent scales, of greenish, golden-yellow color, rapidly soluble in cold water, 
partially soluble in alcohol. Dose, gr. iij-v. 

Vinum Ferri Amarum, Bitter Wine of Iron, — has of the preceding 5 parts, Tinct. 
Aurantii Dulcis 15, Syrup 30, White Wine to 100. Dose, 3J-iv. 

Ferri et Strychninae Citras, Iron and Strychnine Citrate, — Ferri et Ammonii Citras 
98, Strychninae I, Ac. Citric. I, Aq. Destil. 120, mixed and evaporated. Transparent, 
garnet-red scales, deliquescent, readily soluble in water, slightly so in alcohol. Contains 
1 per cent, of Strychnine. Action, — astringent and stimulating. Dose, gr. j-iij. 



FERRUM. 319 

Syrupus Ferri, Quininse et Strychninae Phosphatum, Syrup of the Phosphates of 
Iron, Quinine and Strychnine. [Described under Phosphorus.] 

Syrupus Hypophosphitum cum Ferro, Syrtip of Hypophosphites with Iron. [De- 
scribed under Phosphorus.] 

Unofficial Preparations of Iron. 

Ferratin, Acid Albuminate of Iron, — is a patented preparation, claimed to be the 
characteristic iron compound of the liver, but this is denied by competent authority. It 
is artificially prepared from albumin, is insoluble in water and dilute acids, but is soluble 
in water having a slight alkaline reaction. It causes no digestive disturbance, and has 
given good results in anemia, chlorosis, and allied affections. Dose, gr. jss-viij. 

Ferri Albuminas, Iron Albianinate, — a cinnamon-brown powder, soluble in water 
acidulated slightly with HC1. Dose, gr. x-xxx, in simple aqueous solution, or in pill. 

Ferri Arsenas, Ferrous Arsenate, Fe 3 As 2 8 , — a green, tasteless powder, insoluble in 
water, soluble in HC1. Its activity is due to the arsenic alone. Dose, gr. yo— ^. 

Ferri Bromidum, Ferrous Bromide, FeBr 2 -f- 3H 2 0, — a yellow salt, of styptic taste, 
unstable, deliquescent and very soluble. A syrup is official in the Br. Ph. which has 
about \Y Z grains of the bromide in each fluid-drachm. Dose of the syrup, ^ss-j. 

Ferrum Dialysatum, Dialyzed Iron, — composition varies from Fe 2 Cl 6 -j- l2Fe 2 3 to 
Fe 2 Cl 6 -f- 95Fe 2 3 , and is a 10 per cent, solution of Ferric Oxychloride in water. Pre- 
pared by treating a solution of Chloride of Iron with Ammonia, ferric hydrate being 
precipitated, this being dissolved by agitation is placed in a dialyzer and suspended in 
water, which is renewed as long as it shows a trace of HC1. A reddish-brown 
liquid, free from astringent, styptic taste, but a very feeble chalybeate. Is used as a 
chalybeate, and as an antidote to Arsenic, but is not considered an eligible preparation. 
Dose, TT\x-xxx. 

Ferri Malas, Ferrous Malate, — is a combination of the juice of sour apples and 
powdered iron, much esteemed in Germany, where it is official and is given in tincture, 
Tinctura Ferri Po??iatum (Ph. Ger.), the dose of which is TTLxv-xxx. 

Syrupus Ferri et Manganesii Iodidi, Syrup of Iron and Manganese Iodide, — is a 
pale, straw-colored liquid, containing a little sulphate of potassium, and in each fluid ^ 
has 50 grains of the mixed iodides in the proportion of Iron Iodide 3 parts to I of Man- 
ganese Iodide. Dose, rr^x-xxx-^j. 

Syrupus Ferri et Manganesii Phosphatis, Syrup of Iron and Manganese Phos- 
phate, — as used by Dr. Simpson, of Edinburgh, contains in each 5 of syrup 2 grains of 
Iron Phosphate and I grain of Manganese Phosphate. Dose, 3 j. 

Mistura Ferri Aromatica, Aromatic Iron Mixture, — Pale Bark 4, Calumba 2, 
Cloves I, Iron Wire 2, Tr. Cardamomi Co. 12, Tr. Aurantii Cort. 2, Aq. Menth. Pip. 50. 
Macerate the first 4 in the last one for 3 days, filter, add the tinctures and make up to 
50 parts. Dose, %']-\). 

Mistura Ferri Laxans. Laxative Iron Mixture, — Ferri Sulph. gr. ij, Magnesii 
Sulph. 5J, Ac. Sulph. Dil. rr\^iij, Spt. Chlorof. TT\xx, Aq. Menth. Pip. ad 3J. Dose, ^ j. 

Mistura Ferro-salina, Ferro-saline Mixture, — Magnesii Sulph. ^j, Potassii Bitart. 
3J, Ferri Sulph. Exsic. gr. x, Aquse quart j. Dose, a wineglassful. 

Notes on the Preparations. 
The blandest iron preparations are those which are insoluble or but 
sparingly soluble in water ; as — metallic iron, ferrous carbonate, ferric 
hydroxide, ferric hypophosphite and ferric valerianate. Of the aqueously 
soluble compounds, those which are salts of the vegetable acids, and the 
mixed salts ferric phosphate and ferric pyrophosphate, are more or 
less bland, especially the citrate, the tartrate and the phosphate, which 
are purely bland, the acetate and lactate comparatively so. The salts of 
the strong mineral acids are irritant and astringent or styptic in varying 



320 FERRUM. 

degree; the iodide and bromide being irritant but not very astringent, 
ferrous sulphate and the ammonio-ferric sulphate being powerfully astrin- 
gent but not styptic, and ferric chloride, ferric nitrate and both ferric 
sulphates being powerfully astringent and styptic. In overdoses the 
astringent salts are irritant poisons and may produce fatal results if in 
sufficient volume and concentration of solution. The per-salts (ferric) 
are the most actively irritant. The ferrous salts are the most readily 
absorbed and tolerated, are less irritant and astringent than the ferric 
salts, and are the most suitable ones for prolonged administration. 

The Oxides and Carbonates possess the hematinic action of iron with 
but slight astringency, and are therefore employed to restore the quality 
of the blood in cases of anemia, chlorosis and amenorrhea with tendency 
to dyspepsia and constipation. Ferrum Reductum is one of the best 
preparations for internal use, but it causes sulphuretted or phosphoretted 
eructations which are disagreeable. The Subcarbonate is little more than 
the red oxide, but in the massa ferri carbonatis oxidation is prevented by 
the sugar. The Hydrated Oxide is used only as an antidote in arsenical 
poisoning. 

The Vegetable Acid Salts are the least irritant to the stomach, but are 
also the least efficient as chalybeates. They may be administered in 
white wines, or with alkalies and vegetable acids in effervescent mixtures. 
The Mineral Acid Salts are characterized by their astringent and corru- 
gating action on the tissues, and are used locally as hemostatics, the solu- 
tion of the subsulphate being preferred for topical use as it is powerfully 
styptic but not corrosive. The pyrophosphate is easily assimilated, readily 
soluble and devoid of irritant qualities. The tincture of the chloride is 
one of the most efficient preparations for internal use, and is most agree- 
able in the form of Creuse's tasteless solution (see ante, p. 316). Other 
Compounds contain iron in combination with other active agents, as the 
preparations of the iodide and bromide, those with quinine, strychnine, 
etc. These preparations are generally used for a twofold purpose, 
namely — to relieve anemia and to act upon the specific ailment upon 
which the anemia depends, The Albuminate contains 5 per cent, of 
ferric oxide and is considered by many practitioners to be the most 
readily assimilated of all the iron preparations. 

Physiological Action. 
Metallic Iron is not inert, for in the stomach it acquires molecular ac- 
tivity through its oxidation. It is a normal constituent of the blood (1 
part to 230 of red corpuscles), and is also found in the bile, lymph, 
chyle, gastric juice, in the pigment of the eye, in the milk and in the 
urine. Occurring in the blood, the tissues generally and many of the 
healthy secretions, also in most of the foods upon which the body 



FERRUM. 321 

is nourished, it may be considered a food rather than a medicine, though 
it has many medicinal uses. Administered internally in small doses it 
acts as a stomachic and general tonic, promotes appetite and digestion 
and improves the quality of the blood, increasing the number of the 
red corpuscles. 

In large doses or in small ones long continued it is directly unfavorable 
to digestion, nausea and vomiting being caused by the soluble prepara- 
tions. Its per-salts are actively irritant, and some, as the iodide, 
chloride, nitrate and sulphate, are active poisons, highly astringent to the 
tissues and very injurious to the teeth. Locally the iron salts of the 
mineral acids are more or less constringent and irritant to the mucous 
membranes and the tissues, acting as astringents and hemostatics by 
virtue of their power to coagulate albumin. The tincture of the chloride 
is considered diuretic. 

Absorbable iron preparations administered to a healthy person, or for 
a long time in disease, exert but little influence, giving rise to but few 
and slight clinical symptoms. A sense of tension and fulness of the head, 
dull pains, discomfort, also a .hard and quickened pulse, constitute usu- 
ally the only obvious derangement. When given, however, to a person 
suffering from anemia or chlorosis the morbid symptoms expressive of 
deficient hemoglobin generally subside and the patient soon improves in 
health and strength. The action of iron is to cause an increase of the 
hemoglobin of the red blood corpuscles, either by its direct conversion 
into an ingredient of hemoglobin, or by stimulating the functional ac- 
tivity of the hematopoietic organs, or perhaps by both means combined. 
This power of enriching the red blood corpuscles in hemoglobin is essen- 
tially the whole constitutional action of iron. About 40 to 50 grains are 
estimated to be present in the tissues of a healthy adult, but only about 
-^ to \ of a grain is daily supplied by the ordinary dietary. This amount 
of intake is sufficient to preserve the iron equilibrium, about the same 
quantity being excreted daily, chiefly in the feces and to a slight extent 
in the urine. 

In the stomach all iron preparations are changed to the chloride by the 
HC1 of the gastric juice, and in the duodenum to an alkaline albuminate. 
The greater portion is carried on through the intestinal canal, where it is 
converted into a sulphide, which blackens the feces ; a part, however, 
being absorbed by the intestinal epithelium in solid form and perhaps in 
solution. After reaching the blood by way of the lymph channels, this 
small quantity of absorbed iron is deposited in the spleen, where it may 
undergo some changes, is again taken up by the blood and deposited in 
the liver and perhaps in the bone marrow. In the liver the originally 
inorganic iron is converted into higher forms and eventually into hemo-- 
globin, ferratin being probably one step in the series. When there is no 



322 FERRUM. 

deficiency of iron in the system the liver slowly yields its store to the 
blood again, to be carried to the cecum and large intestine, by the epi- 
thelium of which it is finally excreted. 

The doctrine of Kletzinsky, Bunge and others, concerning the non-ab- 
sorption of iron, though often shown to be erroneous, is occasionally 
resuscitated by writers and teachers of medicine. Briefly stated, this doc- 
trine is as follows : That the iron existing in food-stuffs as a constituent 
of nucleo-albumin is the only source of iron supply to the system for the 
formation of hemoglobin. That no iron compound administered by the 
stomach is absorbed, but after conversion to a chloride by the gastric 
juice the only function of iron so administered is to chemically satisfy the 
hydrogen sulphide and other sulphur compounds in the intestinal canal, 
thereby protecting the ingested food-iron from attack by these sulphur 
compounds and permitting it to enter the system. Against this theory 
have been urged the facts that no metal replaces iron in the treatment of 
chlorosis, though others would similarly satisfy the sulphur compounds ; 
that iron is curative in chlorosis when injected hypodermically, and that 
the sulphide administered so as to reach the intestines unchanged acts as 
well as other iron preparations. Furthermore, it has been shown that 
ordinary preparations of iron given internally are absorbed ; also that 
anemia is not necessarily accompanied by intestinal putrefaction ; while 
it has never been demonstrated that hydrogen sulphide is invariably present 
in the intestinal canal of chlorotic subjects. 

Incompatibles. 

Alkalies and their carbonates, Acids, acidulous salts, and vegetable Astringents are 
incompatible with most preparations of Iron, the latter group being so by virtue of their 
Tannic and Gallic Acids which form a deep blue-black precipitate (tannate of iron) 
with the per-salts. The Tincture of the Chloride is decomposed by alkalies, alkaline 
earths and their carbonates, astringent vegetable infusions, and by mucilage of acacia, 
the latter producing therewith a brown, semi-transparent jelly. 

Therapeutics. 
The chief indication for the internal administration of Iron is anemia, 
when plethora, hemorrhage or fever exist it is contraindicated. It should 
always be given after meals, and occasionally suspended for a time, to 
avoid deranging the stomach. It is generally considered useless to pre- 
scribe iron in any form until after constipation has been relieved and a 
regular action of the bowels established. When the appetite and digestion 
are improved by Iron it will do the greatest amount of good, many 
authorities holding that the principal benefit derived from its use, even 
in anemia, is due to its stimulating action upon digestion and the primary 
assimilation. The Sulphate is one of the most efficient salts and is well 
used in combination with Aloes when any intestinal torpor exists, espe- 
cially as it increases the cathartic power of the latter drug, economizing 



FICUS FCENICULUM. 323 

it, and conferring upon it a permanence of action, which alone it does 
not possess. In chlorosis, pseudo-leucocythemia, chorea of anemic girls 
at the age of puberty, epilepsy and neuralgia of the anemic, amenorrhea 
and other menstrual disorders of the same class of subjects, and in acute 
rheumatism of pale, cachectic persons, the chalybeates are generally very 
efficient remedies, especially the Tincture of the Chloride. The same 
preparation is extensively employed in erysipelas and diphtheria with 
good results, and in albuminuria with chronic disease of the kidneys it is 
a useful chalybeate diuretic. In many cardiac diseases of the anemic, 
fatty heart, weak heart, dilatation, mitral disease, etc., ferruginous prepa- 
rations are often of signal advantage. In the syphilitic cachexia, chan- 
croid, and sloughing phagedena, the Iodide gives good results, particu- 
larly when the subject is one of debilitated constitution. In the nocturnal 
incontinence of children the Syrup of the Iodide is one of the most effi- 
cient remedies. In all chronic affections of the respiratory organs, when 
hemorrhage is not existing or threatened, the Iron, Quinine and Strych- 
nine Phosphate is used with much benefit. In passive hemorrhages, 
especially when due to anemia, the Tincture of the Chloride is very effec- 
tive, and in all active bleeding the Solution of the Subsulphate locally 
used is a prompt and efficient hemostatic. A weak solution of the latter 
preparation (3J ad £viij), used in the form of spray, is the most serviceable 
astringent in obstinate epistaxis, and in hematemesis the same solution 
may be swallowed in small quantities at short intervals. In chronic 
diarrhea and dysentery the Solution of the Nitrate is an efficient astringent, 
and a weak solution of the Chloride is used as a rectal injection in tropical 
dysentery and against thread-worms. The Sulphate is much employed as 
a cheap disinfectant for sewage, its action being to precipitate the pro- 
teids, which carry down the bacteria mechanically. The Hydrated 
Oxide is the most effective antidote in arsenical poisoning, as it forms 
with arsenous acid an almost insoluble compound. The solutions used 
in its preparations should be kept on hand and mixed only when wanted 
for use. 

FICUS, Fig, — is the fleshy receptacle of Ficus Carica, bearing fruit upon its inner 
surface. The fig-tree is a member of the nat. ord. Urticaceae and a native of the shores 
of the Levant, but is cultivated in Southern Europe and in other warm countries. Figs 
contain about 62 per cent, of grape sugar, also gum, fat, etc., and are a constituent of the 
official Confectio Senna. 

Figs are demulcent, laxative and nutritious. They are used in their fresh state as an 
aliment, but if eaten in quantity may produce flatulence, enteralgia and diarrhea. They 
are chiefly used as an article of diet in habitual constipation, but may be employed as an 
ingredient of demulcent decoctions, and locally as a poultice to gum-boils. 

FCENICULUM, Fennel, — is the fruit of Fozniculum capillaceum, a European 
cultivated plant of the nat. ord. Umbelliferae. It contains a volatile oil, united with a' 
terpene, and is a constituent of Pulvis Glycyrrhizoe Compositus. 



324 FORMALIN — FRANGULA. 

Oleum Fceniculi, Oil of Fennel, — the volatile oil, a light yellow-colored liquid, 
having the odor of fennel, a warm taste and neutral reaction, soluble in alcohol. It is 
an ingredient of Spiritus Juniperi Compositus. Dose, TT\.ij-v. 

Aqua Fceniculi, Fennel Water, — contains 2 parts of the oil in 1000 of distilled water. 
Dose, gss-^j. 

Fennel is an aromatic .stomachic and a mild stimulant. It is chiefly used as an agree- 
able carminative in flatulence and colic, and as a corrigent to Senna, Rhubarb, and other 
disagreeable medicines. An infusion is often used as an enema to expel flatus in infants. 



FORMALIN (Unofficial), — is the proprietary name given by its 
patentees to a 40 per cent, aqueous solution of Formic Aldehyde or For- 
maldehyde (see ante ^ page 130), which solution has heretofore been used 
mainly as a preservative of meat and in histological work as a fixing agent. 
It is one of the most powerful germicides, equal if not superior to corrosive 
sublimate and practically non-toxic in the strength employed. It is also 
a most energetic disinfectant, and sprayed over floors and walls or dropped 
on hot plates or sheets of metal, will disinfect a room more effectually 
than any other agent. As a deodorant it is equally efficient, completely 
destroying the peculiar methyl-mercaptan odor of the feces, and entirely 
deodorizing sulphuretted hydrogen. It is rapidly becoming the favorite 
surgical antiseptic. It mixes with water in all proportions, so that any 
dilution required can be easily prepared. To make a 1 per cent, solution 
one part of Formalin is added to forty parts of water (1 oz. to 2^ pints), 
it being itself a 40 per cent, solution. Solutions of 1 per cent, strength 
are sufficiently strong for most purposes, and when sprayed above the 
patient's head by a steam-atomizer for 20 minutes thrice daily have proved 
highly efficient in whooping-cough and chronic bronchitis. Weaker 
solutions {y 2 per cent.) are used as gargles and mouthwashes and for the 
irrigation of cavities, and stronger ones (2^ per cent.) for psoriasis, 
lupus and other skin diseases. Solutions of 1 part in 2,000 or 3,000 
are highly recommended by Dr. Davidson for local application in the 
septic abrasions of the cornea ending in hypopyon ulcers, which form so 
large a part of ophthalmological work in manufacturing communities. 
Formalin has a tannin-like effect upon the skin, producing a leathery 
condition which passes into that of a localized necrosis without suppu- 
ration, leaving the surface with the appearance of a newly-healed super- 
ficial wound. It has marked toxic properties when inhaled in quantity, 
and the vapor is very irritating to the eyes and the throat. Amyloform, 
Dextroform and Glutol, are compounds of Formaldehyde with starch, 
dextrin and gelatin respectively, and have been used as antiseptic dressings. 

FRANGULA, Buckthorn, — the bark, collected at least one year before being used, 
of Rhamnus Frangula, or Alder Buckthorn, a European shrub of the nat. ord. Rhamneae. 
It contains several principles, of which the only important one is Frangulin, or Rhamno- 
xanthin, a lemon-yellow, odorless and tasteless glucoside, insoluble in water and but 
sparingly so in alcohol or ether, and thought to be identical with Cathartin, the active 



FUSCHIN GAULTHERIA. 325 

principle of Senna. Another species of the genus Rhamnus is described under the title 
Rhamnus Purshiana. 

Extractum Frangulae Fluidum, Fluid Extract of Frangula. — Dose, ^ss-ij. 

Frangula-bark when fresh is a -violent irritant to the gastro-intestinal tract, producing 
vomiting, purging, and much pain. The old dried bark is a safe purgative without irri- 
tant qualities, and is much used in the constipation of pregnancy, and other conditions 
requiring purgation. The fluid extract is the best form for administration. 

FUSCHIN, Roseine, Magenta, Anilin Red (Unofficial), — is the Hydrochlorate of 
Rosanilin, C 20 H 10 N 3 -f- HC1, occurring in brilliant, elongated crystals having a green lustre, 
readily soluble in water and therewith making a bright red solution. Given internally it 
has produced salivation, vomiting, and diarrhea ; and when injected intravenously it has 
caused trembling, staggering, albuminuria and fatty degeneration of the kidneys, symptoms 
which are thought to be possibly due to the presence of Arsenic or Anilin as impurities. 
It imparts a magenta color to the urine, and is excreted by the kidneys, liver and salivary 
glands. It has been found to be very efficient in reducing albuminuria, in many instances 
having entirely arrested it. It is best administered in pill with a vegetable extract as 
Liquorice or Gentian, and in doses of gr. %— iv, according to age. 

FUCUS VESICULOSUS, Bladder-wrack, Sea-wrack (Unofficial),— is a peren- 
nial plant of the nat. ord. Algae, growing on the shores of the Atlantic and Pacific Oceans 
as a sea- weed. It has a flat leaf, with a midrib throughout its length, and small spherical 
vesicles, filled with air, in the leaf. It contains mucilage and much Soda in saline com- 
bination, also Iodine, but less of the latter than other algae growing in deeper water. A 
decoction of the fresh plant is the best form for administration. 

Fucus Vesiculosus is one of a number of marine plants which are used in various parts 
of the world as food for man and cattle and as manure. The species under consideration 
is considered alterative and tonic, and has been employed in goitre, glandular and joint 
enlargements and psoriasis, but especially to produce absorption of adipose tissue in the 
obese. An extract is sold under the title "Anti-fat." 

GALBANUM (Unofficial), — is a gum-resin obtained from Ferula ga/banifua, an 
Asiatic plant of the nat. ord. Umbelliferae, and probably from other allied plants. It 
occurs in minute tears, agglutinated into a hard mass, of balsamic odor and acrid, bitter 
taste. It contains a Volatile Oil isomeric with Turpentine, a Gum, and a mixture of 
Resins which yield by dry distillation a blue oil and Umbelliferon, a tasteless substance 
in satiny crystals. Dose, gr. x-xx, in pill or emulsion. 

Galbanum is stimulant, expectorant and antispasmodic, acting much like Ammonia 
and Asafetida, and usually given with either of these substances. It is used in chronic 
bronchitis and catarrh of mucous membranes generally, in amenorrhea and chronic rheu- 
matism. 

GALLA, Nutgall, — is an excrescence on Quercus lusitanica, the Dyer's Oak, a 
shrub of the nat. ord. Cupuliferae, growing in Western Asia, and is caused by the punc- 
ture and deposited ova of the insect Cynips Gallce tinctorice. Galls are hard, globular 
bodies, of blackish-gray color, tuberculated on the surface, having a central cavity and 
an intensely astringent taste. They contain from 15 to 75 per cent, of Tannic Acid, 
about 5 per cent, of Gallic Acid, and other unimportant constituents. Dose, gr. v-xv. 

Tinctura Gallae, Tincture of Nutgall, — strength 20 per cent. Dose, £ss-iij. 

Unguentum Gallae, Nutgall Ointment, — strength 10 per cent. 

The action of Nutgalls is powerfully astringent, due to the Tannic and Gallic Acids 
contained in them. Having no special action or use of their own, their qualities maybe 
learned by consulting the articles Acidcjm TANNICUM and AciDUM Gallicum. 

GAULTHERIA, Wintergreen (Unofficial) ,— is the leaf of Gaultheria procumbens, 
an American evergreen plant of the nat. ord. Ericaceae. Its active principle isthe^Wtf- 
tile Oil, which is official. It also contains Tannic Acid, Arbutin, Ursone, Ericolin, etc.. 

Oleum Gaultheriae, Oil of Wintergreen, — is the volatile oil, a liquid of peculiar and 
aromatic odor, sweetish, warm taste, and a slightly acid reaction. It is readily soluble 



326 GELSEMIUM. 

in alcohol, and consists of Methyl Salicylate 90 per cent. , and Gaultherilene, a hydrocar- 
bon, 10 per cent. Dose, TT\nj-x. It is nearly identical with the Volatile Oil of Betula. 

Spiritus Gaultheriae, Spirit of Gaultheria, — has of the oil 5 per cent., dissolved in 
95 of alcohol. Used for flavoring. Dose, gss-ij. 

Gaultheria is stimulant and slightly astringent. Its chief value is as one of the sources 
of the oil named after it, which is also found in the sweet birch and many other plants, 
and, containing so large a proportion of Methyl Salicylate or Methyl salicylic Acid, is 
powerfully antiseptic and antipyretic. In large doses it is irritant to the stomach, in one 
case ^j having caused death by violent gastritis. 

Oil of Gaultheria is used successfully as a substitute for Salicylic Acid in many condi- 
tions, especially in rheumatic and gouty disorders. The plant has been used as an 
emmenagogue and a galactagogue, but its principal employment is in the form of the 
spirit as an agreeable flavoring agent. 



GELSEMIUM, Gelsemium, Yellow Jasmine, — is the rhizome and 
roots of Gelsemium sempervirens, a climbing plant of the nat. ord. Logani- 
acese, with showy yellow flowers, which grows in the forests of the south- 
ern U. S., forming festoons from one tree to another. It contains a 
volatile oil, a resin and an alkaloid, Gelsemine, in combination with 
Gelsemic Acid. Dose, gr. ij-xx. 

Preparations. 

Extractum Gelsemii Fluidum, Fluid Extract of G else muim. — Dose, rtyj-xx. 

Tinctura Gelsemii, Tinctitre of Gelsemium , — strength 15 percent. Dose, tt\x-3 j. 

Gelsemina, Gelsemine, C n H 19 N0 2 (Unofficial), — an amorphous, colorless, inodorous, 
nearly insoluble solid, of intensely bitter taste, and strong basic properties, neutralizing 
the strongest acids, and with them forming soluble salts. Dose, gr. -%q—£q. 

Physiological Action. 

Gelsemium is a powerful motor-depressant, causing paralysis of motility 
and depression of sensibility by central action on the spinal cord. It is 
also antispasmodic and diaphoretic. In moderate doses it produces 
languor, slowing of the cardiac rate, enfeebled muscular action, impaired 
sensibility, drooped eyelids and dilated pupils, with some diaphoresis. 
In toxic dose, as a teaspoonful of the fluid extract, it produces vertigo, 
diplopia, drooped eyelids and dilated pupils (paralysis of 3d nerve), 
labored respiration, slow and feeble heart, dropped jaw, staggering gait, 
extreme muscular weakness and almost complete anesthesia, profuse dia- 
phoresis, loss of articulation, and death by asphyxia from paralysis of the 
muscles of respiration, consciousness being preserved until C0 2 narcosis 
sets in. Convulsions, with backward movements, occur in animals but 
not in man. Motion is affected before sensibility in warm-blooded ani- 
mals, sensibility before motion in frogs. 

Gelsemium is not an arterial depressant, although it lowers the heart- 
rate, and is not irritant to the gastro-intestinal tract, but it produces a 
decided lowering of the body-temperature. The effects of a moderate 
dose pass off in about three hours. 



/ 



GENTIANA. 327 

Antagonists and Incompatibles. 

Morphine is the most complete antagonist, so are also Digitalis, Ammonia, Alcohol, 
and to some extent the tincture of Xanthoxylum fraxineum. Emetics, heat, faradization 
of the respiratory muscles and artificial respiration are measures of prime importance. 
The caustic Alkalies and Tannic Acid are chemically incompatible. 

Therapeutics. 

Gelsemium is indicated in all conditions of exalted nerve function, 
and contra-indicated whenever there is a weak heart. It is best used in 
cerebro-spinal meningitis, mania with great motor excitement and persis- 
tent insomnia, delirium tremens, many forms of sleeplessness, pneumonia 
and pleurisy if the heart be strong, coughs of convulsive and spasmodic 
character, neuralgia of the fifth nerve, remittent fever, after-pains, ovarian 
neuralgia, dysmenorrhea, irritable bladder of women, and incontinence 
of urine from spasm of the vesical muscular fibres. In most of these 
affections the remedy must be pushed to the inducing of some physio- 
logical symptoms, but its action should not be carried beyond the pro- 
duction of drooped eyelids, diplopia and muscular debility. It has been 
used with varying success in intercostal neuralgia, myalgia, sciatica, spas- 
modic asthma, sick headache, eczema, pruritus and tetanus. Its especial 
field, however, is in remittent and typho-malarial fevers and cerebro-spinal 
meningitis. It is not suitable to low fevers and has not sufficient power 
as a cardiac depressant to be of much use in sthenic forms. 

There is much evidence for the claim, made for the alkaloid Gelsemine, 
of singular efficiency in antagonizing the mental condition occasionally 
manifested by an unusual degree of dread, in regard to some approaching 
ordeal, or ordinary trial of life ; as, for example, that of a woman con- 
cerning her impending confinement, or of a student in reference to his 
examinations. In very many such cases, the use of Gelsemine, in small 
doses frequently repeated (gr. -j-J-q ter die), has seemed to remove the 
state of abnormal fear entirely. 

GENTIANA, Gentian,— is the root of Gentiana lutea, the Yellow 
Gentian, one of a numerous family of plants (nat. ord. Gentianeae), 
growing in the mountainous districts of Europe. An American species, 
G. Catesbcei, Blue Gentian, is considered nearly equal in value to the 
official species. It contains an active, bitter glucoside, Gentopicrin or 
Ge?itianin, C 20 H 30 O 12 , which is crystalline and soluble in water, also an 
inert, amorphous body, Geniianic or Geniesic Acid, gum, considerable 
sugar, and a trace of volatile oil, but no tannin. 

Preparations. 
Extractum Gentianae, Extract of Gentian, — aqueous. Dose, gr. j-v. 
Extractum Gentianae Fluidum, Fluid Extract of Gentian, — Dose, gss-j. 



328 GERANIUM GLYCERINUM. 

Tinctura Gentianae Composita, Compound Tincture of Gentian, — Gentian io, 
Bitter Orange Peel 4, Cardamon I, Alcohol and Water to 100. Dose, gss-ij. 

Unofficial Preparations. 

Infusum Gentianae Compositum, Co?npound Infusion of Gentian, — contains Gen- 
tian 10, Bitter Orange Peel 2^, Coriander 2^, Alcohol 40, Water to 320. Dose, 

Mistura Gentianae Alkalina, Alkaline Mixture of Gentian, — Ac. Hydrocyan. Dil. 
Ttyij, Sodii Bicarb, gr. xv, Infusum Gentianae Co. to ^j. One dose. 

Mistura Gentianae et Sennae, Mixture of Gentian and Senna, — Infusum Sennse 
giij, Tr. Cardamomi Co. sjj, Infusum Gentianae Co. sjyj. One dose. 

Physiological Action and Therapeutics. 
Gentian is a simple bitter without astringency or aroma, its action cor- 
responding to that of Calumba, but it is more apt to disagree with the 
stomach. In addition, like Cornus, a member of the same class, it has 
considerable repute as an antiperiodic and febrifuge. Gentian has been 
considered a valuable tonic throughout Europe from the earliest historical 
times. It is highly esteemed as a stomachic tonic in dyspepsia connected 
with the gouty diathesis, in hysteria, jaundice, and convalescence from 
acute diseases and from malarial fever. The compound tincture is an 
excellent vehicle for cod-liver oil, and the infusion is a good vehicle 
for the administration of chalybeates, mineral acids and neutral salts. 
The discoloration which iron salts make with gentian preparations is 
probably due to gentesic acid and not to tannin, as it contains none of 
the latter. 

GERANIUM, Cranesbill, — is the rhizome of the indigenous perennial Geranium 
maculatum (nat. ord. Geraniaceae). Its active constituents are tannic and gallic acids. 

Extractum Geranii Fluidum, Fluid Extract of Geranium. — Dose, TT\,v-^j. 

Geranium is an efficient astringent, and its action corresponds with that of Tannic 
Acid. Having no unpleasant taste it is a useful agent for infants and others having deli- 
cate stomachs, and is a very popular domestic remedy in many parts of the country. It 
is especially used in diarrheas, dysentery, cholera infantum, hemorrhages, relaxed con- 
ditions of mucous membranes, gleet and leucorrhea. 

GLYCERINUM, Glycerin, — is a liquid obtained by the decom- 
position of vegetable or animal fats or fixed oils, containing not less than 
95 per cent, of absolute Glycerin, C 3 H 5 (HO) 3 , which is a Trihydric 
Alcohol existing in fats and fixed oils in combination with the fatty acids. 

Glycerin is a clear and colorless liquid, of syrupy consistence, hygroscopic, non drying, 
odorless, of warm and very sweet taste, neutral reaction, sp. gr. 1.250, soluble in water 
and in alcohol, insoluble in ether, chloroform and fixed oils. It dissolves Tannin, 
Gallic Acid, Carbolic Acid, Salicylic Acid, Bromine, Iodine, etc., and with the aid of 
heat metallic salts and oxides, alkaloids, etc. With strong Nitric Acid it forms Nitro- 
glycerin, and it reduces Potassium Permanganate, Chromic Acid and Chlorinated Lime 
with great violence. An impurity frequently present in it is Acrolein, formed by the use 
of too high a degree of heat in its manufacture, and which is very acrid and poisonous. 
Glycerin is a constituent of the 6 Glycerites, Pilulae Phosphori, Mucilago Tragacanthae, 
Massa Hydrargyri, and several extracts and fluid extracts. Dose, gj-ij, diluted. 



GLYCERINUM. 329 

Preparations. 

Suppositoria Glycerini, Suppositories of Glycerin, — each has Sodium Carbonate 
grains 4j^, Stearic Acid grains 7^, dissolved by heat in 90 grains of Glycerin, cooled 
in a mould, and wrapped in tin-foil. Used per rectum in chronic constipation. 

Glycerites of Carbolic Acid, Tannic Acid, Starch, Boroglycerin, Hydrastis, Yolk of 
Egg, — are described under the titles of their respective ingredients. 

Glycozone (Unofficial), — is described under Oxygenium. 

Physiological Action and Therapeutics. 
Glycerin is highly antiseptic, abstracts water from tissues with which it 
comes in contact, and unless pure is often very irritating to the skin. It 
is freely absorbed by the cutaneous and mucous surfaces, and is decom- 
posed in the system, passing out as. formic and other acids. On the 
stomach it has no particular action, but in large quantities it is laxative 
and is said to cause the solution of the red blood corpuscles and hemo- 
globinuria. The urine of persons using glycerin contains a body which 
acts like sugar in the copper and fermentation tests, but is not sugar. 
Glycerin is a good emollient and is considered nutritive by many authori- 
ties. It has been used as a substitute for cod-liver oil in wasting diseases, 
but with little benefit. It has also been tried as a remedy in diabetes, 
but with unsatisfactory results so far as reported, except as a sweetening 
substitute for sugar in the dietary of those afflicted with that disease. It is 
said to be fatal to intestinal trichinae, and to be an efficient internal remedy 
in acne and flatulence. In chronic constipation, most excellent results are 
obtained from rectal enemata of Glycerin, or from the official supposi- 
tories thereof. As a vehicle it is used for many drugs, and- is a good 
ingredient of solutions for hypodermic use, promoting the solubility of 
many alkaloids and acting as an antiseptic. It is also employed to pre- 
serve and aid the action of the digestive ferments, Pepsin and Pancreatin, 
as well as to prevent the decomposition of vaccine lymph. Locally it is 
valuable in many cutaneous affections as an emollient and softening 
agent. In acute coryza it gives great relief if applied by a brush or as a 
spray to the nasal mucous membrane. It is used on cotton to the cervix 
uteri as a depleting agent, and mixed with an infusion of flaxseed as an 
enema to relieve tenesmus in acute dysentery. With tincture of Benzoin 
it is an excellent application to chapped hands or lips and fissured 
nipples. In the external auditory canal it is usefully employed to soften 
cerumen, diminish the secretion of pus, deplete the tissues, and keep the 
surface moist. 

Unna's Paste (Unofficial), — is a mixture of equal parts of glycerin and mucilage of 
acacia, with which are incorporated various substances, such as zinc oxide, mercuric 
oxide, etc. 

Unna's Paint (Unofficial), — has of Glycerin 10, Gelatin 4, Zinc Oxide 4, and 
Water 10, incorporated together to form a white mixture, which when cold resembles 
white rubber. It is applied on gauze bandages for chronic ulcers, sprains and eczematous' 
patches with induration. The glycerin has a dehydrating effect upon edematous tissues, 



330 GLYCYRRHIZA. 

the gelatin forms the basis of the paint and imparts elasticity to the finished dressing. 
The zinc oxide is soothing to the skin, especially when the dressing is applied to a chronic 
eczema. 

Antiphlogistine (Unofficial), — is the trade name of a preparation very similar to 
Unna's Paint, and stated by its manufacturers to be " composed of Glycerin, Boric Acid, 
Salicylic Acid, Iron Carbonate, Peppermint, Gaultheria, Eucalyptus and Iodine, com- 
bined with the base de-hydrated Oxide of the Silicate of Alumina and Magnesia ; which 
combination results in a chemical compound possessing antiseptic, anodyne, nutrient and 
antiphlogistic properties." It is used as a dressing or poultice applied to the surface of 
the body for inflammatory conditions of the skin, muscles and joints, also in pneumonia, 
pleurisy, peritonitis, acute rheumatism, etc., with the object of abstracting water from 
the tissues and thereby relieving tension ; and in cases of deep-seated inflammation to 
produce a superficial hyperemia and thus relieve the affected part. 

GLYCYRRHIZA, Glycyrrhiza, Liquorice Root— is the root of 
Glycyrrhiza glabra, var. glandulifera, a plant of the nat. ord. Legumi- 
nosae, native in southern Europe and Asia, but largely cultivated in many- 
other parts. It contains a yellow, amorphous glucoside, Glycyrrhizin, 
C 24 H 36 9 , also Glycyrrhizic Acid, Asparagin, sugar, resin, gum, etc. 
Glycyrrhizin when boiled with dilute acids yields glucose and a very bitter 
substance named Glycyrrheiin. 

Preparations. 

Extractum Glycyrrhizae, Extract of Glycyrrhiza, — is the commercial extract of the 
root, occurring in glossy-black rolls, of sweet, peculiar taste. Not less than 60 per cent, 
of it should be soluble in cold water. 

Extractum Glycyrrhizae Purum, Pure Extract of Glycyrrhiza, — made with Aqua 
Ammonise and Water, by percolation and evaporation. Dose, indefinite. 

Extractum Glycyrrhizae Fluidum, Fluid Extract of Glycyrrhiza, — made with 
Aqua Ammoniae and diluted Alcohol. Dose, indefinite. 

Mistura Glycyrrhizae Composita, Compound Mixture of Glycyrrhiza, Brown 
Mixture, — has of the Pure Extract 3 parts, Syrup 5, Acacia 3, Tr. Opii Camph. 12, 
Vinum Antimonii 6, Spt. yEtheris Nitrosi 3, and Water to 100. Dose, ^j- Jj. 

Pulvis Glycyrrhizae Compositus, Compound Liquorice Powder, — Senna 18, Glycyr- 
rhiza 23^, Oil of Fennel 4, Washed Sulphur 8, Sugar 50 parts. Dose, £j. 

Trochisci Glycyrrhizae et Opii, Troches of Glycyrrhiza and Opium, — each has of 
Extract of Glycyrrhiza gr. ij, Powdered Opium gr. T X g , Acacia, Sugar and Oil of Anise. 
Dose, j-ij every hour. 

Glycyrrhizinum Ammoniatum, Ammoniated Glycyrrhizin, — the sweet principle of 
Liquorice rendered soluble by Ammonia and therefore tasteable, believed to be the form 
in which Glycyrrhizin exists in the root. Occurs in brownish-red scales, very sweet, 
and soluble in water or in alcohol. Dose, gr. v-xv. Is a constituent of Velatine, for 
which see page 276. 

Physiological Action and Therapeutics. 
Liquorice is demulcent and mildly laxative. It has an agreeable taste, 
and increases the flow of saliva and mucus when slowly chewed or sucked, 
the increased secretions acting as emollients to the throat. It is used in 
many pharmaceutical preparations, covering the taste of senna, senega, 
hyoscyamus, turpentine, ammonium chloride, the bitter sulphates, and to 
some degree the bitterness of quinine. The powdered extract or root is 
used as an excipient in pills and troches. The compound mixture is an 



GOSSYPIUM. 331 

efficient expectorant, much employed in acute bronchitis and catarrhal 
laryngitis, but owing its power over cough mainly to the opium contained 
in it. The compound powder is a gentle laxative, of which senna is the 
most active ingredient. The troches are used for cough, but must be 
carefully prescribed for children, as each troche contains gr. -^ of pow- 
dered opium. 

GOSSYPIUM, Cotton, — is the hairs of the seed of Gossypium 
herbaceum, and of other species of Gossypium (nat. ord. Malvaceae), freed 
from adhering impurities and deprived of fatty matter. In this form it is 
official as Gossypium Purificatum, Purified Cotton, Absorbent Cotton, 
insoluble in ordinary solvents, but soluble in copper-ammonium-sulphate 
solution. Cotton-fibre is familiar in appearance to every one, but when 
examined microscopically it shows as flattened, hollow and twisted bands, 
spirally striate, and slightly thickened at the edges. It is a modification 
of Cellulose, C 12 H 10 O 10 , and corresponds therewith in all its ordinary 
chemical properties. 

Preparations of the Cotton Plant. 

Gossypii Radicis Cortex, Cotton Root Bark, — thin bands or quilled pieces, brownish- 
yellow exteriorly, white interiorly, of slightly acrid and astringent taste. Dose, gr. xxx-^j. 

Extractum Gossypii Radicis Fluidum, Fluid Extract of Cotton Root Bark, — made 
with Glycerin and Alcohol, by maceration and percolation. Dose, Tr^xxx-gj. 

Oleum Gossypii Seminis, Cotton-seed Oil, — the fixed oil expressed from the seeds 
and purified. Is yellow, odorless, of bland taste and neutral reaction, soluble in ether, 
but slightly soluble in alcohol. Is introduced into the pharmacopoeia for the reason that 
it constitutes most of the "Olive Oil" sold in foreign-shaped bottles and under foreign - 
appearing labels. It is used in the official Liniments of Ammonia and Camphor. 

Pyroxylinum, Pyroxylin, Soluble Gun-cotton, Colloxylin, — is official for the purpose 
of making Collodium. It is prepared by macerating Cotton in a mixture of Sulphuric 
and Nitric Acids, washing, draining and drying. 

Collodium, Collodion, — made by dissolving Pyroxylin 3, in Ether 75 and Alcohol 25. 

Collodium Flexile, Flexible Collodion, — Collodion 92, Canada Turpentine 5, Castor 
Oil 3, mixed thoroughly. 

Collodium Stypticum, Styptic Collodion, — Ether 25, Alcohol 5, Tannic Acid 20, 
Collodion to 100. 

Collodium Cantharidatum, Cantharidal Collodion, Blistering Collodion, — Canthar- 
ides 60, Flexible Collodion 85, Chloroform q. s. to 100. 

Physiological Action and Therapeutics. 
Cotton-root is believed to be an efficient emmenagogue and oxytocic 
by Southern practitioners, also somewhat of a galactagogue, but experi- 
ments on pregnant animals have not confirmed this view of its action. 
The Oil of the seed is very bland and may be applied to all the purposes 
for which olive oil is used. Cotton itself, when freed from oily matter, 
is remarkably absorbent of water, and is a good agent for excluding air 
from injured surfaces. Pyroxylin is highly inflammable, and explosive 
at 300 F. Collodion is also inflammable, and rapidly dries on exposure 



332 GRANATUM. 

to the atmosphere by evaporation of its ether, leaving a transparent film 
of Pyroxylin on the surface to which it has been applied ; which film, if 
the flexible collodion be used, does not contract on drying or readily 
crack, making it an excellent protective application. Styptic Collodion 
is a solution of Tannin, and is an excellent hemostatic. Cantharidal 
Collodion is a convenient blistering agent, suitable for cases where the 
patient is inclined to remove a blister if applied in the ordinary way. 

Absorbent Cotton is a valuable agent in surgical practice, being em- 
ployed as an application in burns and scalds, erysipelas, articular rheuma- 
tism, etc., to exclude the atmosphere, allay pain, and when covered with 
oiled silk or rubber cloth to keep up local perspiration. It may be car- 
bolated, borated or salicylated, by soaking in the respective solutions, 
and is then used as an antiseptic dressing for wounds, ulcers, etc. It is 
employed by the pharmacist in funnels to filter oils, and for the prepara- 
tion of the official waters. 

Cotton-root bark is much employed by the negroes of the Southern 
States in decoction as a supposed abortifacient, oxytocic and emmena- 
gogue. It is used in the South for intensifying uterine action in normal 
labor, also in dysmenorrhea and amenorrhea. A decoction, §iv in a 
quart of water boiled to a pint, is the favorite preparation, administered 
in wineglassful doses. 

Collodion is used as a protective covering for superficial burns, ulcers 
and wounds, slight cuts, cracked nipples, anal fissures, and erysipelas. 
For these affections the flexible collodion should be used, but where it is 
desirable to produce pressure on the part the ordinary form is best, as it 
contracts with considerable force in drying. This property makes it 
highly useful in drawing the edges of wounds together, bringing pressure 
on buboes, incipient boils, carbuncles, etc. Styptic Collodion has many 
uses as a hemostatic and protective which will suggest themselves, and the 
cantharidal form is a convenient epispastic for uneven surfaces, the thera- 
peutics of which are detailed under Cantharis. 

GRANATUM, Pomegranate, — is the bark of the stem and root 
of Punica Granatum, a small tree of the nat. ord. Lithrariese, cultivated 
in subtropical countries. It contains Tannic and Punico-tannic Acids, 
Mannite and an active liquid alkaloid Pelletierine, C 8 H 13 NO, which is 
soluble in water, alcohol, ether, chloroform, etc., and has strong basic 
properties. There are no official preparations. 

Unofficial Preparations. 
Extractum Granati Fluidum, Fluid Extract of Pomegranate. — Dose, ^ss-jss. 
Decoctum Granati, Decoction of Pomegranate, — gxvij of bark from the fresh root 
in ^xvij of boiling water, boiled down to ^xij and strained. Dose, 3iv-vj every hour, 



GRINDELIA. 333 

preceded and followed in a few hours by a brisk cathartic. The decoction of the Br. 
Phar. is of I to io strength and is given in doses of ^ss-ij. 

Pelletierinae Tannas, Pelletierine Tannate. — Dose, gr. v-x, taken fasting and fol- 
lowed in 15 minutes by a sharp purgative, as Castor Oil. 

Physiological Action and Therapeutics. 
Granatum and its alkaloid are teniafuge, and very efficiently so, rarely 
failing to bring away the whole worm. The decoction is usually em- 
ployed, but latterly Pelletierine has been coming into fashion, a proprietary 
form being sold as Tanrefs Pelletierine in bottles containing one adult 
dose at three dollars each. The decoction in full doses causes nausea and 
vomiting, flatulence, purging, and sometimes cramps in the legs, giddi- 
ness, dimness of vision, general numbness of the limbs and increase of the 
quantity of urine. 

For the expulsion of tape-worm a mixed treatment by Pomegranate-root bark, Pump- 
kin seeds and Oleoresin of Male-fern is preferred by many practitioners. The following 
formula has proved very efficient, rjc . Granati ^ij, Aquas Ojss, boiled to ^ vij ; Pep- 
inis ^j, deprived of outer coats and beaten to a paste with fine powdered sugar ; Oleo- 
resinae Aspidii, gr. xxx, made into emulsion with Acacia and the above decoction of 
Granatum, then added to the paste of Pepo, and flavored with Syrups up to ^ ix. One- 
third of this to be taken in the morning after a light diet and a laxative on the previous 
day. If not successful the second and third portions may be taken at intervals of 3 hours. 
The worm should be passed sitting in a tepid sitz-bath, to prevent the expelled portion 
tearing off the head by its weight. 



GRINDELIA, — is the leaves and flowering tops of Grindelia robtista, 
and of Grindelia squarrosa, herbaceous perennial plants of the nat. ord. 
Compositae, indigenous to the Pacific slope of the United States and 
Mexico, where they are common along the coast and in the mountains, 
having yellow flowers, a balsamic odor and a pungent, aromatic and bitter 
taste. They contain a resin, which is probably the active constituent, a 
fixed and a volatile oil, also Robustic Acid and an alkaline principle 
named Grindeline. There is but one official preparation. 

Extractum Grindeliae Fluidum, Fluid Extract of Grindelia, — is alcoholic and con- 
tains much resin. Dose, Tr^x-^j or more, every 3 or 4 hours, in sweetened water or 
milk, the mixture being well stirred to prevent the resin adhering to the glass. 

Physiological Action and Therapeutics. 
Grindelia has an acrid, bitter taste, and excites the secretion of saliva 
when chewed. Its principal action is that of an antispasmodic, but it is 
also a motor-depressant, somewhat expectorant and decidedly diuretic. 
Given in large doses to small animals it induces paralysis, beginning in 
the hind extremities and affecting the sensory nerve-trunks first, then the 
sensory side of the spinal cord, afterwards involving the motor nerve- 
trunks, and finally the spinal motor tract. It stimulates the cardiac in- 
hibitory apparatus and the vaso-motor centre, slowing the heart and 



334 GUAIACUM. 

respiration, and raising the blood-pressure. In sufficient quantity it 
causes dilatation of the pupils, reduced cutaneous sensibility and sluggish 
reflexes, even narcotism in small animals. Its elimination occurs by the 
bronchial mucous membrane and the kidneys, both of which it stimulates, 
and in large doses it has produced renal irritation. 

Grindelia is chiefly employed as a palliative in spasmodic asthma and 
the dyspnea accompanying bronchitis. In several cases of recurring 
asthma in elderly persons ^ss of the fluid extract has afforded almost in- 
stantaneous relief, but has not prevented the return of the paroxysms. 
It is an efficient remedy in chronic bronchitis, especially that of the aged, 
also in whooping-cough and other spasmodic coughs, in hay fever and in 
the dyspnea of various pulmonary and cardiac affections, and has been 
employed with benefit in chronic cystitis. Locally, it is used with advan- 
tage as a lotion for the dressing of burns and blisters, in vaginitis and 
uterine catarrh, and to allay the pain of herpes zoster. In the proportion 
of i part of the fluid extract to 9 of water, as a sedative lotion, it is a very 
efficient application for the cutaneous irritation due to poison-oak or ivy, 
also in skin diseases attended with itching and burning sensations. 



GUAIACUM, Lignum Vitae, — is official in two forms, — Guaiaci 
Lignum, the heart-wood of Guaiacum officinale and of Guaiacum sanctum, 
and Guaiaci Resina, Guaiac, the resin of the wood of Guaiacum officinale , 
a large West Indian tree of the nat. ord. Zygophylleae. The Resin is 
the important constituent, and itself consists of three resins, namely, 
Guaiaconic Acid, C 19 H 20 O 5 , 70 per cent., Guaiac Acid, C 6 H 8 3 , resem- 
bling Benzoic Acid, and Guaiarec Acid, C 20 H 26 O 4 ; also an indifferent 
resin. The wood also contains a yellow coloring matter, gum, etc., and 
yields, by destructive distillation, Guaiacol (see ante, page 291). 

Guaiaci Lignum, Guaiacum Wood, — generally used in the form of 
raspings, of a greenish-brown color, resinous odor, taste slightly acrid. 
Is a constituent of Decoctum Sarsaparillae Compositum. 

Guaiaci Resina, Guaiac, — occurs in large masses of a greenish-brown 
or reddish-brown color, fracture having a glassy lustre, insoluble in water, 
soluble in alcohol, ether, chloroform and alkaline fluids. Dose, gr. 
v-xxx, in wafer. Is a constituent of Pil. Antimonii Compositse. 

Preparations. 

Tinctura Guaiaci, Tincture of Guaiac, — 20 per cent. Dose, rr\v-3 j, in mucilage 
or syrups, as the resin is precipitated by water. 

Tinctura Guaiaci Ammoniata, Ammoniated Tincture of Guaiac, — bas of Guaiac 
20, Aromatic Spirit of Ammonia to 100. Dose, TTLx-^ss. 



GUARANA GURJUN BALSAM. 335 

Physiological Action and Therapeutics. 
Guaiac is diaphoretic, expectorant and alterative ; also laxative and 
purgative, according to the dose administered. Its taste is acrid and 
very disagreeable. Internally it is a local stimulant, producing salivation, 
an acrid sensation in the throat, warmth in the epigastrium, increase of 
the gastric and intestinal secretions and the flow of bile, and reflex stimu- 
lation of the heart. Its continued use causes gastric catarrh, and in large 
doses it is a gastro-intestinal irritant, causing vomiting, purging and 
severe congestive headache. Though a colloidal body it enters the blood, 
stimulates the liver and other excretory glands and the production of 
bronchial mucus, and causes increased circulation and diaphoresis. 
Sometimes it fails to act on the skin and then it is markedly diuretic. 

Mineral Acids and Spirit of Nitrous Ether are chemically incompatible with Guaiac 
preparations. 

Guaiac was first used as an antisyphilitic, being employed in decoc- 
tion and in large quantity, with a spare diet and external warmth. It 
acquired a great reputation in that disease during the 16th century, but 
it is now abandoned therefor except as an ingredient of the Compound 
Decoction of Sarsaparilla. It is a very efficient remedy in tonsillitis, 
given in gss doses of the tincture in emulsion with mucilage or yolk of 
egg, to abate the inflammation and abort the disease. It has considerable 
reputation in neuralgic dysmenorrhea, amenorrhea, chronic rheumatism, 
gout, lumbago and sciatica. The ammoniated tincture in water makes a 
cleanly and not very disagreeable gargle. The effectiveness of Guaiac in 
many chronic and obscure complaints is due, partly to its purgative prop- 
erty and partly to its nastiness, a quality which is highly appreciated by 
many patients. 

GUARANA, — is a dried paste consisting chiefly of the crushed or pounded seeds of 
Paullinia Cupana, a climbing plant of the nat. ord. Sapindaceae, growing in Brazil. It 
occurs in brown cakes or sticks, having an odor of chocolate, and a bitter, astringent 
taste, partly soluble in water and in alcohol. It contains 25 per cent, of tannic acid, 
gum, albumin, starch, and a greenish fixed oil, also an alkaloid Guaranine (5 percent.), 
which is thought to be identical with Caffeine. The specimens of Guarana in the market 
are very untrustworthy, unequal in quality and expensive, it being a secret mixture pre- 
pared in Brazil. Hence it has been omitted from the list of Squibb's preparations, a 
fluid extract of green coffee being substituted in its place. 

Extractum Guaranae Fluidum, Fluid Extract of Guarana, — Dose, TTLx-^ij. 

Guarana has similar actions to those of Coffee, the active principles of both plants 
being perhaps identical, both chemically and physiologically. It is chiefly employed in 
the treatment of nervous sick-headache (migraine) administered in half-drachm doses of 
the fluid extract when the attack is developing. It has been used in the diarrhea of 
phthisis, in convalescence from acute diseases, and generally in conditions requiring tonic 
treatment. 

GURJUN BALSAM, Balsamum Dipterocarpi, Wood Oil (Unofficial),— is an - 
oleoresin obtained from incisions in various trees of the genus Dipterocarpus, growing in 



336 H.EMATOXYLON HAMAMELIS. 

India. It is thick, opaque and grayish-brown by reflected light, soluble in chloroform 
and partly so in alcohol, ether and volatile oils, odor balsamic, taste bitter. It contains 
from 40 to 70 per cent, of a Volatile Oil, a Resin and Gurjunic Acid. Dose, mjc-^ij, 
in emulsion, or in capsules. 

The properties of this balsam are similar to those of Copaiba, but it is less disagreeable 
and less apt to upset the stomach, also less actively diuretic. It has been used with good 
success in leprosy, given internally in full doses and used locally at the same time. Mixed 
with 4 parts of Lime-water it is well applied in chronic eczema, lupus and psoriasis. 

H^MATOXYLON, Log-wood, — is the heart- wood of Hcematoxylon campe- 
chianum, a tree of the nat. ord. Leguminosae, native of tropical America, but naturalized 
in the West Indies. It occurs in chips or powder of a dark brown-red color, often with 
a greenish lustre, and colors the saliva a dark pink when chewed. It contains Tannic 
Acid, and a sweet, crystalline coloring principle named Hce?naloxylon, C 10 H 14 O 6 , which 
is colorless when pure, but turns red on exposure to light. 

Extractum Haematoxyli, Extract of Hcematoxylon, — Dose, gr. v-xx. 

Decoctum Haematoxyli, (Unofficial), — strength I in 17. Dose, ^j-ij. 

Logwood is mildly astringent, its properties depending on the Tannin contained in it. 
As it is devoid of irritating qualities it is well adapted to the diarrheas and hemorrhages 
of young children. It does not produce constipation or disorder the bowels, but colors 
the urine and stools blood-red, and has caused phlebitis. It has been used as a hemo- 
static in bleeding of the lungs, and in hemorrhages from the uterus and intestines, also as 
an astringent injection in leucorrhea. 



HAMAMELIS, Witch-hazel, — the leaves, collected in autumn, of 
Hamamelis virginiana, a shrub of the nat. ord. Hamamelaceae, growing 
in the United States. They contain about 8 per cent, of Tannic Acid, a 
bitter principle and probably some volatile matters, but the chemistry of 
the plant has not been fully studied. 

Preparations. 

Extractum Hamamelidis Fluidum, Fluid Extract of Hamamelis. — Dose, TTy-gj. 
It is the only official preparation, and is prepared from the leaves. 

Hamamelin (Unofficial), — is an uncertain extract of very indefinite composition. 
Dose, gr. j-ij. 

Distilled Extracts, so-called, but really Waters distilled from the bark, are sold by 
various manufacturers, and are said by the vendors to contain the volatile principles of 
the plant. Pond's Extract is such a preparation, said to be made by distilling the 
bark with a very dilute alcohol, and is a proprietary medicine of uncertain composition. 

No trustworthy experimentation has yet been made with this drug. It 
is tonic, astringent, styptic and sedative, owing most of its properties to 
its tannin, but appears to possess some special influence over the venous 
circulation similar to that of Aconite on the arterial system. In full 
doses it may produce severe throbbing pain in the head. It is used both 
internally and locally with great benefit in hemorrhoids, particularly 
those of the bleeding variety, varicose veins and ulcers, varicocele, venous 
congestions and threatening local inflammations. It is highly recom- 
mended in hemorrhages from the nose, stomach, lungs, rectum and kid- 
neys, in threatened abortion, and externally for sprains and bruises, foul 
ulcers, the pruritus of eczema, also in leucorrhea and gonorrhea. An 



HEDEOMA HELLEBORUS. 337 

ointment of Witch-hazel is found in the shops, and suppositories may be 
prepared extemporaneously by evaporating the fluid extract and incorpo- 
rating the residue with cacao-butter. 

HEDEOMA, Pennyroyal, — the leaves and tops of Hedeoma pulegioides, a plant of 
the nat. ord. Labiate, common to all parts of the U. S. Its only important constituent 
is the Volatile Oil, which is official. 

Oleum Hedeomae, Oil of Pennyroyal, — is the volatile oil, readily soluble in alcohol. 
Dose, rryj-x. 

Spiritus Hedeomae, Spirit of Pennyroyal (Unofficial), — contains I part of the oil in 
9 of alcohol. Used externally or as a spray. 

Hedeoma is a stimulant aromatic, also somewhat carminative and emmenagogue. Its 
odor is extremely repulsive to insects, especially fleas and mosquitoes. In warm infusion 
it is a popular remedy for amenorrhea and flatulent colic. It may be used as a corrective 
with other medicines, and the spirit is well employed on the hands and face to keep away 
mosquitoes. The writer has known death by narcosis to result from an overdose of the 
oil self-taken to produce an abortion. 



HELLEBORUS, Hellebore (Unofficial),— the rhizome and root- 
lets of Helleborus niger (Black Hellebore) and Hellebotus viridis (Green 
Hellebore), plants of the nat. ord. Ranunculaceae, natives of Europe. A 
third variety, Helleborus occidentalis, growing in Greece, is probably the 
true Hellebore of the ancients. Its most important constituents are two 
glucosides, Helleborin and Helleborein, both crystalline and poisonous. 

Unofficial Preparations. 
Extractum Hellebori Nigri, Extract of Black Hellebore. — Dose, gr. j-x cautiously. 
Extractum Hellebori Nigri Fluidum, Fluid Extr. of Black H. — Dose, n^ij-xv. 
Helleborin, C 36 H 42 6 , — insoluble in water, soluble in alcohol and in chloroform. 
Helleborein, C 26 H 44 15 , — crystalline, very soluble in water, slightly so in alcohol, in- 



Physiological Action and Therapeutics. 

Black Hellebore is a drastic, hydragogue cathartic, and an emmen- 
agogue. In overdoses it is a violent gastro-intestinal irritant, producing 
vomiting, hypercatharsis, vertigo, cramps and convulsions, which may 
result fatally. Locally applied, the fresh root is violently irritant to the 
skin, producing inflammation and vesication. 

Helleborin is an active poison, acting on the tongue like Aconite, and 
on the nervous system as a narcotic, producing in animals paresis of 
motion and sensation, cerebral and spinal Congestion, dilated pupils and 
death. It is less irritant than Helleborein to the mucous membranes. 

Helleborein is less actively toxic to animals, but is very irritant, pro- 
ducing conjunctivitis, sneezing, salivation, nausea, vomiting and purging. 
It affects the heart like Digitalis, small doses frequently repeated slowing- 
its action, but large ones quicken it and then suddenly paralyze it through 



338 HOANG-NAN— HUMULUS. 

the pneumogastric nerve. Respiration is at first accelerated, then slowed 
and rendered laborious. Diuresis is a constant result, the kidneys and 
uterus are congested, gradual paralysis and severe convulsions follow, and 
death occurs by paralysis of the heart. 

Black Hellebore is an old remedy, having been highly esteemed by 
the early physicians in insanity, dropsies, worms, cutaneous affections and 
amenorrhea. It has gone out of fashion, but might be usefully employed 
in dropsies and as a revulsant in acute cerebral affections. Helleborein 
has come into notice as a substitute for Digitalis in cardiac affections, 
being of less bulk and more definite composition. Its action on the 
heart is attained by doses much smaller than those necessary to produce 
its irritant effects on the gastro-intestinal canal. Its solubility in water 
and the freedom with which it can be used hypodermically are important 
qualities to recommend it. 

HOANG-NAN, or Hwang-Nao (Unofficial), — is the bark of Strychnos Gauthe- 
riana, Tropical Bind-weed, a creeping vine of the nat. ord. Loganiaceas, found in the 
mountains of Tonquin. It contains the alkaloids Strychnine and Brucine, thus resem- 
bling in composition its congeners Nux- Vomica and Ignatia, but differing from them, as 
they do from each other, in the proportional quantities in which the alkaloids are con- 
tained, — Brucine predominating in this plant, as Strychnine does in the other two. 

Like the other members of the Strychnos family, Hoang-Nan is an active tetanizer, its 
action generally corresponding to that of Nux-Vomica. It was first brought into notice 
by the missionary fathers stationed in the French colonies in Asia, they having found its 
employment general among the natives for leprosy and hydrophobia. Along the coast of 
Tonquin and Cochin-China, and in Pondicherry, Trinidad, Venezuela, etc. , it has an 
established reputation in the two terrible diseases mentioned, also as a remedy for the 
bites of venomous serpents and other reptiles, scrofulous and syphilitic ulcers, indolent 
sores, etc. It has been used successfully for malarial fevers, in lieu of quinine, and is 
highly spoken of by Father Brosse, as a stimulant to the intellect, without producing any 
subsequent depression. 

The dose of the powdered drug is about gr. iij-v ; of the aceto-alcoholic Extract, gr. 
V%-Vt 5 an d °f tae concentrated Tincture, H\j-v. 



HUMULUS, Hops, — the strobiles (fruit-cones) of Humulus Lupu- 
lus, a cultivated creeping plant of the nat. ord. Urticaceas. Its constitu- 
ents are wax, resins (50 per cent.), tannin (5 per cent.), a liquid volatile 
alkaloid named Lupuline, a Volatile Oil (2 per cent.) which consists in 
part of Valerol and Trimethylamine, and the crystalline, bitter principle, 
Lupulinic Acid (11 per cent.). These, except tannin, are more abundant 
in the glandular powder of the strobiles, which is named Lupulin. 

Preparations. 

Tinctura Humuli, Tincture of Hops, — strength 20 per cent. Dose, ^j-ij. 

Infusum Humuli, Infusion of Hops (Unofficial), — ^ss to the pint. Dose, ^j-iv. 

Lupulinum, Lupulin, — is the glandular powder separated from the strobiles, of 
bright, brownish-yellow color, aromatic and bitter taste. The Volatile Oil resides in the 
Lupulin grains, and contains Valerol, which is changed into Valerianic Acid by long ex- 
posure, giving a disagreeable odor to old hops. Dose, gr. v-xv. 



HYDRANGEA HYDRARGYRUM. 339 

Extractum Lupulini Fluidum, Fl. Ext. of Lupulin, — alcoholic. Dose, rr^x-gj. 
Oleoresina Lupulini, Oleoresin of Lupulin, — an ethereal extract. Dose, gr. ij-v. 
Tinctura Lupulini, Tincture of Lupulin (Unofficial), — strength y&. Dose, gss-ij. 
Mineral acids and metallic salts are chemically incompatible with preparations of Hops. 

Humulus is a bitter tonic, and a feeble hypnotic, also somewhat dia- 
phoretic, astringent and anaphrodisiac. It increases the cardiac action 
and the cutaneous circulation. After slight cerebral excitement it pro- 
duces calm and a soporific disposition, especially if the solution adminis- 
tered be strongly alcoholic. The. stomachic and tonic effects are due to 
the bitter principle, Lupulinic Acid, and are found in bitter ale. The 
primary stimulant and secondary sedative effects are due to the volatile 
oil and are also possessed by ales and beer. 

Hops are used as a tonic and calmative in delirium tremens, in which 
a combination of the tincture with tincture of capsicum is very efficient 
and is an excellent substitute for alcohol. In dyspepsia of atonic form 
Humulus is an excellent stomachic tonic, and in nervous irritability the 
fluid extract of Lupulin may be used as a calmative and hypnotic, or the 
hop-pillow, which certainly exercises considerable influence, imaginary 
or otherwise. A poultice of hops is a favorite domestic application in 
inflammations and pain. Lupulin has been used with benefit in irritable 
bladder and alcoholism, and as an anaphrodisiac in the treatment of 
chordee, gonorrhea, spermatorrhea and other affections of the genito- 
urinary organs. 

HYDRANGEA (Unofficial), — is the root of Hydrangea arborescens, a plant of the 
nat. ord. Saxifragacese, growing in the southeastern U. S. It is a white, tough root, 
containing gum, albumin, starch, resin, and a ferrous salt, with other salts. Dose, 
3 ss— 3; ij , best in fluid extract. A decoction of the root may be prepared and used in 
doses of ^j-ij. 

Hydrangea has been long used by the Cherokee Indians in calculous affections, and 
reports of cases by competent observers show that it is of unquestionable utility in this 
class of disorders, promoting the removal of gravel from the bladder, and relieving pain 
during the passage of renal concretions through the ureters. Large doses produce ver- 
tigo, oppression of the chest, and considerable cerebral disturbance. 

HYDRARGYRUM, Mercury, Quicksilver, Hg,— is a shining, 
silver-white metal, fluid and slowly volatile at ordinary temperatures, 
solidifies at — 39 F., boils at 675 F., volatilizes without residue, in- 
soluble in ordinary solvents, wholly soluble in nitric acid, odorless and 
tasteless, sp. gr. 13.558 at 59 F. 

Preparations of Mercury. 

Hydrargyrum cum Creta, Mercury with Chalk {Gray Powder), — has of Mercury 
38, Honey 10, Prepared Chalk 57, Water q. s. shaken and triturated together and dried 
to 100, then reduced to a uniform gray powder. Dose, gr. ss-x. 

Massa Hydrargyri, Mass of Mercury {Blue Mass, Blue Pill),— -has of Mercury 33, 
Liquorice 5, Althaea 25, Glycerin 3, Honey of Rose 34. Each grain contains gr. y z of 
Mercury. Dose, gr. ss-x. 



340 HYDRARGYRUM. 

Unguentum Hydrargyri, Mercurial Ointment {Blue Ointment), — Mercury 50, Lard 
25, Suet 23, Oleate of Mercury 2, triturated together, until globules of Mercury cease to 
be visible under a lens having a magnifying power of ten diameters. 

Emplastrum Hydrargyri, Mercurial Plaster, — Mercury 30, Oleate of Mercury 1.2, 
Lead Plaster to 100. 

Emplastrum Ammoniaci cum Hydrargyro, Ammoniac Plaster with Mercury, — 
see ante, page 144. 

Chlorides and their Preparations. 

Hydrargyri Chloridum Corrosivum, Corrosive Mercuric Chloride {Bichloride of 
Mercury, Corrosive Sublimate), HgCl 2 , — heavy, colorless crystals, of acrid, metallic taste, 
and acid reaction ; soluble in 16 of water and in 3 of alcohol, in 2 of boiling water, 1.2 
of boiling alcohol, 4 of ether and in about 14 of glycerin. Dose, gr. gVrV 

Hydrargyri Chloridum Mite, Mild Mercurous Chloride {Subchloride of Mercury, 
Calomel) , Hg 2 Cl 2 , — a heavy, white, impalpable powder, odorless and tasteless ; insoluble 
in water, alcohol or ether. Is an ingredient of Pil. Antimonii Co. and Pil. Catharticse 
Co. Dose, gr. 2V -X - The dose depends on the effect desired. 

Hydrargyrum Ammoniatum, A?nmoniated Mercury { White Precipitate, Mercuric 
Ammonium Chloride), NH 2 HgCl, — is a white, insoluble powder, odorless and tasteless. 
Only used externally. 

Unguentum Hydrargyri Ammoniati, Ointment of Ammoniated Mercury ( White 
Precipitate Ointment), — Ammoniated Mercury 10, Benzoinated Lard, 90 parts. 

Oxides and their Preparations. 

Hydrargyri Oxidum Flavum, Yellow Mercuric Oxide, HgO, — an orange-yellow, 
heavy, impalpable powder, odorless and tasteless, insoluble in water or alcohol, but 
wholly soluble in nitric or hydrochloric acid. Used to prepare : — 

Unguentum Hydrargyri Oxidi Flavi, Ointment of Yellow Mercuric Oxide, — 
strength I to 9 of Ointment (Unguentum). 

Oleatum Hydrargyri, Oleate of Mercury, — has of the Yellow Oxide 20, Oleic 
Acid 80 parts. 

Hydrargyri Oxidum Rubrum, Red Merairic Oxide [Red Precipitate), HgO, — a 
heavy, orange-red, crystalline powder, having the same properties as the yellow oxide, 
from which it differs only in being crystalline, and in not so minute a state of sub- 
division. Dose, gr. ^"tV 

Unguentum Hydrargyri Oxidi Rubri, Ointment of Red Mercuric Oxide, — strength 
I to 8^ of Unguentum and ^ of Castor Oil. 

Iodides and their Preparations. 

Hydrargyri Iodidum Rubrum, Red Mercuric Iodide, Red Iodide (Biniodide) of 
Mercury, Hgl 2 , — a scarlet-red, crystalline powder, almost insoluble in water, soluble in 
130 of alcohol, in solution of Potassium Iodide or of Mercuric Chloride. Prepared by 
double decomposition between Potassium Iodide 5, and Mercuric Chloride 4 parts. 
Dose, gr. ^-iV 

Liquor Arsenii et Hydrargyri lodidi, Solution of Arsenic and Mercuric Iodide 
[Donovan 1 s Solution), — see ante, page 199. 

Hydrargyri Iodidum Flavum, Yellow Mercurous Iodide (Protiodide of Mercury), 
Hg 2 I 2 , — a dull green or greenish-yellow powder, insoluble in alcohol or ether and almost 



Acid Combinations and their Preparations. 

Liquor Hydrargyri Nitratis, Solution of Ale r curie Nitrate, — a liquid containing in 
solution about 60 per cent, of Mercuric Nitrate, Hg(N0 3 ) 2 , with about II per cent, of 
free Nitric Acid. Prepared from the Red Mercuric Oxide 40, by Nitric Acid 45, and 
Distilled Water 15. Used as a caustic. 

Unguentum Hydrargyri Nitratis, Ointment of Merctu'ic Nitrate {Citrine Oint- 
ment), — Mercury 7 dissolved in Nitric Acid 7^, adding Lard Oil 76. 



HYDRARGYRUM. 34 I 

Hydrargyri Subsulphas Flavus, Yellow Mercuric Subsulphate [Basic Mercuric 
Sulphate, Turpeth Mineral), Hg(HgO) 2 S0 4 , — a heavy, lemon-yellow powder, practically 
insoluble in water or alcohol, soluble in nitric acid, and in io of HC1 without residue. 
Dose, as an emetic, gr. ij-v. 

Cyanide. 

Hydrargyri Cyanidum, Mercuric Cyanide, Hg(CN) 2 , — colorless crystals, of metallic 
taste, soluble in 12.8 of water and in 15 of alcohol. Dose, gr. x^-yq. 

Triturations. 

These may be prepared according to the general formula under the title TRITURA- 
TIONES in the Pharmacopoeia, 10 parts of the substance to 90 of Sugar of Milk. Mer- 
cury itself or any of its salts may be so treated with excellent results, the particles being 
much finer and therefore more easily absorbed than if rubbed up with another agent. 

Unofficial Preparations. 

Lotio Hydrargyri Flava, Yellow Wash, — prepared by adding Corrosive Sublimate 
gr. xviij to Lime-water ^x, producing the yellow oxide ; a favorite application for syph- 
ilitic sores. 

Lotio Hydrargyri Nigra, Black Wash, prepared by adding Calomel gr. xxx, to 
Lime-water ^ x, producing the black oxide, and used as an application to syphilitic sores. 

Unguentum Hydrargyri Nitratis Rubrum, — Red Ointi?ient of Mercuric Nitrate 
[Brown Citrine Ointment), — differs from the official ointment only in being made with 
Cod-liver Oil, which gives it a brown color, and a more agreeable odor. 

Physiological Action. 
Mercury is tonic, purgative, alterative, antiphlogistic and sorbefacient, 
and indirectly cholagogue. Some of its salts are corrosive poisons, others 
are local caustics, all produce by long-continued administration the 
peculiar cachexia termed Hydrargyrism. The metal itself is inert, but 
by combination with the acids and fluids of the body it becomes active, 
and is easily absorbed in any form_, passing into the blood from the skin, 
mucous membranes, lungs and stomach, in each case probably as an oxy- 
albuminate of mercury. Entering the stomach in any form it is first 
converted into a double chloride of sodium and mercury, then uniting 
with the albuminous juices to form a complex molecule of mercury, 
sodium, chlorine and albumin, which being soluble in an excess of sodium 
chloride or albumin, exists in solution and is easily absorbed, then being 
decomposed in the blood and changed to the oxyalbuminate. Entering 
the intestines a purgative action is soon set up, of more or less severity 
according to the preparation used, a small portion only is absorbed, the 
rest being converted into a sulphide and excreted with the feces, unless 
combined with Opium, which delays its progress through the intestines 
and permits of its freer absorption. On the blood its effects in small 
doses are tonic, but in quantity it indirectly produces impoverishment 
thereof, impairs the ozonizing function, diminishes the red corpuscles, 
and consequently disorders nutrition and deranges digestion. From the 
blood it enters the tissues, where it remains for an indefinite period, exert-, 
ing a peculiar influence, termed "alterative," on all processes character- 



34 2 HYDRARGYRUM. 

ized by growth of young cells, but not producing any definite anatomical 
changes either in the viscera or the nervous tissue, though in the latter a 
low form of inflammation arises, resulting in loss of coordination-power. 
It stimulates most of the glands of the body to the production of patho- 
logical secretions, especially the salivary glands and the pancreas, and is 
excreted with comparative slowness by all the excretory organs, being 
found in the saliva, sweat, milk, urine and bile. It tends to accumulate 
in the liver, while stimulating its cells, and is not a direct cholagogue, 
though stimulating the flow of bile already secreted by reflex action on 
the bile-ducts due to its purgation of the duodenum. Its excretion is 
hastened and completed by the use of Potassium Iodide. 

In small doses administered for a short time the mercurial preparations 
are blood-tonics, improving the general condition, increasing the number 
of red corpuscles and the body-weight. They soon begin to promote 
waste by stimulating the lymphatic system, and if the small doses are long 
continued or the quantity is increased, symptoms of mercurial poisoning 
begin to manifest themselves. 

The first symptoms of Hydrargyrism are fetid breath, swollen and 
spongy gums having a bluish line along their margins, stomatitis, sore and 
loosened teeth, inflamed and tender salivary glands pouring out a peculiar, 
thin saliva of foul odor in large quantity, and a metallic taste in the mouth. 
Anorexia, diarrhea and fever follow, also ulceration and in some cases 
even gangrene of the lips and tongue. If the use of the drug be con- 
tinued nutrition will be greatly impaired through the extreme promotion 
of retrograde metamorphosis, and various nervous disturbances will follow, 
the effects being emaciation, pallor, edema, ulcerated skin, erythematous, 
vesicular or pustular eruptions, headache, insomnia, neuralgia, tremor 
through paresis of the muscles of the head and extremities, epilepsy, coma 
and convulsions. In pregnant women abortion will occur by reason of 
the impoverishment of the blood. Indeed, as Dr. Ringer said in the 
earlier editions of his Handbook of Therapeutics, the phenomena produced 
by mercury are singularly similar to those which will result from syphilis, 
and the serious symptoms known as secondary and tertiary syphilis can 
be produced both by syphilis and by mercury. The drug is a specific 
antagonist to the syphilitic virus, probably by reason of its affecting the 
same organs and tissues of the body on a similar line of action, both 
poisons mutually destroying each other in the organism. It is certainly 
capable of bringing about a radical cure of syphilis, if introduced into 
the system in considerable quantity and its use protracted over a very long 
time, the action of the drug in all cases being kept short of ptyalism or 
any pronounced physiological effects. 

The observations on the antiphlogistic and sorbefacient actions of 
Mercury are clinical rather than physiological, but it is generally agreed 



HYDRARGYRUM. 343 

that exhibited in inflammation mercurials antagonize the increase of the 
hemic fibrin which is so constant an effect of the inflammatory process, 
and that in chronic diseases attended by the formation of semi-organized 
deposits, a mild mercurial course will almost insensibly remove the new- 
formed material. 

Salivation is most readily produced by blue mass, next by calomel, and 
less easily by gray powder. Individuals differ greatly in their suscepti- 
bility to the action of mercury, some persons having been affected after 
a single moderate dose. Children are not easily salivated. Inhalation 
of mercurial vapors is most apt to affect the nervous system ; the internal 
administration and that by inunction are more likely to produce saliva- 
tion. A not uncommon result of full doses of blue pill is an acute coryza 
of very severe character, which the writer has frequently observed to 
follow on neglect of the old-fashioned precaution to " work off" the mer- 
curial by a saline cathartic. The symptoms produced are those of a severe 
attack of influenza, — epistaxis, conjunctivitis and obstinate muco-puru- 
lent discharge from the nasal passages being especially marked. Similar 
effects have been observed during physiological experiments with mercury 
on animals by Overbeck and Bennett. 

Notes on the Action of the Preparations. 

Metallic Mercury is not used internally except in the finely divided 
form obtained in blue pill and gray powder, which are capable of pro- 
ducing the effects previously described. Mercurial Ointment is the prepa- 
ration generally used for inunction, a piece the size of a small nut being 
daily rubbed into the soft skin at the flexures of joints. The Oleate painted 
over the surface is a more cleanly method of making the same application. 
Both these preparations are efficient parasiticides. 

The Bichloride is the most actively toxic of the mercurial salts. It is 
probably the most active zymoticide and parasiticide, a solution of i part 
in 2,000 being efficiently antiseptic for use as injections or dressings, and 
a solution of 1 in 250 being the usual strength for use against epizoa and 
in parasitic skin affections. It is a very active gastro-intestinal irritant, in 
toxic dose producing nausea, retching and vomiting, a metallic taste, con- 
striction of the fauces, burning pain in the stomach, suppression of urine, 
bloody diarrhea, collapse and death often preceded by convulsions. It 
affects specifically the lower bowel [Calomel preferring the upper intes- 
tine], and produces inflammation and ulceration of the rectum. It is, 
however, one of the most manageable and efficient of the mercurials when 
used in proper doses. 

The Subchloride (Calomel) is very insoluble and unirritating, tasteless, 
laxative in grain doses, decomposed by the alkaline contents of the intes- 
tines, oxide of mercury being formed, and acts especially on the excre- 



344 HYDRARGYRUM. 

mentitious glandular appendages of the upper intestine, stimulating the 
liver by indirect reflex action as a duodenal purgative. In the presence 
of alkaline chlorides it is converted into the bichloride, but not in suf- 
ficient quantity to render it dangerous in the gastro-intestinal canal. 
Externally applied it is very sedative to the mucous membranes and the 
skin. It is a very efficient diuretic, in small doses frequently repeated. 
Ammoniated Mercury is an Ammonio-Chloride, and a useful stimulant 
and parasiticide when used locally in the form of ointment. 

The Iodides are actively poisonous, the Red being much the most irri- 
tant, in overdoses producing symptoms and results very similar to those 
caused by the bichloride. The Cyanide is also actively poisonous. The 
Yellow Subsulphate is a prompt and usually harmless emetic, but has occa- 
sionally produced fatal results by local irritant action. The Oxides are 
irritant, the Red being the most so, and are rarely used internally. The 
Acid Nitrate is a good escharotic, the pain caused by it being transient 
though severe, and its caustic action being comparatively superficial. The 
Ointment of the Nitrate (Citrine Ointment) is more irritant than that of 
ammoniated mercury, and generally needs dilution. All these prepara- 
tions may produce the constitutional effects of mercury, and the subjects 
of their administration should be carefully watched for the first symptoms 
of mercurialization. 

Antidotes and Incompatibles. 

Albumin in some form, the white of one egg to gr. iv of the Bichloride, forms the albu- 
minate, which must be at once evacuated by emesis or the stomach pump, as it is soluble 
in an excess of albumin or in the alkaline contents of the intestines. 

The Chlorides are incompatible with very many agents, and the Bichloride should be 
administered in distilled water or pill by itself, being easily decomposed. Calomel is 
decomposed by alkaline iodides or bromides. The combination of Calomel with Hydro- 
chloric Acid or Chlorides is apt to produce corrosive sublimate. In the "mixed treat- 
ment " of syphilis, a mercurial is combined in solution with Potassium Iodide, and the 
Red Iodide is the preparation usually selected, as the Bichloride is decomposed by the 
potassium iodide, red iodide of mercury being precipitated. All trouble regarding incom- 
patibility can be avoided by using sugar-of-milk triturations according to the general 
official formula therefor. In this form, says Piffard, " a larger proportion of the drug 
is utilized for specific purposes, while but a small amount remains to give rise to local 
irritation." 

Therapeutics. 
Mercury is undoubtedly a specific in syphilis, but it is not applicable to 
the tertiary form of that disease. It is best administered in very small 
doses carefully watched and stopped just short of ptyalism, but renewed 
and so continued for a long time. Fumigation by Calomel volatilized by 
heat, or inunction by the Oleate or by Mercurial ointment may be used 
when the stomach will not bear any mercurial. The hypodermic method 
is also used, employing a solution of the Bichloride gr. j to %) each of 
glycerin and distilled water, of which the dose is ttlx once daily ; or the 
Albuminate in solution with sodium chloride. The Yellow Iodide in 



HYDRARGYRUM. 345 

doses of gr. -jL- to -J thrice daily with opium is the best preparation for 
internal use. Accuracy of diagnosis is an absolutely necessary prelimi- 
nary to the administration of mercury, for where there is no syphilitic 
virus to be antagonized the constitutional effects of mercurials will become 
manifest sooner and may do great harm in feeble subjects, besides the risk 
of mistaking them for the results of the disease supposed to be present. 

Tonsillitis, parotitis and other acute glandular inflammations of the 
throat and neck may often be rapidly cured by Calomel gr. -^ or Gray 
Powder gr. -J- every two hours. In irritable stomach with obstinate vom- 
iting the same small doses of Calomel every half hour are very efficient. 
The dysentery of adults with slimy and bloody stools is best treated by 
small doses (gr. y^-) of the Bichloride, and in the diarrhea and dysentery 
(ileo-colitis) of infants Gray Powder gr. -j- or Calomel gr. J-q W1 ^ be found 
very effective. In gastric ulcer and in the first stage of hepatic cirrhosis, 
the Bichloride in doses of gr. -^ to -g^ thrice daily is a good remedy. 
Typhoid fever is treated in Germany by daily doses of Calomel, gr. x for 
three days, as an antipyretic. Diphtheria is by many practitioners consid- 
ered to be best antagonized by Calomel in large doses, and in this affection 
the Cyanide has many advocates given in doses of gr. yiJro^V everv hour, 
a weak solution being at the same time used as a gargle. Asiatic cholera 
is frequently treated by small, repeated doses of Calomel with opium from 
the start. Inflammations of sthenic character in the stage of exudation, 
especially when affecting serous membranes, are considered by many 
authorities to be best met by the free use of mercurials, but this treatment 
is fast going out of favor, excepting in cases of iritis, which affection is 
very often of syphilitic causation, and in pneumonia, which is frequently 
treated, according to the best American authorities,! with sedative doses 
(gr. xv-xx) of Calomel. 

In the general condition known as "biliousness," manifested by whitish 
or clay-colored stools, constipation, nausea, anorexia, coated tongue, 
slight jaundice, etc., mercurial purgatives have long been a routine 
remedy, but mild saline purgatives are by many authorities considered 
equally efficient. As an antiseptic to the gastro-enteric tract in many 
forms of stomach and intestinal disorders (dyspepsia septica) the admin- 
istration of minute doses of the Yellow Oxide will be found remarkably 
efficient. It is best used in trituration with sugar of milk, i to 1,000, and 
in doses of gr. gL— -^. By the use of these small doses failing digestion 
and nutrition may almost certainly be improved. 

In laryngeal diphtheria (membranous croup) the Subsulphate as an 
emetic is by many considered to have some specially beneficial influence. 

Locally, an ointment of Calomel gj to §j of lard is an excellent anti- 
pruritic, and ointments of the Chlorides and Iodides are much used in 
skin diseases, particularly psoriasis, herpes, acne and pityriasis. In para- 



346 HYDRASTIS. 

sitic affections a lotion of the Bichloride, gr. ij to §j of distilled water, or 
a 5 per cent. Oleate with j^th part of ether, is very efficient. The 
Oleate is a serviceable application to syphilitic indurations, but is not 
deemed advisable when ulceration exists. In conjunctivitis Calomel may 
be used as a sedative application, or still better an ointment of the Yellow 
Oxide, gr. ij-x to ^j of vaselin, triturated to the utmost fineness before 
mixing. Goitre and enlarged spleen are often speedily reduced by rub- 
bing into the skin covering them the ointment of the Red Iodide some- 
what diluted and applied before a hot fire or in the direct sunlight. The 
Acid Nitrate solution is one of the best caustics for destroying chancroid 
and syphilitic warts and vegetations. Black and Yellow Washes are used 
as applications to syphilitic erosions and ulcerated indurations. 

As an antiseptic injection or application to dressings a solution of the 
Bichloride, gr. vijss in a quart of hot water ( 20 1 o0 ), is probably the most 
efficient that can be used, and still weaker solutions ( 50 1 00 ) are sufficiently 
antiseptic for most purposes. 

HYDRASTIS, Golden Seal,— the rhizome and roots of Hydrastis 
canadensis, a small plant of the nat. ord. Ranunculaceae, growing in most 
parts of the U. S. It contains an unnamed Resin and 3 alkaloids, 
Hydrastine, C 21 H 21 N0 6 , white and crystalline, soluble in alcohol, ether, 
etc., Berberine, C 20 H 1T NO 4 , yellow crystals soluble in hot water and in 
alcohol, but not in ether, and Xanthopuccine, also yellow and crystalline. 
All these alkaloids unite with acids to form salts. From Hydrastine 
is prepared an oxidation product or artificial alkaloid, Hydrastinine, 
C n H n N0 2 , the Hydrochlorate of which is official. 

Preparations. 

Extractum Hydrastis Fluidum, Fluid Extract of Hydrastis. — Dose, TT\v-xxx. 

Tinctura Hydrastis, Tincture of Hydrastis, — strength, 20 per cent. Dose, gss-ij. 

Glyceritum Hydrastis, Glycerite of Hydrastis, — Hydrastis 2, in Glycerin I, by per- 
colation with Alcohol and Water. Used as a local application. 

Hydrastininae Hydrochloras, Hydrastinine Hydrochlorate, C u H n N0 2 HCl, — the 
hydrochlorate of an artificial alkaloid derived from Hydrastine. Light yellow, amorphous 
granules, deliquescent, very soluble in water, also in 3 of alcohol. Dose, gr. j in a ten 
per cent, solution, as a hypodermic injection. 

Hydrastin (Unofficial), — an impure extract precipitated by Hydrochloric Acid from 
the alcoholic solution, consisting chiefly of Berberine Muriate. Dose, gr. ij-v. 

Physiological Action. 
Hydrastis is a simple bitter and a stomachic tonic. It promotes appe- 
tite and digestion and increases the secretions of the gastro-intestinal tract 
and the flow of bile, but if long used it will derange digestion and produce 
constipation. It is possessed of antiperiodic powers, and is a protoplasmic 
poison, arresting the movements of the white blood-corpuscles. By many 



HYDRASTIS. 347 

observers it is also considered alterative to the mucous membranes, deob- 
struent to the glandular system, cholagogue, diuretic and antiseptic. The 
alkaloid Hydrastine produces effects on the nervous system somewhat 
similar to those caused by quinine, but seems to be devoid of toxic 
power, large doses only producing a sense of warmth in the epigastric 
region, and noises of a rushing character in the ears. 

Incompatibles. 

Tannic Acid, Hydrochloric Acid and the Alkalies are chemically incompatible with 
preparations of Hydrastis. 

Therapeutics. 

Hydrastis is chiefly used as a stomachic tonic, an antiperiodic, a mild 
laxative and an antiseptic. Its alkaloid (Hydrastine) and extract (Hy- 
drastin) are ranked high in the treatment of intermittents and chronic 
malaria, though much less efficient than quinine. It is an excellent 
remedy locally and internally in all forms of catarrh, especially that of 
the stomach, duodenum, gall-ducts, bladder, uterus and vagina. Inter- 
nally it is efficient in many glandular swellings, in chronic constipation 
due to a sluggish state of the liver or deficiency of the other intestinal 
secretions, in chronic dyspepsia, and as a substitute for alcohol in dipso- 
maniacs when a catarrhal state of the stomach has been induced. In 
gonorrhea, gleet, and chronic nasal catarrh, it is locally employed with 
much benefit, also in syphilitic affections of the mouth, throat and nares. 
As a local alterative and antiseptic application it is highly recommended 
for unhealthy ulcers and sores, cancerous ulcerations, mercurial and aph- 
thous stomatitis, rectal fissure, fistula and prolapse, internal and external 
hemorrhoids, cracks, fissures and abrasions of the nipples, erosion and 
ulceration of the cervix uteri, and in conjunctivitis with muco-purulent 
discharge. In gonorrhea a very efficient injection is an infusion of 
Hydrastis, gj of the powdered root to ^viij of boiling water, or the fluid 
extract diluted in the proportion of ^ss or 3J to the pint of water, but it 
should not be used until the acute stage has subsided. 

Hydrastinine has long been known as a uterine vaso-constrictor, and as 
such has been successfully employed in metrorrhagia. It has been 
credited with powerful qualities as an antispasmodic, and also with ac- 
tion of decreasing the excitability of the cerebral cortex. It is considered 
preferable to Hydrastine on account of its stimulant action on the cardiac 
muscle, and the persistent constriction which it produces in the walls of 
the vessels. The Hydrochlorate is employed in grain doses hypodermi- 
cally, using a ten per cent, solution ; the injections being best made, for 
menstrual irregularities, during a few days previous to the expected term. 
It has been used with great benefit in uterine hemorrhage and dysmenor- 
rhea; also in metritis, endometritis, myomataand pyo-salpingitis. It has 



34-8 HYDROCOTYLE HYOSCYAMUS. 

been employed successfully in the treatment of hydrophobia, strych- 
nine-poisoning and epilepsy, in the latter case having been given in 
doses of gr. ^-^ up to gr. ij daily, and with benefit in four cases out 
of six. 

HYDROCOTYLE, Pennywort (Unofficial), is the leaf of Hydrocotyle asiatica, 
a small plant of the nat. ord. Umbelliferae, a native of southern Africa and India. It 
contains a peculiar, oleaginous substance, Vellarine, which has a bitter, persistent taste, 
and is thought to be the active principle. It has long been used in its native countries 
as an alterative to purify the blood, and has been found of great service in eczema, lupus, 
psoriasis, syphilitic and scrofulous sores, and in leprosy. An ounce of the dried plant or 
leaves is given daily in infusion. It causes great itching over the whole body, ovarian 
pain in females, and urinary irritation. In one case in which the drug was being given 
for lupus of the hand a severe orchitis was set up without any other apparent cause: It 
certainly exerts a markedly special influence on the genito-urinary tract. 



HYOSCYAMUS, Henbane, — the leaves and flowering tops, col- 
lected from plants of the second year's growth, of Hyoscyamus niger^ 
a biennial plant of the order Solanacese, growing in Europe and the 
northern U. S. It contains an alkaloid, Hyoscyamine, C 1Y H 23 N0 3 , which 
is isomeric with Atropine and identical with Daturine and Duboisine, 
occurring as an oily liquid or in tufted crystals of silky lustre and yellow 
color, soluble in hot water, alcohol or ether. Another substance, Hyos- 
cine, C 17 H 21 N0 4 , is by some authorities considered a derivative of Hyos- 
cyamine, by others a second alkaloid. It is semi-liquid, isomeric w r ith 
Atropine, and yields Tropic Acid 'and Pseudotr opine. Hyoscyamus leaves 
also contain a fatty Oil and much Potassium Nitrate, while from their 
destructive distillation is obtained an empyreumatic Oil which is a power- 
ful narcotic. They are ovate, long and broad, glandular-hairy, with 
prominent midrib, heavy, narcotic odor, taste bitter and acrid. 

An allied plant is Scopolia camiolica, also of the Solanacese, a common plant in the 
mountains of Bavaria and Hungary, which contains in the root an alkaloid Scopolamine 
(or Scopoleine), C 17 H 21 N0 4 , also found in small quantities in belladonna root, stramonium 
seeds and in duboisia. Nearly all the Hyoscine Hydrobromate supplied by manufactur- 
ing chemists consists of Scopolamine Hydrobromate (Schmidt). The two bases may be 
considered identical (Hesse). 

Preparations. 

Extractum Hyoscyami, Extract of Hyoscya?nus, — Dose, gr. j, when active. 

Extractum Hyoscyami Fluidum, Fluid Extract of Hyoscyamus, — Dose, TT^v-xx. 

Tinctura Hyoscyami, Tincture of Hyoscyamus, — Strength 15 per cent. Dose, 
gj-iv ; as a hypnotic ^ss-j is necessary. 

All the preparations of Hyoscyamus are uncertain in strength and activity, so that the 
effective dose of the extract formerly official ranged from 2 to 250 grains. 

Hyoscyaminae Sulphas, Hyoscyamitte Sulphate, (C 17 H 23 N0 3 ) 2 H 2 S0 4 , — small, yel- 
low scales or crystals, deliquescent, of bitter taste, and very soluble in water and in alcohol. 
It varies much in purity of the base and consequently in activity. A grain of the commer- 
cial article, which was formerly very impure, has been given with impunity, but gr. ■£$ 
of the'pure alkaloid has produced violent poisoning. Dose, hypodermically, should not 
exceed gr. -^ ; by the mouth gr. JS^-j may be given in urgent cases. 



HYOSCYAMUS. 349 

Hyoscyaminae Hydrobromas, Hyoscyamine Hydrobr ornate, C n H 23 N0 3 HBr, — a 
yellowish- white, amorphous mass, or prismatic crystals, of tobacco-like odor, and acrid, 
bitter, nauseous taste ; deliquescent, soluble in l /^ of water and in 2 of alcohol. Dose, as 
the Sulphate. Hyoscyamine of good quality is difficult to procure and is very expensive, 
while Duboisine is easily obtained in any quantity, so that if these alkaloids prove to be 
physiologically as well as chemically identical, the latter will be used to the exclusion of 
the former. 

Hyoscinse Hydrobromas, Hyoscine Hydrobromate , C 17 N 21 N0 4 HBr -j- 3H 2 0, — 
colorless, transparent, rhombic crystals, odorless, of acrid, slightly bitter taste ; soluble in 
2 of water and in 13 of alcohol. Dose, gr. j^Q-fo b Y mouth, gr. ^p-sV hypodermi- 
cally. Nearly all the Hyoscine Hydrobromate furnished by manufacturing chemists con- 
sists of Scopolamine Hydrobromate. 



Physiological Action. 

Hyoscyamus has similar action to that of Belladonna, Duboisia and 
Stramonium, except that it is the least powerful and irritant of the group, 
but the most calmative and hypnotic. The delirium produced by it is 
never furious and is without hyperemia, but is accompanied by insomnia. 
It is more stimulant to the vaso-motor system and to the cardiac accelera- 
tor apparatus than is Stramonium, but is less active on the pneumogastric. 
It has decidedly laxative and carminative effects on the intestines and a 
very marked sedative influence on the urinary passages. 

Hyoscyamine corresponds in action to the plant and its congeners, 
being considered by many authorities as almost identical with Atropine, 
but less powerful. No death has resulted directly from it. Except in 
very large doses it is more an anodyne or anesthetic than a narcotic or 
soporific. It is a mydriatic, excites the cerebral functions and depresses 
the spinal. Many observers deny that it possesses any soporific influence. 

Hyoscine is a cerebral and spinal sedative, and a powerful hypnotic, 
directly depressing the higher functions of the brain, and affecting the 
heart but feebly. It is probably the action of this agent which prevents 
Hyoscyamus from causing the excitation and delirium of Belladonna. After 
the hypodermic administration of a full dose (gr. -gL), there is, in most 
subjects, a period of semi-maniacal delirium, with flushed face and dry 
mouth, lasting from one to two hours, and followed by the sedative action 
of the drug, during which the pulse-rate and frequency of respiration, at 
first quickened, are distinctly lowered. It especially affects the motor 
tract of the spinal cord and the cerebral cortex, slightly depresses the 
heart, but paralyzes respiration. It is free from irritant qualities and may 
be used hypodermically. Its habitual use brings on muscular paralysis 
and delirium of violent character. It is frequently used as a hypnotic 
by alcoholics and nervous subjects, and will probably ere long be respon- 
sible for many deaths. As a mydriatic its reputation is doubtful, some 
observers claiming greater power for it in this respect than that of 
Atropine, while others say that mydriasis may follow its use but is not 
always produced by even large doses. Severe toxic symptoms have fol- 



350 HYOSCYAMUS. 

lowed the application of 4 drops of a 1 per cent, solution (equal to gr. 
Jg-) to the ocular conjunctivae. In large doses Hyoscine is a dangerous 
depressant of the respiration, but it may be used without unpleasant 
effects in medicinal doses. Whenever full doses are employed the respi- 
ration should be watched for several hours. 

Dr. Balagopal, of India, has reported a case in which a man suffering from intermit- 
tent attacks of maniacal delirium was accidentally given gr. i of the hydrobromate of 
hyoscine hypodermically. Severe toxic symptoms supervened, which were however an- 
tagonized by Sulphuric Ether administered subcutaneously. The patient recovered, and 
thereafter remained free from all mental or cerebral disorder. 

Antagonists and Incompatibles. 

These are the same as for Belladonna (see ante, page 215). Liquor Potassse though 
incompatible is frequently prescribed in combination with Hyoscyamus. All the fixed 
caustic alkalies decompose its alkaloid, as also those of the allied plants. 

Therapeutics. 

Hyoscyamus is a valuable though feeble narcotic and is chiefly used as a 
hypnotic and an anodyne when Opium is contraindicated, and for children. 
It is by far the best agent to use in acute mania with great motor excite- 
ment, obstinate insomnia and varied hallucinations. Chronic mania has 
been more benefited by it than by any other drug, and it is very efficient 
in insanity characterized by frequent delusions. In delirium tremens and 
the delirium of fevers it is an excellent hypnotic, and the monomania of 
hypochondriacs is alleviated and often cured by it. Whooping-cough, 
nervous coughs, and especially a dry, tickling night-cough, are greatly 
alleviated by full doses of Hyoscyamus. It is also efficient in colic of 
various forms, to palliate the trembling of paralysis agitans and mercurial 
tremor, and to relieve the pains and disordered coordination of locomotor 
ataxia. In constipation it is a good remedy, the extract being much 
employed in combination with other purgatives to render them more effi- 
cient and less drastic, but the quantity generally used is too small to be 
of any particular benefit. The tincture is an efficient remedy in irrita- 
bility of the bladder from any cause. 

Hyoscyamine may be used for the same purposes as Atropine, but 
being liable to considerable variation in purity and activity, it is not a 
popular agent with the profession. 

Hyoscine has been frequently used in neuralgia, whooping-cough, acute 
mania, insomnia from cerebral excitement, delirium tremens, asthma and 
enteralgia, also in ophthalmic practice as a mydriatic. The Hydrobro- 
mate is the salt in general use, in doses of gr. -^ hypodermically, gr. -fa 
by the mouth. It efficiently, but temporarily, controls the tremor of paral- 
ysis agitans, and is highly useful at times in the treatment of the morphine- 
habit, especially for the extreme restlessness and insomnia resulting from 
the final withdrawal of that drug. In such cases, however, it must be 



IGNATIA. 351 

used only in emergencies and should not be given habitually, as it excites 
a high degree of delirium in most subjects at first, followed after about 2 
hours by its secondary sedative influence. Excessively or carelessly 
employed in such cases, it is liable to seriously derange the mental facul- 
ties in the same manner as Atropine, and is probably responsible for 
many of the impaired intellects which emerge from the so-called " Bichlo- 
ride of Gold Cures " for alcoholism. 

Dr. Lionel Weatherly warns the uninitiated against mistaking Hyoscine for Hyos- 
cyamine, as these two alkaloids have very different characteristics clinically. He believes 
strongly in the power of Hyoscine as a mental alterative, and has found it to be par- 
ticularly useful in that form of mental disturbance which renders the patient violent and 
abusive, restless and domineering — a nuisance to every one who has anything to do with 
him. Under the administration of repeated small doses of hyoscine such a patient 
becomes a changed man. Violence and abusiveness give place to an amiable politeness, 
and instead of indulging himself in the free exercise of an extensive, if somewhat shady 
vocabulary, the patient subsides into silence. 



IGNATIA, St. Ignatius' Bean (Unofficial),— is the seed of Strych- 
nos Ignatii, a small tree of the nat. ord. Loganiaceae, native in the Phil- 
ippine Islands, and also called Ignatia Amara. It contains the alkaloids 
Strychnine and Brucine, about 1 per cent, of each, for a description of 
which see under the title Nux Vomica. 

Tinctura Ignatiae, Tincture of Ignatia (Unofficial), — strength 10 per cent. Dose, 

ntfj-x. 

Physiological Action and Therapeutics. 

Ignatia closely resembles Nux Vomica in action, a poisonous dose pro- 
ducing the same exaltation of the spinal functions, with muscular twitch- 
ing, tetanic spasms, and death by asphyxia through tetanic fixation of the 
respiratory muscles, but as it contains a greater quantity of Strychnine than 
the latter it is more powerful in the same dose. It exalts the suscepti- 
bility of the sensory nerves and the nerves of special sense for a time, but 
an opposite condition soon succeeds, manifested by numbness and torpor 
with great mental depression. It causes a feeling of constriction about 
the throat and a sensation of anguish at the pit of the stomach. Its 
antagonists and incompatibles are the same as those for nux vomica. 

Ignatia is recommended in hysteria to control the general hyperes- 
thesia, also for insomnia, clavus hystericus, mental excitement or depres- 
sion, aphonia, perverted appetite, and convulsive crying or laughing. It 
will often remove the intercostal neuralgia of hysterical subjects, and the 
sensation as of a ball rising to the throat (globus hystericus). Cerebro- 
spinal irritability is diminished by small doses though excited by large 
ones, Ignatia being probably the most efficient controller of functional 
phenomena of the cerebro-spinal axis. In the convulsions of children 
from intestinal irritation without cerebral congestion, and in insomnia 



352 ILLICIUM — INULA IODUM. 

from nervous erethism, small doses of Ignatia are used with the happiest 
results. It is by many practitioners preferred to nux vomica as a stom- 
achic tonic, and is useful in the treatment of dyspepsia, hypochondriasis 
and various nervous affections. 

ILLICIUM, Star Anise, — is the fruit of Illicium verum, an Asiatic shrub of the 
nat. ord. Magnoliacese. It contains a Volatile Oil which is chemically and practically- 
identical with the Oil of Anise. Another species, Illicium anisatum [Illicium religiosum), 
is very poisonous, causing vomiting, epileptiform convulsions, dilated pupils and cyanosed 
countenance. Its carpels are more woody, shrivelled and wrinkled, and end in a curved 
beak. Illicium is recognized officially as a source of the Oil of Anise, and has actions 
and uses similar to those of Anisum. (See ante, page 167.) 

INULA, Elecampane, — is the root of Inula Helenium, a plant of the nat. ord. 
Compositae, growing in Europe and N. America. It contains a volatile oil, a resin, a 
crystalline substance named Helenin, C 6 H g O, and a peculiar principle resembling starch, 
Inulin, C 6 H 10 O 5 , which is found in Arnica, Taraxacum and other plants. Having the 
same chemical composition as starch, Inulin differs from the latter in being colored yel- 
low by Iodine, and depositing from its solution in hot water as the solution cools. It is 
contained in Elecampane in large quantity, from 19 to 44 per cent., the latter in the 
autumn. There are no official preparations, but a decoction (^ss to Oj) may be given 
in doses of^j-ij. Dose of the powdered root, gr. xx-^j. 

Inula is a gentle stimulant to the secretory organs, and is said to be expectorant, dia- 
phoretic and diuretic. In large doses it causes nausea and vomiting. It was formerly 
supposed to be emmenagogue and was much used in amenorrhea. It is now chiefly 
employed as a domestic remedy in chronic bronchitis and dyspepsia, and to promote the 
eruption in exanthematous fevers. 

IODUM, Iodine, I, — is a non-metallic element, existing in sea-weed, 
sea-water, some fresh waters and fresh-water plants, also in sponge, oys- 
ters, eggs, cod-liver oil, rock salt and several ores. It occurs in bluish- 
black rhombic plates, of metallic lustre, peculiar odor, acrid taste and 
neutral reaction; sparingly soluble in water (1 in 5,000), readily so in 
ether, and in 10 of alcohol, also in a solution of potassium iodide or 
sodium chloride. It volatilizes slowly at ordinary temperatures, and 
produces a dark-blue color with gelatinized starch in a cold solution. 
Internally it is generally administered in the form of an iodide or as the 
compound solution of iodine. Dose, gr. ss-j. 

Preparations of Iodine. 

Tinctura Iodi, Tinctu7-e of Iodine, — strength 7 per cent. Dose, Tt\j-v ; but it is gen- 
erally used as a local application, or for injection into cavities. 

Liquor Iodi Compositus, Compound Solution of Iodine, LugoPs Solution, — has of 
Iodine 5, Potassium Iodide 10, in Distilled Water to 100. Dose, TT\j-x, well diluted. 

Unguentum Iodi, Ointment of Iodine, — has of Iodine 4, Potassium Iodide I, Water 
2, Benzoinated Lard 93. 

Iodized Phenol, Carbolated Iodine (Unofficial), — is a mixture of Iodine and crystal- 
lized Carbolic Acid in varying proportions, generally I of the former to 4 of the latter : 
for local use, especially in gynecology. 

Iodides and their Preparations. 

Ammonii Iodidum, A?m?ionium Iodide, NH 4 I, — a deliquescent, granular, white 
salt ; soluble in I of water and in 9 of alcohol at 59 F. Dose, gr. ij-x or more. 



iodum. m 353 

Potassii Iodidum, Potassium Iodide, KI, — a colorless, deliquescent, crystalline salt, 
of saline and bitter taste ; soluble in 0.8 of water and in 18 of alcohol. jj of this salt 
dissolved in ^ j of water makes nearly ^ jss of fluid, so that TTLvijss of the solution would 
be required to obtain gr. v, a fact to be remembered in prescribing. Dose, gr. v~3j. 

Unguentum Potassii Iodidi, Ointment of Potassium Iodide, — has of the Iodide 12, 
Sodium Hyposulphite I, Hot Water 10, Benzoinated Lard 77. 

Sodii Iodidum, Sodium Iodide, Nal, — minute, deliquescent crystals; soluble in 0.6 
of water and in 1.8 of alcohol. Dose, gr. v- gj. 

Strontii Iodidum, Strontium Iodide, SrI 2 (H 2 0) 6 , — colorless, hexagonal plates, of 
bitter, saline taste ; very soluble in water and in alcohol. Dose, gr. v-xxx. 

Iodoformum, Iodoform (Formyl Iodide), CHI 3 , — small, lemon-yellow crystals, of 
saffron-like and penetrating odor ; very slightly soluble in water, soluble in about 52 of 
alcohol, 12 of boiling alcohol, and in 5.2 of ether; very soluble in chloroform, benzin 
and fixed and volatile oils. Its solutions have neutral reaction. Dose, gr. j-v. 

To remove its odor without forming a compound the best agents are Thymol (gtt. ij 
ad ^j of Iodoform), Oil of Mirbane (gtt. vj ad gr. xv), Oil of Bitter Almonds, or Oil of 
Rose (gtt. j ad gj). Oil of Turpentine is particularly serviceable in removing the odor 
from the hands, or from spatulas, mortars, etc. 

Unguentum Iodoformi, Iodoform Ointment, — Iodoform, finely pulverized, 10, Ben- 
zoinated Lard 90, thoroughly mixed by trituration. 

Other Iodides and preparations thereof are — Argenti Iodidum, Arseni Iodidum, 
Liquor Arseni et Hydrargyri Iodidum, Hydrargyri Iodidum Rubrum, Hydrargyri Iodi- 
dum Flavum, Syrupus Ferri Iodidi, Pilulse Ferri Iodidi, Plumbi Iodidum, Sulphuris 
Iodidum and Zinci Iodidum. As these preparations are allied in action and uses less 
closely to Iodine than to the other elements in their composition, they are described under 
other titles. (See Argentum, Hydrargyrum, etc.) Ethyl Iodide or Hydriodic Ether is 
described under vEther (see ante, page 113). 

Preparation of Hydriodic Acid, 

Syrupus Acidi Hydriodici, Syrup of Hydriodic Acid, — contains I percent, of abso- 
lute Hydriodic Acid, HI. Dose, gj-iv, well diluted. 

Physiological Action. 

Iodine is irritant to the mucous membranes and to the skin. Applied 
to the latter it stains a deep yellowish-brown color and combines with the 
albumin of the tissue, causing considerable pain and subsequent exfolia- 
tion of the epidermis. Vesication may be quickly produced if the quan- 
tity used be large. Inhaled its vapor irritates the respiratory mucous 
membrane, producing sneezing, cough, dyspnea, also pain in the chest 
and in the frontal sinuses. In the gastro-intestinal canal it is equally 
irritant, but is gradually converted into the iodide or iodate of sodium, 
in which form or as an albuminate it is absorbed into the blood. Iodine 
decomposes organic molecules, and in the presence of phosphoretted or 
sulphuretted gases it acts like chlorine but more feebly, uniting with their 
hydrogen and thus breaking up those noxious compounds it is disinfectant 
and deodorant. 

The Iodides of Sodium, Potassium, etc., are very diffusible and are as 
rapidly excreted ; setting free nascent oxygen (Ozone) and Iodine at the 
points of elimination they are remotely irritant to the mucous mem- 
branes, causing violent coryza, with soreness of the throat, acute con- 
junctivitis, profuse mucous discharges, headache and irritation of the 
2 3 



354 iodum. 

kidneys and the skin. Intravenous injections of these salts produce at 
first a rapid elevation of arterial pressure with acceleration of the cardiac 
rate ; followed by slowing of the heart, and later on lowered blood-pres- 
sure with increased heart-rate. If used for any length of time they induce 
great waste and rapid elimination of waste products, causing anemia, 
emaciation and mental depression ; but these effects are credited chiefly 
to the metallic constituent, being most severe from the potassium salt. 
They combine with certain poisons in the system, particularly lead, 
mercury and the products of the syphilitic disease, hastening their elimi- 
nation. Iodism is the term applied to the general condition produced 
by these agents, and comprises the symptoms above noted together with 
frontal headache, ptyalism, a saline taste in the mouth, dysphagia, tem- 
porary impotence, and an acneform eruption on the face and limbs. 
Sometimes the eruption is furuncular or even purpuric. It is less apt to 
result from the use of the Strontium Iodide than from that of the others. 
The copious dilution of these preparations with water promotes their 
excretion, and to a great extent prevents the development of unpleasant 
results. The ptyalism occasionally produced by iodides is not a direct 
result of their action, and occurs only in persons who have previously 
taken mercurials. In such cases the mercury, which had been deposited in 
the tissues as an albuminate, is set free by the iodide and coming again 
into the circulation it produces its constitutional effects. (Murrell). 

Potassium Iodide occasionally gives rise to some peculiar symptoms in 
certain susceptible persons. Among these are diuresis, cerebral excite- 
ment as from alcohol, hemorrhages from the urethra and the vagina, 
glossitis (Gross), also laryngitis and sudden edema of the glottis. The 
latter may be of so intense a character as to require the instant perform- 
ance of tracheotomy in order to avert death. On the circulation it pro- 
duces marked and important effects in most cases. It causes acceleration 
of the pulse and vascular dilatation, leading to abundant secretion from 
several glands. It reduces the temperature a degree or more, and slows 
the rate of the respiration. 

Iodoform contains from 94 to 97 per cent, of Iodine and naturally 
resembles the latter in action. Locally its action is anesthetic and pow- 
erfully antiseptic. It is one of the best agents to prevent decomposition 
and to destroy the germs of putrefaction and of disease, but must be 
carefully employed, as when used in quantity on an extensive raw surface 
it has often produced fatal results with symptoms of narcotic poisoning. 
The first sign of its dangerous absorption is increase of temperature, 
which may reach 104 or more, then headache, quick and feeble pulse, 
marked anxiety and restlessness. Collapse and death may suddenly super- 
vene. The quantities which have produced fatal results from local 
absorption have varied from 525 to 4,500 grains. In small doses inter- 



iodum. 355 

nally it is considered to be a tonic and alterative, wasting does not occur, 
but the body-weight increases and the general condition improves. In 
these respects its action markedly differs from that of Iodine or the 
Iodides. In medicinal doses internally administered for any length of 
time it may cause profuse salivation. 

Ethyl Iodide (see ante, pages 113 and 116) is used by inhalation to 
bring the system rapidly under the influence of Iodine. It is a good anti- 
spasmodic and general stimulant and a very slow anesthetic. 

Antidotes, Antagonists and Incompatibles. 

Starch is the antidote to free Iodine, but the stomach must be evacuated soon as the 
resulting iodide is active. Albumin, starch, lime-water, tannin and soap may be used in 
poisoning by the iodides, and free emesis should be induced. In chronic iodide poison- 
ing a free salivary flow, brought on by chewing Pyrethrum root, will hasten elimination 
of the drug. Restoratives and vaso-motor tonics, as Quinine, Digitalis, etc., are thera- 
peutically antagonistic. 

Incompatibles with Iodine and the Iodides are the Mineral Acids, Metallic Salts, Alka- 
loids and their salts, also Ammonia. Potassium Iodide combined in solution with Potas- 
sium Chlorate results in a poisonous compound. As Potassium Iodide decomposes nearly 
all the metallic salts, and is incompatible with many substances, it is best prescribed 
alone or in some simple vehicle, a favorite one being the Compound Syrup of Sarsaparilla. 
It may be prescribed with Tincture of Cinchona, an ounce of which dissolves 30 grains, 
or in combination with Liquor Potassii Arsenitis, which prevents the iodic eruption to 
some extent. In the " mixed treatment " of syphilis it is combined with the Biniodide 
of Mercziry. It is better borne when combined with Nux Voniica or Potassium Acetate, 
or alternately with Iodide of Iron (Squire). Its efficacy is increased by uniting it with 
Ammonium Carbonate, 2 parts to I or l}4, of the Iodide (Gull). 



Therapeutics of Iodine. 
The tincture and the compound solution are much employed locally as 
counterirritants and by injection into cavities as alterative applications, 
instances of which are their use in glandular tumors, hypertrophied ton- 
sils, cervical and ovarian cysts, empyema, hydrocele, etc. In various 
skin diseases, as chloasma, lentigo, lupus, the tincture or a glycerite is 
well applied, and in many splenic and hepatic disorders of chronic type 
the ointment or tincture is a favorite counterirritant application. In 
sores, ulcers, and fissures, the Iodide of Starch or a mixture of Iodoform 
and Tannin are strongly recommended, and the tincture is much used 
locally to promote absorption of the products of acute inflammations. 
In acute catarrh and hay-fever inhalations of Iodine-vapor or that from 
Iodized Phenol are very serviceable, and in the vomiting of pregnancy 
1- to 5-drop doses of the tincture every hour are often efficient. The 
compound solution well diluted is given thrice daily in typhoid fever 
with good results in many cases, and in malarial fevers the same prepara- 
tion combined with Carbolic Acid has shown curative power. In strumous 
conditions Iodine internally is generally considered to be more efficient 
than any of the Iodides. 



35^ IODUM. 

Therapeutics of the Iodides. 

Potassium Iodide is the most frequently used iodide, and is the form in 
which Iodine is generally administered internally. It is usually given in 
simple solution or in the compound infusion or syrup of Sarsaparilla. 
Though its mode of action has never been explained satisfactorily, it is 
known by clinical experience to counteract many pathological conditions, 
to promote the absorption of morbid products, and the elimination of 
several metallic poisons. It is almost of specific rank in tertiary syphilis 
and its results, as neuralgias, paralyses from gummata, ulcerations, syphi- 
loma of the internal viscera, lupus, chronic rheumatism and sciatica, in 
all of which when of syphilitic origin this iodide in large doses (50 to 150 
grains daily) to saturation of the system will speedily cause improvement. 
So also in mercurial poisoning and other chronic metallic toxemiae, the 
best treatment is by rapid saturation with Potassium Iodide. The products 
left behind by pneumonia, pleurisy and pericarditis often yield to 
moderate doses (5 grains), which if used for a prolonged period seem to 
retard the changes of chronic nephritis. It is the best remedy for the 
early stage of hepatic cirrhosis, and acts as a most efficient expectorant 
in chronic bronchitis. Aneurisms are often cured by large doses (20 to 
30 grains) of Potassium Iodide, the sac becoming solid by fibrinous 
deposit. In acute catarrh and hay-fever, it is useful with Arsenic, the 
Iodized Phenol being at the same time used locally in weak solution. In 
tonsillitis and simple sore throat a weak solution (gr. ij-v to the J) is a 
good gargle, and in large doses it is often efficient in spasmodic asthma 
induced by bronchial catarrh. 

Ammonium Iodide in grain dose repeated frequently is an excellent 
remedy in acute catarrh, hay-fever, duodenal catarrh and its accompany- 
ing jaundice, in chronic and capillary bronchitis, and in catarrhal pneu- 
monia to prevent caseation of the products. In the first stage of hepatic 
cirrhosis and in chronic malarial poisoning it is equally efficient adminis- 
tered in conjunction with Arsenic. Being somewhat more irritating than 
the other iodides it is usually given in smaller quantity, but being less 
stable it is more energetic in action. 

Sodium Iodide may be used instead of the potassium salt, in all affec- 
tions in which the latter is indicated ; but requires to be administered in 
somewhat larger doses, being less active and less toxic. Strontium 
Iodide is still less liable to produce eruptions, and has been employed with 
benefit in scrofulous, rheumatoid and cardiac disorders. It is said to be 
free from causing intestinal irritation or depression of nutrition. 

Hydriodic Acid is used as a substitute for Iodine and the Iodides. As 
an alterative it is believed by some to possess all the powers of Iodine 
while it is much less offensive to the taste and the stomach. It has been 



iodum. 357 

used with benefit in asthma and bronchitis. This acid is not now official, 
as it is liable to change by the development of free Iodine. 

Iodoform is chiefly employed in local diseases as an antiseptic, anes- 
thetic and alterative agent. It may be dusted in fine powder over a wound 
or sore, or used in ethereal solution to saturate gauze or absorbent cotton. 
It is a useful application to sloughing and phagedenic ulcers, gunshot 
wounds, chancroids, fistulae, sinuses and painful affections of the rectum 
or uterus. Internally it may be used as a general tonic and alterative in 
syphilis and other cachexias, also for neuralgia, and is frequently pre- 
scribed with Iron. Triturated with Tannin it forms a good application 
to the cervix uteri in erosions and ulcerations thereof, or an Iodo-tannin 
may be prepared by saturating the Tincture of Iodine with Tannic Acid, 
and applied on a cotton tent to the uterine mucous membrane in many 
chronic affections of that organ. Tuberculosis is successfully treated by 
Iodoform, which certainly checks the activity of the bacillus of that dis- 
ease. Diabetes has been apparently cured by Iodoform, and syphilis 
may be combated successfully thereby in lieu of Potassium Iodide. 

Unofficial Substitutes for Iodoform. 

Aristol, Dithymol Iodide, — is a combination of Iodine and Thymol, containing nearly 
46 per cent, of the former, and is prepared by adding an alkaline solution of Thymol to 
a solution of Potassium Iodide and Iodine. It occurs as an amorphous, odorless, unstable, 
non-toxic powder, of a brown-red or fawn color, insoluble in water or glycerin, spar- 
ingly soluble in alcohol, freely so in ether, chloroform, and fatty oils. As its Iodine 
leaves it readily, no heat should be used in dispensing it, and it should not be mixed 
with alkalies, metallic oxides, or starch. It is used locally as a substitute for Iodoform. 

Aristol is highly praised by those who have used it in the local treatment of ulcers, 
wounds, and other breaches of the tissues ; in which it is considered nearly, if not 
quite, as efficient as Iodoform, with the great advantage of being odorless. Excellent 
results have been obtained with it in the treatment of indolent soft ulcers, lupus, psoria- 
sis, syphilitic ulcerative processes, eczema, severe burns, affections of the ear, nose, and 
pharynx, as well as in the various cases in gynecological and dermatological practice in 
which Iodoform has hitherto stood supreme. Its prolonged use may give rise to chronic 
iodine poisoning. Aristol is best applied in powder, in solutions in Oil or Ether (5 to 10 
per cent.), or as ointments with a base of Lanolin or Vaselin (5 to 10 per cent.). A use- 
ful application is a liniment, prepared by dissolving 5 grains of Aristol in g ij of a mix- 
ture of equal parts of Ether and Alcohol, then incorporating % j of soft Soap. 

Europhen, Isobutyl-orthocresol Iodide, — is produced by the action of Iodine upon 
Isobutyl-orthocresol in a solution of Potassium Iodide, and contains about 27 per cent, of 
Iodine, which it gives up to metallic oxides and mercury salts, and when brought into 
contact with aqueous liquids. It occurs as a very fine, amorphous, yellow powder, of 
faint, aromatic odor like that of saffron ; insoluble in water and in glycerin, soluble in 
alcohol, ether, chloroform and fatty oils ; readily decomposed by heat and by starch, 
slowly by light. It is five times lighter and more bulky than Iodoform, and is used as a 
substitute therefor in all local applications where a dry antiseptic is required. Like 
Aristol, it should be kept in a dry place, and protected from the action of light. Its 
virtues are probably due to the readiness with which it liberates free, nascent Iodine, 
when in contact with aqueous liquids; being fully equal in this respect to Iodoform. 
Used externally, it is dusted on in powder, or applied as a 5 to 10 per cent, ointment 
with Lanolin as a base. It must not be combined with metallic oxides or mercurials, 
nor with zinc starch paste. For hypodermic use a 3 to 10 per cent, solution in Olive Qil 
is employed. A mixture of Europhen and Aristol, equal parts of each, is highly recom- 
mended for adhesiveness. 



35§ IPECACUANHA. 

Bismuthi Subiodidum, Bismuth Subiodide, BiOI, — is a heavy, amorphous, brick-red 
powder, insoluble in any reagent without decomposition. 

Bismuthi Subgallas, Pismut/i Subgallate [Dermatol'), — is a very fine saffron-yellow, 
odorless powder. 

These are two of the very best among the agents proposed as substitutes for Iodoform 
in local applications. They are non-irritant, powerfully bactericidal, and entirely odor- 
less. In the author's experience the Subiodide is exceedingly efficient in stimulating the 
growth of granulations in a large wound, such as that often necessary in the surgical 
treatment of fistula in ano. They are described under Bismuth [ante, page 220). 

Iodol, Tetra-iodo-pyrrol, — is obtained by treating Pyrrol, (a coal-tar product), with a 
solution of Iodine and Potassium Iodide, usually known as Potassium Iodo-iodide solution. 
It occurs in very long, minute, delicate, prismatic crystals, of a yellowish tint, sparingly 
soluble in water, but readily in alcohol. When even slight decomposition is going on the 
crystals take on a brown tinge, due to the free iodine. Its odor is very slight, it being 
practically odorless when pure ; and, unlike Iodoform, it has no toxic properties when 
undecomposed. It contains about 89 per cent, of Iodine. Dose, gr. ss-v, in tablet. 
Though insoluble practically in water, Iodol dissolves readily in the gastric juice, and is 
rapidly absorbed and as quickly diffused throughout the system. It has the same gen r 
eral action as Iodoform, except that it is devoid of toxic power. 

Iodol is a very close rival to Iodoform, and is used in almost every instance where the 
latter agent is applicable (Squibb). It should replace Iodoform largely as a topical 
application, on account of its freedom from unpleasant odor. Internally it is highly 
esteemed as a remedy in chronic gastric catarrh, intestinal catarrh, and in ulceration of 
the gastro-intestinal mucous membrane. It has been found to be highly useful in 
bronchitis, bronchial catarrh, and in various respiratory neuroses; and has seemed to 
render good service in the treatment of tuberculosis and syphilis. In eczema of the ear 
Iodol has proved very efficient. In moist confluent eczema of the pinna, extending 
within the auditory canal, the powder should be blown into the canal and upon the sur- 
rounding parts, after the surfaces have been thoroughly cleansed. In the dry, external 
form it is best applied as an ointment with Lanolin. The inflammation disappears 
generally within two weeks, but irrigation should be kept up for a short time afterwards 
in order to complete the treatment. (Chatellier.) 

Nosophen, Iodophen, — is a patented preparation, chemically entitled Tetra-iodo- 
phenol-phthalein, and obtained by the action of iodine on a solution of phenol-phthalein. 
It contains 60 per cent, of Iodine and occurs as a yellow, insoluble powder, of feebly 
acid character, with alkalies forming soluble salts, the sodium salt being of blue color and 
named Antinosin. Nosophen is highly germicidal and is used as an antiseptic dusting 
powder for wounds, ulcers, etc., also internally for catarrhal inflammations of the gastro- 
intestinal tract. Dose, gr. v-viij. 



IPECACUANHA, Ipecac, — is the root of Cephaelis Ipecacuanha, 
a small shrubby plant of the nat. ord. Rubiacese, growing in Brazil and 
Columbia. It contains Cephaeline, C u H 19 N0 2 , which is a crystalline 
alkaloid ; Emetine, C u H 18 (CH 3 )N0 2 , an amorphous alkaloid and a methyl 
compound of cephaeline ; also a third alkaloid in very small quantity, a 
glucoside named Ipecacuanhic Acid, starch, gum and a trace of a volatile 
oil. Dose of the powdered root, as an expectorant gr. ss-ij, as an emetic 
gr. xv-xxx. 

Official Preparations. 

Extractum Ipecacuanhae Fluidum, Fluid Extract of Ipecac, — Dose, iry-v-xx. 

Syrupus Ipecacuanhae, Syrup of Ipecac, — strength 7 per cent. Dose, 3^ j— iv. 

Vinum Ipecacuanhae, Wine of Ipecac, — strength 10 per cent. Dose, Tt\J-3J. 

Pulvis Ipecacuanhae et Opii, Pozvder of Ipecac and Opium, Dover's Powder [Pulvis 
Doveri), — has of Ipecac 10, Powdered Opium 10, Sugar of Milk 80, triturated together 
to a fine powder. Dose, gr. ij-xv or xx. 



IPECACUANHA. 359 

Tinctura Ipecacuanhae et Opii, Tincture of Ipecac and Opium, — has of Tincture 
of Deodorized Opium ioo evaporated to 80, Fluid Extract of Ipecac 10, Diluted Alcohol 
to 100. Is a fluid representative of Dover's powder. Dose, TT^ij-xx or xxx. 

Trochisci Ipecacuanhae, Troches of Ipecac, — each troche contains of Ipecac about 
gr. %. Dose, j-iij. 

Trochisci Morphinae et Ipecacuanhae, Troches of Morphine and Ipecac, — each 
troche contains about gr. ^ of Morphine Sulphate, about gr. T L of Ipecac, with Oil of 
Gaultheria, Sugar, etc. Dose, j-iij. 

Unofficial Preparations. 

Ipecacuanha De-emetinisata, De-emetinized Ipecac, — is Ipecacuanha deprived of 
its alkaloids, for use in dysentery. Dose, gr. v-xx. 

Emetina, Emetine, — colorless, amorphous, soluble in alcohol, ether, chloroform and 
benzin, very sparingly in water, insoluble in caustic alkalies. Its salts are readily soluble 
in water, the Hydrochloride and Hydrobromide being those chiefly used in medicine. It 
is powerfully toxic in large doses. Dose, as an expectorant, gr. j^o™^ as an emet ic, 
g r - \~\- _ 

Emetinae Hydrobromas, Emetine Hydrobromate, — crystalline in silky tufts of 
needles, readily soluble in water, contains 68 per cent, of the alkaloid. Dose, gr. -^—^V 

Cephaelinae Hydrochloras, Cephaeline Hydrochloride, — is readily soluble in water. 
Cephaeline is more powerfully emetic than Emetine, but does not produce depressing 
effects in doses of gr. ^-\ and is slow of action. 

Physiological Action. 

Ipecac is nauseant, emetic, expectorant, cholagogue, diaphoretic, hemo- 
static, sternutatory, and irritant. Applied to the skin it produces red- 
ness, itching and occasionally a pustular eruption ; injected subcutane- 
ously it causes pain and inflammation often terminating in abscess. Used 
as snuff it excites violent sneezing and profuse mucous secretion ; in 
some persons the inhalation of the smallest quantity induces an asthmatic 
paroxysm, with swelling and injection of the conjunctival and nasal 
mucous membranes, salivation, tears, sneezing, coughing and bronchial 
catarrh. Its action on the gastro-intestinal mucous membrane is also 
decidedly irritant. Internally, small doses (gr. -J— J) act as a stomachic 
and hepatic tonic and increase the gastric secretions ; larger doses (gr. 
v-xx) are nauseant and emetic in from 20 minutes to half an hour, but 
the emesis produced is not violent nor is it followed by much depression. 
If these doses are repeated a tolerance of the stomach to the drug becomes 
established and a cathartic action is produced, the stools having a peculiar 
bilious character. The circulation is only slightly affected by Ipecac, 
but it relaxes the skin and increases the broncho-pulmonary mucus. In 
large doses it is decidedly irritant to the intestinal canal, but here also it 
is capable of the same tolerance as in the stomach. In poisonous doses 
it has frequently produced hemoptysis and other hemorrhages. Ruther- 
ford found it to be a powerful hepatic stimulant. Woodhull believes that 
it is a direct nervous stimulant, acting chiefly, if not entirely, upon the 
sympathetic system. 

Emetine possesses strong constringent action on the blood-vessels and 



360 IPECACUANHA. 

is powerfully emetic and expectorant. It causes death in animals by car- 
diac paralysis, and the autopsies show evidence of gastro-intestinal irrita- 
tion and hyperemic lungs with patches of hepatization. 

Antagonists and Incompatibles. 

Narcotics generally antagonize the emetic action, so also do Bismuth, Carbolic and 
Hydrocyanic Acids. The salts of Lead and Mercury, Vegetable Acids and astringent 
infusions are incompatible with Ipecac. 

Therapeutics. 

Ipecac is much used as an emetic, being safe, efficient and non-depres- 
sant, though slow of action. It is the best agent of the kind to relieve 
the stomach in acute indigestion and bilious sick-headache, and an 
ipecac-vomit is considered by many good practitioners to be very ser- 
viceable at the commencement of eruptive, continued and periodical 
fevers. The syrup is a favorite domestic emetic to cut short an attack of 
spasmodic croup, and it may be used beneficially in laryngismus stridulus 
and in capillary bronchitis. In small doses Ipecac is an excellent stimu- 
lant of the gastric and hepatic functions, and an expectorant of great 
value. In atonic dyspepsia, catarrhal jaundice, intestinal colic, bronchial 
asthma, hay fever, bronchial catarrh, acute laryngitis and pharyngitis, 
also in nervous and other coughs, it has rendered good service. In still 
smaller doses (nij of the wine) frequently repeated it is an efficient anti- 
emetic in vomiting of nervous origin, and especially in the vomiting of 
pregnancy, also in that of gastric atony as seen in chronic alcoholism ; 
its action in this affection being due perhaps to its possessing a sedative 
influence upon the pneumogastric in small doses. It is an excellent rem- 
edy in hemoptysis if given in small and frequently repeated doses until 
nausea occurs. As an antihemorrhagic it has been efficiently used in 
epistaxis, menorrhagia and post-partum hemorrhage, in the latter affection 
being given in combination with Ergot. In doses of a grain several times 
a day it has given satisfaction in cases of idiopathic neuralgia, hyperi- 
drosis, intermittent fever, erysipelas, acute and suppurative hepatitis and 
opium narcosis, also in many of the affections which frequently compli- 
cate the puerperal state. 

In acute intestinal affections Ipecac has achieved its greatest reputation 
as a remedy, one of its oldest titles being radix antidysenterica. Its power 
over acute dysentery was known to Piso and Helvetius in the 17th cen- 
tury, and was mentioned by Balmain (1797), Playfair (18 13), Twining 
(1831) and Delioux (185 1). The reports thereon by Docker (1858) 
attracted general attention, and since the latter date it has been univer- 
sally recognized as a specific remedy for acute tropical dysentery and that 
of malarious districts. Under large doses, 20 to 60 grains every four 
hours, the tormina and tenesmus disappear, the character of the stools 



IRIS. 361 

improves and the constitutional symptoms are relieved. Such doses are 
not necessarily emetic in all persons, especially if administered in the 
powder, with a very small quantity of water, preceded by a full dose of 
opium or a hypodermic injection of morphine and followed by a mustard 
plaster applied to the epigastrium and perfect quiet in the recumbent 
posture. De-emetinized Ipecac is said to be as efficient as the unaltered 
drug in this disease, while nearly free from nauseant and emetic action. 
Chronic dysentery may also be benefited by this treatment, though some 
physicians prefer to use smaller doses for a prolonged time in this affection. 
Diarrheas of simple but painful form, especially the summer diarrhea of 
young children and that of teething infants, are often greatly relieved by 
Ipecac in doses of 1 to 5 grains, the bilious character being thereby 
restored to the discharges and a healthy stimulation of the alimentary 
mucosae produced. Cholera morbus and cholera infantum have frequently 
been cured by this remedy, the action of which, in these affections and 
in dysentery, is most probably that of a sympathetic nerve stimulant, 
restoring the nervous tone of the intestinal mucous membrane (Wood- 
hull). After 50 years' experience in the use of Ipecac, Dr. Higginbottam 
(1868) stated that "its main efficacy is in stimulating and restoring the 
normal action of the capillary system . ' ' The non-emetic use of this drug, 
so ably advocated by Woodhull, is not merely a method but a principle, 
and means the use of the remedy, regardless of dose, so as to develop its 
stimulant rather than its emetic power. 

Ipecac is said to be destructive to the bacillus of anthrax though not to 
its spores. As the latter are not present in malignant pustule, this drug 
may prove efficient therein and success has followed its employment. It 
is used locally after excision of the pustule, also internally in moderate 
doses. 



IRIS, Blue Flag, — is the rhizome and roots of Iris versicolor, an 
indigenous plant of the nat. ord. Iridese, growing in moist meadows and 
on the borders of swamps, having large blue flowers. It contains tannin, 
sugar, starch, gum, an acrid resin, fixed oils and traces of an alkaloid. 
Dose of the powdered root, gr. v-xx. 

Preparations. 

Extractum Iridis, Extract of Iris. — Dose, gr. j-v.. 

Extractum Iridis Fluidum, Fluid Extract of Iris. — Dose, Vt\v-^j. 

Iridin or Irisin (Unofficial), — is a so-called resinoid found in the shops, of undeter- 
mined composition, but probably an oleoresin precipitated by water from an alcoholic 
preparation. Dose, gr. j-v. 

Iris when fresh is actively purgative, emetic and diuretic, producing 
severe nausea and prostration. Iridin has been the subject of experimen- 



362 JALAPA. 

tation upon dogs, and is shown to be a powerful hepatic stimulant with 
considerable influence on the intestinal glands, being more purgative than 
Euonymin and less irritant than Podophyllin. In very small doses it 
causes obstinate constipation by producing rectal inactivity. 

Iris is very serviceable in duodenal catarrh with obstruction of the 
bile-ducts and consequent jaundice, also in malarial poisoning, bilious 
remittents, and jaundice of malarial origin. It is used in many hepatic 
and intestinal disorders as a cholagogue and purgative of mild but effi- 
cient action, also as a diuretic in dropsies. In small doses (mj of a tinc- 
ture) it is strongly recommended in a peculiar blinding headache in the 
right supraorbital region with nausea or vomiting, supposed to be of 
hepatic origin. 

JALAPA, Jalap, — is the tuberous root of Ipomcza Jalapa, a Mexican 
plant of the nat. ord. Convolvulacese. It contains 15 to 20 per cent, of 
the official Resin, which is composed of two glucosides, Jalapin, soft, 
soluble in ether, and Convolvulin, C 31 H 50 O 16 , which is hard, insoluble in 
ether, and the most active of the two. Dose, gr. v-xx. 

Preparations. 

Extractum Jalapse, Extract of Jalap. — Dose, gr. ij-x. Is an ingredient of Pil. 
Catharticse Co., and Pil. Catharticse Vegetabiles. 

Resina Jalapse, Resin of Jalap, — prepared from a tincture by precipitation by water. 
Is insoluble in water, soluble in alcohol. Dose, gr. ij-x. 

Pulvis Jalapae Compositus, Compound Powder of Jalap, [Ptilvis Purgans), — has 
of Jalap 35, Potassium Bitartrate 65, rubbed together until thoroughly mixed. Dose, 
g r - X ~3J- 

Physiological Action and Therapeutics. 

Jalap is an active cathartic, producing copious and watery stools, with 
considerable tormina and tenesmus, also sometimes nausea. It does not 
produce hemorrhoids, but does increase the secretions of the intestinal 
canal and the flow of bile. Its action is not due to any one of the con- 
tained principles, but all the active constituents are found in the resin. 
Compared with other agents of the same class its action most nearly resem- 
bles that of Scammony. It is more drastic than Senna and less irritant 
than Gamboge, but in overdoses may produce dangerous hypercatharsis. 

Convolvulin in sufficient dose is an active irritant poison, producing 
gastro-enteritis and narcotism. Its action as a purgative seems to be 
wholly local, as from its intravenous injection no catharsis results, yet it 
exerts little if any irritant action on the conjunctiva, nasal mucous mem- 
brane or skin. It is not eliminated in the urine or the feces, and is there- 
fore probably destroyed in the system by oxidation. 

In olden bowel-moving times Jalap and Calomel were used together in 
doses of gr. x each (" ten and ten "), as a routine purgative prescription. 



JAMBUL JUGLANS JUNIPERUS. 363 

Less ponderous doses are now considered equally efficient, and one grain 
of each agent with the same quantity of extract of Hyoscyamus as a cor- 
rective may be used with advantage at the onset of fevers and inflam- 
mations. As the compound powder it is much employed to produce free 
watery evacuations in ascites and anasarca. Being nearly tasteless it is a 
useful cathartic for children, and may be administered in syrup of Rhubarb 
(gr. ij-v in ^ss). As a vermifuge it is efficient as an adjunct to more 
powerful agents, and is employed with Calomel and Santonin for the 
expulsion of lumbrici. Jalap is contraindicated in all inflammatory con- 
ditions of the intestinal mucous membranes, but in proper doses it is one 
of the most manageable and efficient cathartics. 

JAMBUL, Jamun (Unofficial), — the seeds and bark of the Eugenia Jambolana, a 
native tree of India, has a very varied history of successes and failures in the treatment 
of diabetes. The British Medical Association has directed its Committee on Therapeutics 
to investigate the claims made for and against this agent, so that some reliable informa- 
tion may be expected concerning this very important question. One writer contends that 
any efficient preparation should be made from the fresh seeds, discarding the pericarps, 
and avoiding the application of heat ; also that a weak alcoholic menstruum exhausts the 
drug and gives a stable preparation. Dose of a fluid extract, TTLv-xv. 

Reports, from observers abroad and in this country, show that favorable results have been 
obtained with Jambul in many cases of diabetes, even after the unsuccessful use of all the 
usual remedies. In two severe cases, in which 7 and 3 per cent, respectively of glucose 
was excreted, the urine was brought back to normal and kept there for two years, by the 
use of this remedy. It should be given with or after meals, in water or wine sweetened 
with a small quantity of saccharin, and accompanied by general treatment. 

JUGLANS, Butternut, — is the bark of the root, collected in autumn, of Jitglans 
cinerea, the Butternut or White Walnut, an indigenous forest tree of the nat. ord. 
Juglandaceae. It contains an orange-yellow, crystalline and acrid substance named 
Juglandic Acid or Nucin, resembling Chrysophanic Acid, also some resin, volatile acid, 
etc., but neither tannin nor any alkaloid. 

Extractum Juglandis, Extract of Juglans. — Dose, gr. v-xx or more. 

Juglans is a mild cathartic operating without the production of pain or irritant symp- 
toms. It is never used in substance, but the extract is a good laxative in doses of gr. 
v-x, and a purgative in larger doses. It has considerable reputation in dysentery and 
chronic constipation. 



JUNIPERUS, Juniper, — the source of the official Oleum Juniperi, 
is the fruit of Juniperi s communis, an evergreen shrub of the nat. ord. 
Coniferae, growing in Europe and N. America. It contains a Volatile Oil, 
which consists of terpenes and camphors in complex combination, also a 
non-crystallizable principle named Juniperin, and grape sugar, resin, 
formic, acetic and malic acids, etc. The Oil, a Spirit, and a Compound 
Spirit are official. 

Preparations. 

Oleum Juniperi, Oil of Juniper, — is the volatile oil, a colorless or faintly greenish- 
yellow liquid, sp. gr. 0.850 to 0.890; of terebinthinate and sweetish taste and the odor 
of juniper; soluble in 4 times its vol. of alcohol, and in an equal vol. of carbon disul- 
phide. Dose, Tt\v-xv. 



364 KAMALA KAVA KAVA. 

Spiritus Juniperi, Spirit of Juniper, — has of the Oil 5 in Alcohol 95. Dose, gj-iv 
or more, according to the quantity of alcohol desired. 

Spiritus Juniperi Compositus, Compound Spirit of Juniper, — has of the Oil 8, Oil 
of Caraway I, Oil of Fennel 1, Alcohol 1400, Water to 2000. It approximates closely 
a good grade of Gin. (See ante, page 13 1.) Dose, £j-iv, or more, according to the 
quantity of alcohol desired. 

Oleum Cadinum, Oil of Cade (Empyreumatic Oil of Juniper}, — is a product of the 
dry distillation of the wood of Juniperus Oxycedrus. It is a tar-like substance, of un- 
certain composition and purity : a dark-brown, clear, thick liquid, of tarry odor and a 
somewhat bitter, burning taste ; insoluble in water, partially soluble in alcohol, com- 
pletely so in ether, chloroform or carbon disulphide. Used locally as a stimulant in pso- 
riasis and chronic eczema. 

Infusum Juniperi, Infusion of Juniper (Unofficial), — has of Juniper Berries ^j in 
Oj of boiling water. Dose, ^j-ij. 

Juniper is a stomachic tonic, diaphoretic, diuretic and aphrodisiac. 
The oil is the active principle, and is readily diffused, exciting increased 
cardiac action, stimulating the renal functions and the action of the skin, 
and causing a subjective sense of heat throughout the system. It is elimi- 
nated chiefly by the kidneys, and may set up renal irritation, in large 
doses producing strangury, priapism, hematuria, suppression of the urine 
and uremic convulsions. It imparts a violet odor to the urine, and will 
produce diuresis when inhaled. 

The Oil of Juniper is used to flavor gin and to impart the diuretic power 
popularly ascribed to that liquor. The medicinal use of the juniper 
preparations (spirit and compound spirit) is restricted to their employ- 
ment as vehicles for less irritant diuretics. The oil acts therapeutically 
like the oil of Turpentine, and may be used in chronic pyelitis and cys- 
titis, prostatorrhea, gleet, etc., but is contraindicated in all cases where 
acute inflammation of the kidneys exists. 

Oil of Cade is used locally in chronic skin diseases as a stimulant appli- 
cation. It is too active for acute eruptions, but has been used with benefit 
in chronic eczema and psoriasis. The Oil of Tar (see under Pix) is equally 
efficient for all the purposes to which the Oil of Cade has been applied. 

KAMALA, Rottlera, — the glands and hairs from the capsules of Mallotus philip- 
pinensis, or Rottlera tinctoria, a small tree of the nat. ord. Euphorbiaceae, growing in 
Abyssinia, Arabia, India, China, etc. It occurs as a granular, mobile, brick-red powder, 
inodorous and nearly tasteless, partly soluble in alcohol and in ether. It contains several 
resins, one of which is named Rottlerin, C n H 10 O 3 , also tannin, starch, gum, red coloring 
matter, etc. There are no official preparations. Dose, gss-iij. 

Kamala is anthelmintic and purgative, sometimes causing nausea and colic, seldom 
vomiting. It is used as a teniafuge and to expel the round and thread worms. One 
or two drachms are given suspended in water, mucilage or syrup, and repeated in 4 
hours if necessary. A tincture ( 3 vj in ^ xvj of alcohol) may be used in doses of g j- ^ ss. 
In India it is used locally in scabies and other skin affections and has been found of 
especial service in herpetic ringworm. As a remedy against tapeworm it is perhaps next 
after Male-fern in efficiency and requires no preparatory treatment. 

KAVA-KAVA, Ava-Kava (Unofficial), — the root of Piper methysticum, a. shrub 
of the nat. ord. Piperacese, growing in South America and the South Sea Islands. It 
contains a crystalline principle, Kavahin or Methysticin, which is analogous to Piperin, 



KINO KRAMERIA LACTUCARIUM. 365 

an acrid, greenish-yellow resin, Kawin, which is probably the active principle, also a 
Volatile Oil. Dose, ^ss-j, macerated in water, or the same quantity of a fluid extract. 
Kava is intoxicant, diuretic and motor-depressant. A beverage is prepared in the 
Hawaiian Islands by chewing the root and then infusing it in water or cocoanut milk, 
which produces a drowsy intoxication with pleasant dreams often of erotic character, and 
followed by severe headache. A moderate dose is tonic and stimulant, lessening the 
sense of fatigue and sharpening the mental faculties. It is highly recommended in 
gonorrhea and gout, also in chronic gleet and obstinate cystitis. 

KINO, — is the inspissated juice of Pterocarpus Marsupium, a tall tree of the nat. ord. 
Leguminosae, growing in India. It contains 75 per cent, of a variety of tannin named 
Kino-tannic Acid, which gives a greenish precipitate with persalts of iron, also a crystal- 
line, neutral substance, Kinoin, and Kino-red, gum, pectin, etc. There are several other 
varieties of Kino in the market, brought from S. America, Africa, Australia, etc., which 
are products of other trees than the official one. 

Tinctura Kino, Tincture of Kino, — has of Kino 10, in Alcohol 65, Water 20 and 
Glycerin 15. Dose, 3 ss— ij. 

Pulvis Kino Compositus, Compound Powder of Kino, (Unofficial) — contains 5 per 
cent, of Opium, and has of Kino 15, Opium I, Cinnamon 4. Dose, gr. v-xx. 

The action of Kino is the same as that of Tannic Acid, though less powerful, and it 
may be used for the same purposes, both internally and locally. It is chiefly employed 
as an astringent gargle and as a constituent of diarrhea-mixtures. The tincture, in 
drachm doses, is one of the most efficient means of combating the atonic diarrhea which 
results from the disuse of opium or morphine. 

KRAMERIA, Rhatany, — is the root of Krameria triandra and Krameria Ixina, 
shrubs of the nat. ord. Polygaleae, growing in S. America, the first-named in Peru and the 
latter in New Granada. It contains 20 to 45 per cent, of Rhatania-tatinic Acid, also 
Rhatanine, an alkaloid, and wax, gum, etc. 

Extr actum Krameriae, Extract of Krameria, — aqueous. Dose, gr. v-x. 

Extractum Krameriae Fluidum, Fluid Extract of Krameria. — Dose, Tt\v-3ss. 

Tinctura Krameriae, Tincture of Krameria, — 20 per cent. Dose, XCSjf-^]. 

Syrupus Krameriae, Syrup of Krameria, — has of the Fluid Extract 45 parts, with 
Syrup 55. Dose, gss-^ss. 

Trochisci Krameriae, Troches of Krameria , — each troche contains gr. j of the extract, 
with Tragacanth, Sugar and Orange- Flower Water. 

Krameria possesses the same astringent qualities as Tannic Acid and maybe employed 
for the same purposes, except as an antidote to Antimony. It has long had a high repu- 
tation as an injection for fissure of the anus, as a local application to spongy gums, as a 
tonic for debilitated subjects, in chronic diarrhea, also in passive hemorrhages and mu- 
cous discharges, as menorrhagia and leucorrhea. 

LACTUCARIUM, Lettuce, — is the concrete milk-juice of Lactuca virosa, the 
Acrid Lettuce, a biennial European plant of the nat. order Compositse. It is partly solu- 
ble in alcohol and in ether, and yields a turbid mixture when triturated with water. Lac- 
tucarium is a mixture of several substances, the most important being Lactocin, which is 
thought to be the active principle. It occurs in white scales, soluble in water, and used 
as a sedative and hypnotic in doses of gr. j-v. Lactucarium also contains three bitter 
principles, Lactucin, Lactopicrin and Lactucic Acid ; also Lactucerin, an inert, waxy 
substance, constituting nearly one-half of the drug. A minute quantity of a mydriatic 
alkaloid, believed to be Hyoscyamine, has been found in the plant, but not in commercial 
lactucarium. 

Tinctura Lactucarii, Tincture of Lactucarium, — 50 per cent. Dose, TTLx-^ij, 
according to the activity of the drug. 

Syrupus Lactucarii, Syrup of Lactucarhim, — has of the Tincture 10 per cent. 
Dose, SJ-gj. 

Lactucarium is feebly hypnotic, somewhat sedative and diuretic. It is supposed to 
act similarly to Opium, but very feebly and without depressing after-symptoms. As much 



^■^ 



366 LAPPA LAVANDULA LEPTANDRA. 

as half an ounce has been given to a dog without causing any special effect. Its prepa- 
rations are very uncertain in activity, and are chiefly used as placebos, to allay cough 
and quiet nervous irritability. The syrup is a good vehicle for expectorants and anti- 
spasmodics. 



LAPPA, Burdock, — is the root of Arctium Lappa, and of other 
species of Arctium, the common Burdock, a biennial weed of the nat. 
ord. Compositae, found in waste places and along roadsides in Europe, Asia 
and N. America. Three varieties are recognized, formerly known as 
Lappa major, Z. Tomentosa, and L. Minor, of which the first-named is 
most frequently met with in this country. It contains a bitter principle, 
traces of a volatile oil, also inulin, resin, tannin, mucilage, sugar, etc. 

Extractum Lappae Fluidum, Fluid Extract of Lappa, — made with diluted alcohol. 
Dose, 3J-ij. Dr. Squibb recommended a Tincture of the seed ; lb. j of ground seed to 
gall, j of whiskey, allowed to stand for two weeks before decanting, and used in doses of 
5 ij-iij before meals. 

Lappa promotes all the secretions and is considered aperient, diuretic 
and diaphoretic, without irritating qualities. In decoction it has been a 
popular domestic remedy for many morbid conditions, especially rheuma- 
tism, gout, pulmonary catarrhs, and chronic cutaneous affections. By 
several practitioners it is praised as an alterative in constitutional diseases, 
as syphilis and scrofula, also as an external application to swellings, 
hemorrhoids and chronic sores. A tincture of the seed has proved re- 
markably efficient as a stomachic tonic and has cured several cases of 
psoriasis inveterata. [See Squibb's Ephemeris, vol. i, page 116.] 

LAVANDULA, Lavender, — the source of the official Oil of Lavender Flowers, 
is the fresh flowers of Lavandula officinalis, a small European shrub of the nat. ord. 
Labiatae, largely cultivated in England. They have a fragrant odor, and an aromatic, 
camphoraceous taste ; and contain resin and tannin, also a Volatile Oil. 

Oleum Lavandulae Florum, Oil of Lavender Flowers, — is a volatile oil distilled 
from fresh Lavender, and having the fragrant odor of the flowers. It is soluble in alco- 
hol in all proportions, also in 3 times its volume of a mixture of alcohol 3 and water I, 
also in glacial acetic acid. Dose, Try -v. 

Spiritus Lavandulae, Spirit of Lavender, — has of the Oil 5, in Deodorized Alcohol 
95. A perfume and flavoring agent. Dose, gss-j. 

Tinctura Lavandulae Composita, Compound Tincture of Lavender, — an aromatic 
stimulant, composed of the Oil 8, Oil of Rosemary 2, Cassia Cinnamon 20, Cloves 5, 
Nutmeg 10, Red Saunders 10, Alcohol 700, Water 250, Diluted Alcohol to 1000. Is a 
constituent of Liquor Potassii Arsenitis. Dose, 3 ss— ij. 

Lavender is aromatic, stimulant and carminative, but is rarely used alone as a medicine. 
It is an agreeable flavoring and perfume, in the form of the official spirit, which is sold 
under the name of "Lavender-water,''' 1 after the addition of Oil of Bergamotand Essence 
of Ambergris. The compound tincture, formerly called the compound spirit of Lavender, 
is a very agreeable combination of spices, and is much used as a remedy for gastralgia, 
nausea, flatulence, etc., and as an adjuvant or corrigent of other medicines. 

LEPTANDRA, Culver's Root, — is the rhizome and rootlets of Veronica virginica, 
an indigenous perennial plant of the nat. ord. Scrofularineee. It contains a glucoside 
named Leptandrin, which is probably the active principle, also Saponin, resin, tannin, 
etc. The Leptandrin of the shops is an impure alcoholic extract. 



LICOPERDON GIGANTEUM LIMON. 367 

Extractum Leptandra?, Extract of Leptandra, — is a constituent of Pil. Catharticae 
Vegetabiles. Dose, gr. j-iij. 

Extractum Leptandrae Fluidum, Fluid Extract of Leptandra. — Dose, VC[xx-^j. 

Leptandra is tonic, laxative, and like other resin-bearing purgatives is decidedly chola- 
gocrue. The recent root is a violent cathartic, but in the dried state it is less active. It 
is indicated in duodenal indigestion and chronic constipation with insufficiency of the 
biliary and intestinal secretions. 

LICOPERDON GIGANTEUM, Puff-Bali (Unofficial),— is a common fungus of 
the nat. ord. Trichogastres, found in hilly and wooded districts. The dust, which con- 
sists of the capillitium and spores, is a valuable hemostatic, and dusted over bleeding 
surfaces acts promptly in arresting hemorrhage. It has been proposed as a surgical 
dressing, but while useful in emergencies where other agents are unattainable, the fetor 
which results from its application to wounds will prevent its use becoming general for 
this purpose. It may prove of value as an internal hemostatic in hematemesis and the 
hemorrhage of typhoid fever. 



LIMON, Lemon, — is the fruit of Citrus Limonum, a tree of the nat. 
ord. Rutacese, native in Asia, but cultivated in Southern Europe and 
many other countries. It is official in the two forms described below. 
The Orange {Citrus Vulgaris and C. Aurantium), the Citron {Citrus 
medico), and the Lime {Citrus acris), all belong to the same genus. 

Limonis Cortex, Lemon Peel, — is the rind of the recent fruit, and 
contains a Volatile Oil, C 10 H 16 , which is official, and a bitter crystalline 
glucoside, Hesperidin, chiefly contained in the white of the rind. 

Limonis Succus, Lemon Juice, — is the freshly expressed juice of the 
ripe fruit, each lemon yielding from ^ to 1 fluid ounce. It contains 
about 7 per cent, of free Citric Acid, besides Phosphoric and Malic 
Acids, Citrates of Potassium and of other bases, etc. Dose, §ss-iv. 

Acidum Citricum, Citric Acid, H 3 C 6 H 5 7 -f- H 2 0, — is obtained 
from the juice of the Lemon or the Lime by adding chalk to form calcium 
citrate, which is then decomposed by dilute sulphuric acid. It occurs 
in colorless, rhombic crystals which are very soluble in water. A solution 
of gr. xvij in ^ss of water corresponds to ^ss of fresh lemon-juice, and this 
quantity of either will neutralize of Potassium Bicarbonate gr. xxv, of 
Sodium Bicarbonate gr. xx, and of Ammonium Carbonate gr. xivss. 
Dose, gr. x-xxx. 

Citrates of Bismuth, Bismuth and Ammonium, Iron, Iron and Ammonium, Iron and 
Quinine, Iron and Strychnine, Lithium, Magnesium, Potassium, nine in all, are official. 
They are described under their respective bases, to which their medicinal qualities are due. 

Preparations. 

Oleum Limonis, Oil of Lemon, C 10 H 16 , — is the volatile oil, isomeric with oil of tur- 
pentine, and extracted from fresh lemon peel by mechanical means. It is used for flavor- 
ing and is an ingredient of Spiritus Limonis, Spiritus Aurantii Compositus, and Spiritus 
Ammonia Aromaticus. Dose, TT\j-v. 

Spiritus Limonis, Spirit of Lemon, Essence of Lemon, — is prepared by macerating 
5 of the Oil and 5 of the Peel, freshly grated, in Deodorized Alcohol to 100. Used for 
flavoring. Dose, according to the amount of alcohol desired to be given. 



368 LINUM. 

Syrupus Acidi Citrici, Syrup of Citric Acid, — has of Citric Acid 10, Water 10, 
Spirit of Lemon 10, Syrup to 100. Dose, indefinite. 

Physiological Action and Therapeutics. 

Lemon-peel is bitter and probably tonic to the stomach, but is used 
only for flavoring purposes. Lemon-juice, on the other hand, is refrig- 
erant and antiscorbutic, entering the blood as alkaline citrates, potassium 
salts and phosphoric acid, the citrates being therein partly oxidized into 
C0 2 and H 2 0, while the potassium salts and phosphoric acid probably act 
upon the red corpuscles. Citric Acid has the same general action as 
Acetic and the other vegetable acids. It is wholly decomposed in the blood, 
and appears to be non-toxic in man, but used internally it may precipi- 
tate uric acid and thus promote the formation of calculi. Lemon-juice 
is employed largely in the treatment and prevention of scurvy, in which 
disease it possesses powers of specific rank, but whether its action therein 
is due to the citric acid, the phosphoric acid or the salts of potassium is 
not known. Lime-juice is equally efficient but Citric Acid itself is not so. 

As refrigerants and diuretic mixtures in fevers, Lemon-juice and Citric 
Acid are much used, entering into the composition of lemonades, effer- 
vescing draughts, etc., to allay thirst and subdue restlessness, and to pro- 
mote the action of the skin and the kidneys. For acidity of the stomach 
they are efficient if given in small doses before meals, but the mineral 
acids are usually preferred for this purpose. Long continued they will 
impair digestion and impoverish the blood. Atheromatous degeneration 
of the vessels is said to be retarded by the daily use of lemon-juice, which 
is supposed to dissolve the excess of inorganic matter and to aid its ex- 
cretion. Obesity may be reduced by using the juice of limes or lemons in 
large quantity, but it will be done at the expense of the digestion. Lemon- 
juice has been found of service in acute rheumatism, probably through 
the alkalies which it conveys into the blood. As a local application it 
has been found efficient in pruritus scroti, sunburn, post-partum hem- 
orrhage, and as a gargle in diphtheritic sore throat. 

LINUM, Linseed, Flaxseed, — is the seed of Linum usitatissimum 

(flax), a cultivated annual plant of the nat. ord. Linese. It contains 

15 per cent, of Mucilage in the epithelium, also 30 to 40 per cent, of 

Fixed Oil in the embryo. Ground Linseed should yield not less than 25 

per cent, of the fixed oil. 

Preparations. 

Oleum Lini, Linseed Oil, — the fixed oil expressed from Linseed without the use of 
heat. A yellow, oily liquid, of slight odor, bland taste, and neutral reaction, soluble in 
about 10 of absolute alcohol and in \]/ 2 of ether. Consists chiefly of the Glyceride of 
Linoleic Acid, C 16 H 28 4 , which having a powerful affinity for oxygen becomes resinoid 
on exposure to the air, making it a " drying oil." Dose, ^ss-ij. 



LITHIUM. 369 

Infusum Lini, Linseed Tea (Unofficial), Linseed 3 iij, Liquorice-root gj, Boiling- 
Water %x, infused for four hours and strained. Dose, indefinite. 

Linimentum Calcis, Lime Liniment, Carron Oil, — consists of equal volumes of 
Linseed Oil and Lime-water, emulsified by agitation. A favorite application for burns. 

Physiological Action and Therapeutics. 
Linseed is demulcent, emollient, expectorant and diuretic. The oil is 
laxative in a dose of §j, and in smaller doses is oxidized in the system 
and excreted as a resinoid body by the kidneys, which it stimulates 
slightly. The Infusion contains the mucilaginous principle and a small 
portion of the oil, and is advantageously used in inflammations of the 
mucous membrane of the throat, the gastro-intestinal tract and the urin- 
ary passages. It is an excellent demulcent in coughs of various kinds, 
and will be found very serviceable in cystitis, irritable bladder, renal 
colic, strangury, etc. The Oil may be administered internally as a laxa- 
tive, and has considerable reputation as a remedy for hemorrhoids in 
doses of gij twice daily. For laxative purposes (especially in children) 
it is usually administered as an enema. Externally it is a favorite appli- 
cation to burns, when made into an emulsion with lime-water, as in the 
official Linimentum Calcis. The ground seed (linseed or flaxseed meal), 
is one of the best agents for making poultices, and is universally employed 
for that purpose. [Compare the article on Poultices in Part III.] 

LITHIUM, Li, — is represented in the Pharmacopoeia by five of its 

salts, of which the Carbonate is but slightly soluble while the others are 

readily so. The low atomic weight of this metal (7) makes its saturating 

power greater than that of other alkaline metals, hence the value of its 

salts in medicine. 

Salts of LAthium. 

Lithii Benzoas, Lithium Benzoate, LiC 7 H 5 2 , — is classed with the Benzoates and 
described under Benzoinum. 

Lithii Bromidum, Lithium Bromide, LiBr, — is classed with the Bromides and de- 
scribed under Bromum. 

Lithii Carbonas, Lithium Carbonate, Li 2 C0 3 , — a light, white powder, permanent in 
the air, odorless, of alkaline taste and reaction, soluble in 80 of water, insoluble in alcohol. 
Dose, gr. ij-xv. 

Lithii Citras, Lithium Citrate, Li 3 C 6 H 5 7 , — a white, deliquescent powder, odorless, 
of faintly alkaline taste and neutral reaction, soluble in 2 of water, almost insoluble in 
alcohol. Dose, gr. v-xxx. 

Lithii Citras Effervescens, Effervescent Lithium Citrate, — prepared from the Car- 
bonate 7, with Sodium Bicarbonate 28, Citric Acid 37, and Sugar to 100. Dose, £j-ij, 
in water, as an effervescent drink. 

Lithii Salicylas, Lithium Salicylate, 2LiC 7 H 5 3 , — is classed with the Salicylates and 
described under Salix. 

Physiological Action and Therapeutics. 
The Lithium salts have strong alkaline qualities and act on the system 
in the same manner as other alkalies (see under Potassium). The high 
24 



370 LOBELIA. 

saturating power of this metal makes its salts more alkaline than those of 
potassium, sodium, or calcium, hence more efficient in alkalinizing the 
urine. Lithium Urate is the most soluble of the alkaline urates, hence 
the value of lithium salts in the uric acid diathesis. The Carbonate and 
Citrate are the salts referred to in this connection, the others partaking 
more of the qualities of their acid factors. Both these salts are antacid 
and strongly diuretic; the carbonate being but slightly soluble should be 
given in carbonic acid water, and the citrate in dilute solution. The 
latter may be extemporaneously prepared by adding citric acid to an 
aqueous solution of the carbonate, and in the organism is decomposed, 
the citric acid being oxidized and the carbonate formed. Many mineral 
waters contain small quantities of the carbonate, varying from a mere 
trace to grain o.oi in a pint, an amount so minute as to be practically 
inert in comparison with the much greater quantities of potassium and 
sodium salts in the same waters. 

Lithium Carbonate and Citrate are extensively used in gout and the 
lithemic diathesis, for the purpose of holding the uric acid in solution as 
lithium urate and preventing its deposit in the tissues as sodium urate 
which is less soluble. Their prolonged administration is so efficient in 
this affection that they have been credited with the power of dissolving 
uric acid calculi and called lithontriptics. They are also highly useful in 
the indigestion and rheumatism of obese subjects, and in irritable bladder 
from excess of acid in the urine. Lithiated Arsenical Water has been 
highly praised as a remedy in diabetes. 

LOBELIA, Lobelia, Indian Tobacco, — the leaves and tops of 
Lobelia inflata, nat. ord. Lobeliaceae, collected after a portion of the 
capsules have become inflated. The plant is a common annual weed 
growing on roadsides throughout the United States, having pale-green 
alternate leaves, and small, pale-blue flowers. It contains gum, resin, 
fixed oil, wax, lignin, salts of calcium, potassium and iron, a liquid alka- 
loid, Lobeline, which is the narcotic principle of the plant, also Lobelic 
Acid, and an acrid substance named Lobelacrin. 

Preparations. 
Extractum Lobeliae Fluidum, Fluid Extract of Lobelia. — Dose, TT\j-x. 
Tinctura Lobeliae, Tincture of Lobelia, — 20 per cent. Dose, TTLv-xxx. 
Infusum Lobelias, Lnfnsion of Lobelia (Unofficial), — ^j to a pint. Dose, 3J-^j- 
Lobelinum, Lobelin (Unofficial), — an impure resinoid. Dose, gr. ss-j. 

Physiological Action and Therapeutics. 
Lobelia has an acrid, nauseous taste, and a heavy, unpleasant odor. It 
is expectorant, diaphoretic, emetic, purgative, antispasmodic, motor-de- 



LYCOPODIUM. 371 

pressant and narcotic. It excites an abundant flow of saliva, much gastric 
mucus, profuse urination and sweating, with nausea, vomiting and great 
depression. The heart's action is enfeebled, and the blood-pressure, at 
first increased, soon falls ; muscular debility, reduced temperature and 
coma follow, and death occurs by paralysis of the respiratory apparatus. 
The drug produces paralysis of the motor nerve-trunks, the peripheral 
vagi, and probably the respiratory and vaso-motor centres also. It strongly 
resembles tobacco in its action, and is highly dangerous in full medicinal 
doses, having caused many deaths when administered therapeutically, the 
most important instance of its fatal results being the case of Ezra 
Lovett, Jr., who in 1809 was poisoned by Lobelia administered by the 
founder of the Thomsonian sect of medical practitioners. The responsi- 
ble party escaped conviction on the plea that he gave the drug in igno- 
rance of its qualities. 

Antidotes and Incompatibles. 

Tannic Acid to form the insoluble tannate. Strychnine, Picrotoxine and Thebaine 
antagonize its action on the nervous system ; the vaso-motor excitants, as Alcohol, 
Digitalis, Belladonna, Ergot, etc., antagonize its effects on the circulation. Caustic 
Alkalies are incompatible, decomposing the alkaloid. 

Lobelia was a favorite remedy with the Indians at the time of the first 
settlement of the United States, and was introduced into regular practice 
as an anti-asthmatic, after having served as the main stock-in-trade of 
irregular practitioners for many years. Its principal therapeutic action is 
that of an antispasmodic, and in cautious hands it is extremely useful in 
paroxysmal spasmodic asthma, as also in dry cough with constant tickling 
in the throat. As an enema in cases of strangulated hernia the infusion 
is much safer than tobacco and fully as efficient, and may overcome 
the obstruction in intussusception, while the tincture in 2-drop doses 
every hour will often relieve a case of impacted cecum. In constipation 
from atony and deficient secretion a 10-minim dose of the tincture at bed- 
time acts excellently, and in the poison-oak eczema the infusion is a good 
local application. As an emetic it is entirely too depressant for children. 

LYCOPODIUM, — is a very mobile, pale-yellow, fine powder, consisting of the spores 
of the Club-moss, Lycopodium clavatum, and of other species of Lycopodium (nat. ord. 
Lycopodiacese), a native of Europe and the U. S. Lycopodium is odorless, tasteless, 
floats on water, which does not wet it, and burns quickly when thrown on a flame. It 
should be free from pine-pollen, starch, sand and other impurities, which are detected by 
means of the microscope, the lycopodium spores being about -g^ of an inch in diameter, 
four-sided and reticulated, with short projections on the edges. They contain about 47 
per cent, of a bland, fixed oil. 

The plant was formerly considered to be diuretic and antispasmodic, and was used in 
rheumatism and epilepsy, also in pulmonary and renal disorders. The powder is em- 
ployed quite extensively in pharmacy to facilitate the rolling of a pill-mass and to prevent 
adhesion of pills to each other. It makes an excellent absorbent and protective powder - 
when dusted over an excoriated surface, as between the thighs of infants. 

By the homeopathic practitioners Lycopodium is elevated to the rank of an active 



372 MAGNESIUM. 

drug when triturated with sugar of milk sufficiently long to break up the seeds and liber- 
ate their oily contents. In their first centesimal trituration ( t £q) it is said to have pro- 
duced symptoms of excitement of the circulation and irritation of the urinary organs, and 
they profess to use it with benefit in affections of the mucous tracts, dyspepsia, pyrosis, 
flatulence, constipation, ileo-colitis of infants, hepatic congestion, aneurism, chronic affec- 
tions of the lungs and bronchi, diphtheria, lithiasis, intertrigo, porrigo capitis, plica 
polonica and pruritus ani, in all of which as an internal remedy and in high attenuation. 



MAGNESIUM, Mg. — This metal is represented by its Oxide, 
Carbonate, Citrate and Sulphate, of which the last occurs native in sea- 
water, caves, etc., the others being prepared from it. The first two are 
almost insoluble in water or alcohol. Its salts are either white or color- 
less, and those which are official are as follows : — 

Official Salts of Magnesium. 

Magnesia, Magnesia, Magnesium Oxide, MgO, — made by heating the light carbon- 
ate in a crucible to expel nearly all the carbonic acid. A white, light and very fine 
powder, almost insoluble in water, insoluble in alcohol, and gelatinizes with 15 of water 
after standing y z hour, having become hydrated. Is a constituent of Pulvis Rhei Com- 
positus, Massa Copaibae and Ferri Oxidum Hydratum cum Magnesia. Dose, gr. x-^j. 

Magnesia Ponderosa, Heavy Magnesia, Magnesium Oxide, MgO, — is a white, 
dense and very fine powder, corresponding in other properties and reactions to Mag- 
nesia, except that it does not gelatinize with water. It is made by calcining the heavier 
carbonate, and is much slower in action than the light magnesia. Dose, gr. x-gj. 

Magnesii Carbonas, Magneshim Carbonate (MgC0 3 ) 4 Mg(HO) 2 -f- 5H 2 0, — light, 
friable masses, or powder, odorless and tasteless, insoluble in alcohol, almost insoluble in 
water. Dose, gr. x-^j. 

Magnesii Sulphas, Magnesium Sulphate, Epsom Salt, MgS0 4 -}- 7H 2 0, — colorless 
prisms or acicular needles, slowly efflorescent, odorless, of cooling, saline taste, and neu- 
tral reaction, very soluble in water, insoluble in alcohol. Is a constituent of Infusum 
Sennse Compositum. Dose, gj-^j. 

Preparations. 

Magnesii Citras Effervescens, Effervescent Magnesium Citrate, — is prepared from 
the Carbonate 10, Citric Acid 46, Sodium Bicarbonate 34, Sugar 8, Alcohol and Distilled 
Water, as required. A coarsely granular, white, deliquescent salt, of acid taste and 
reaction, soluble in 2 of water, insoluble in alcohol. Dose, 3 j— 3 j . 

Liquor Magnesii Citratis, Solution of Magnesium Citrate, — prepared from the Car- 
bonate 15, Citric Acid 30, Syrup of Citric Acid 60, Potassium Bicarbonate 2^, Water to 
360. Dose, Sj iv-vj, repeated for catharsis. 

Mistura Magnesiae et Asafcetidse, Magnesia and Asafetida Mixture, Dewees'' Car- 
minative (Unofficial), — contains of the Carbonate 5, Tincture of Asafoetida 7, Tincture 
of Opium 1, Sugar 10, and Distilled Water to 100. Dose, ^ss-iv. Used for flatulent 
colic and diarrhea in infants. 

Physiological Action. 
Magnesia and the Carbonate are mildly laxative and antacid, neutraliz- 
ing free acids in the stomach and forming therewith laxative salts. If used 
in large quantity for any length of time Magnesia may become hydrated 
and produce intestinal concretions. The freshly precipitated Hydrate 
(see above under Magnesia) is an antidote to arsenic in solution, but less 
effective than the hydrated sesquioxide of iron, with which it is combined 



MAGNESIUM. 373 

in the official Ferri Oxidum Hydratum cum Magnesia. Magnesia may 
also be used in poisoning by acids or phosphorus. 

The Citrate and Sulphate are saline cathartics, the latter being the more 
powerful on account of its bitterness. If administered in plenty of water 
it usually produces a prompt and free discharge from the intestines with 
but little irritation or griping, but often accompanied by a sense of cold- 
ness and depression. The purgative action is chiefly due to its causing a 
greatly increased secretion of intestinal fluids, not by outward osmosis 
from the vessels as was formerly taught, but by stimulation of the intestinal 
glandular appendages. If the purgative action should not take place a 
diuretic one may result, but to secure the desired catharsis the drug 
should be administered in a considerable quantity of water. Magnesium 
Sulphate is the principal aperient constituent of many of the popular 
laxative mineral waters, as Friedrichshall, Piillna, Hunyadi, etc. When 
injected into the circulation it is powerfully toxic, paralyzing first the 
respiration and then the heart. It abolishes sensation and paralyzes the 
sensori-motor reflex centres (Murrell). 



Therapeutics. 
Magnesia and the Carbonate are used as antacids and laxatives, in acid- 
ity, sick headache, flatulent colic, etc., and as antidotes in poisoning by 
acids, arsenic, phosphorus, and mercuric and cupric salts. The Citrate is 
an agreeable laxative, cooling and acceptable to the stomach. The Sulphate 
is one of the most efficient of the saline cathartics and has a wide field of 
application. In acute inflammatory conditions, renal and cardiac dropsy, 
ascites from obstruction of the portal circulation, increased blood-pressure 
within the cranium, intestinal obstruction without acute inflammation, the 
constipation of lead poisoning, and habitual constipation from deficiency 
of the intestinal secretions, this agent will be found to be exceedingly 
serviceable. As it has but little influence on intestinal peristalsis it is 
usually combined with Senna, as in the official Black Draught, which in- 
creases its purgative action. Acute dysentery is well treated by magne- 
sium sulphate combined with diluted sulphuric acid, and followed by 
opium and starch enemata. Bleeding from hemorrhoids and uterine 
hemorrhage are often relieved by the same combination when other agents 
fail. In acne vulgaris and other obstinate eruptions due to derangement 
of the stomach and intestinal canal, good results are often obtained by a 
purgative dose of the sulphate daily before breakfast, or by doses of 5 
grains in water three or four times a day. The same salt, finely triturated, 
makes an excellent dusting powder for acne rosacea. The ferro-saline 
mixture (see ante, page 319) is a useful laxative in the constipation of* 
anemic women. The bitter taste of this salt is best covered by coffee. 



374 MAGNOLIA MANACA MANGANUM. 

MAGNOLIA (Unofficial), — is the bark of Magnolia glauca (Sweet Bay, Swamp 
Sassafras), M. actaninata (Cucumber-tree), and M. tripetala (Umbrella-tree), all of which 
belong to the nat. ord. Magnoliacese, and are indigenous to the Eastern and Southern 
States. It contains a crystalline principle named Magnolin, which is insoluble in water, 
but soluble in alcohol, ether, etc. Dose of the powdered bark, ,^ss-j. 

Magnolia is an aromatic bitter tonic and diaphoretic, usually employed in chronic 
rheumatism, remittent and intermittent fever. In the latter affection it will arrest the 
paroxysms if used freely. 

MANACA (Unofficial), — is the root of Franciscea uniflora, a shrub of the nat. ord. 
Scrophularineae, indigenous to Brazil, where it is known as Mercurio-vegetal, or Vege- 
table Mercury, a name applied by charlatans to a number of widely differing plants. 
Very little is known about Manaca, but it has been extensively advertised as an unfailing 
remedy for sub-acute and chronic rheumatism. It is also considered purgative, diuretic, 
emmenagogue and antisyphilitic, being official in the Brazilian Dispensatories, and 
noticed as follows in the Diet, de Botan. Brazileira. 

" This whole plant, but especially the root, excites powerfully the lymphatic system, 
eliminating morbid matter by the skin and kidneys. It is antisyphilitic ; the interior 
bark is nauseating and stimulates the throat. In small doses it is resolvent ; in larger 
purgative, diuretic and emmenagogue. In large doses it is an acrid poison." 

A fluid extract is on the market, the average dose of which is tt\x. 



MANGANUM, Manganese, Mn. — This metal is represented in 
the Pharmacopoeia by three of its salts, the native Black Oxide, the Sul- 
phate, and the Permanganate of Potassium. 

Mangani Dioxidum, Manganese Dioxide {Black Oxide of Manganese), — is the 
native, crude Dioxide of Manganese, containing at least 66 per cent, of the pure Dioxide, 
Mn0 2 . A heavy, grayish-black powder, odorless and tasteless, insoluble in water or alco- 
hol, giving off oxygen gas at a red heat, and if heated with hydrochloric acid it causes 
the evolution of chlorine gas. Is used in preparing Chlorine Water. Dose, gr. ij-x. 

Mangani Sulphas, Manganese Sulphate, MnS0 4 -f- 4.H 2 0, — colorless prisms, of 
slightly bitter and astringent taste and faintly acid reaction, very soluble in water, insolu- 
ble in alcohol. Dose, gr. ij-v. 

Potassii Permanganas, Potassium Permanganate, KMn0 4 , — deep, purple-violet 
prisms, of sweet and astringent taste, neutral reaction, soluble in 1 6 of water with a 
scanty, brown residue, decomposed by alcohol and by heating to 464 F. It should be 
kept in well stoppered bottles, and should not be triturated or combined in solution with 
organic or readily oxidizable substances. Dose, gr. ss-ij, in pill. 

Unofficial Preparations. 

Syrupus Mangani Iodidi, Syrup of Manganese Iodide, — contains about gj of the 
Iodide in each ^ . Dose, TT^x-xxx. For formula see U. S. Dispensatory. 

Syrupus Ferri et Mangani Iodidi, Syrup of Iron and Manganese Iodide, — each !| 
contains gr. 50 of the mixed iodides in the proportion of 3 of the Iodide of Iron to I of 
that of Manganese. Dose, ri\x-xxx. For formula see U. S. Dispensatory. 

Ferri et Mangani Carbonas Saccharatus, Saccharated Iron and Manganese Car- 
bonate, — is a tasteless, reddish-brown powder. Dose, gr. v-xx. For formula see U. S. 
Dispensatory. 

Pepto-mangan, Liquor Mangano-ferri Peptonatus, — a proprietary preparation, 
advertised to contain in each half-ounce " the equivalent of 3 grains of metallic Iron and 
I grain of metallic Manganese (as Peptonates) in organo-chemical combination." It is 
claimed for this preparation that it does not have the astringent effect of the inorganic 
salts of these metals upon the glands of the stomach, and that it does not affect the alka- 
linity of the bowels.. Dose, ^ ss, three to four times a day, in white wine or milk, or alone. 

Condy's Red Fluid, — is a solution of Potassium Permanganate in Distilled Water, of 
about I % per cent, strength, 8)4 grains to the ounce, or 176 grains in 20 ounces. It is 



MANGANUM. 375 

used as a disinfectant and deodorant for closets and bed-pans, also to wash the hands and 
utensils, but it cannot be employed to disinfect rooms. It is not irritant, and shows by its 
change of color when it has lost its efficacy. A one per cent, solution is official in the 
Br. Phar. the dose of which is given as 3 ij-iv. 



Physiological Action. 

The salts of Manganese in small doses improve the appetite and the 
digestion and stimulate the action of the heart. Used in larger doses and 
for a considerable length of time they lower the heart's action, paralyze the 
muscular system especially the muscular coat of the arteries, and cause 
progressive wasting, paraplegia, and acute fatty degeneration of the liver. 
They are gastro-intestinal irritants, and the Sulphate is emeto-cathartic 
and decidedly cholagogue. Manganese is closely associated with Iron in 
the blood, bile, etc., in the proportion of about i to 20. The Black 
Oxide is an efficient emmenagogue. 

Potassium Permanganate is an active oxidizer, containing as it does a 
large proportion of oxygen which it yields very readily in the form of 
ozone, and then becomes manganese dioxide. This property gives it the 
qualities of an antiseptic, a disinfectant and a deodorant. It is considered 
by some authorities to be an efficient emmenagogue. Used internally it 
is probably not absorbed in its own state, as it must be quickly decomposed 
by the contents of the stomach ; at the same time it oxidizes any oxidiz- 
able substance therein. 

Therapeutics. 
The salts of Manganese are used by those practitioners who affect to see 
a manganese-anemia in cachectic subjects, but they are always combined 
with preparations of iron. In amenorrhea, gastrodynia and pyrosis the 
dioxide is a good remedy, and the same salt is used as an ointment in 
many skin diseases. In jaundice of malarial origin or catarrh of the 
biliary passages the sulphate gives good results. Manganese is becoming 
more of an acknowledged remedy in derangements of the menstrual 
function, as irregular or scanty menstruation, amenorrhea, menorrhagia, 
and even metrorrhagia. By some authorities the emmenagogue power 
of potassium permanganate is ascribed to its large proportion of oxygen, 
which it is supposed to give up to the uterus ; as potassium chlorate 
was formerly supposed to do to the system at large. According to the 
views of others who have studied its action, Manganese should be classed 
with the excito-motors, increasing arterial tension, and specifically acting 
upon the uterus. The best preparation is the Dioxide, in freshly made 
pills of two grains each, of which 1 to "3 or 5 pills may be taken twice or 
thrice daily. Potassium Permanganate has generally been the preparation, 
given when the effects of Manganese were desired ; but as it causes great 



I 



37^ MANGO. 

gastric irritability, with abdominal pains and burning sensations, besides 
other decidedly unpleasant symptoms, it is a difficult matter to get patients 
to take it for any length of time. 

Potassium Permanganate is employed as an antiseptic and oxidizing 
agent in such affections as diphtheria, scarlatina, septicemia, erysipelas, 
etc., in which it may be given internally and used locally at the same 
time. It is given with apparent benefit in dyspepsia, flatulence, lithemia 
and obesity, and has often seemed to be of service in acute rheumatism. 
In amenorrhea it is reported to be very efficient, and has been used with 
success as a remedy for the bites of venomous serpents and for other 
animal poisons. For internal use it should be given in pill, as the taste 
of a solution is very disagreeable. Locally it is frequently employed (3J 
to the pint) to correct fetor in cancer, ulcer, caries, abscesses, ozena, etc., 
and it will destroy the odor of a foul breath or that of the fetid perspira- 
tion of the feet. It is used both as a test and as a corrigent for organic 
impurities in drinking water. The stain left by it on fabrics may be re- 
moved by sulphurous acid, but as sulphuric acid is formed in the reaction 
the fabric should be immediately washed or rinsed in water. 

Potassium Permanganate has lately come into use as an antidote against 
morphine or opium in the stomach, for which purpose it was recom- 
mended in 1884 by an English physician, Mr. J. Barker Smith. Little 
attention was paid to his suggestion until it was practically tested by Dr. 
William Moor, of New York, on himself, in 1895. After a light supper 
he swallowed 3 grains of morphine sulphate, followed almost immediately 
by 4 grains of potassium permanganate in water, and experienced no ill 
effects, although being highly susceptible to the drug he would have been 
affected if even gr. yi of morphine had been absorbed. On another 
occasion, two hours after breakfast, he took 5 grains of morphine sulphate 
in water, and also 8 grains of the permanganate in 8 ounces of water soon 
afterwards, without experiencing any symptoms of morphine action. It 
has long been known that morphine is deoxidized and rendered in- 
nocuous by this agent, but it was supposed that the presence of albumin 
in the stomach would prevent their reaction. It is now shown that the 
permanganate reduces morphine sulphate more rapidly than it does albu- 
minous matter, and in fact exhibits a marked selective affinity for morphine 
and also for physostigmine (eserine), but gives up its oxygen more 
quickly to albuminous substances than to strychnine, oxalic acid, colchi- 
cum or hydrocyanic acid. It exerts no oxidizing effect, in the presence 
of albumin, on atropine, hyoscyamine, hyoscine, caffeine, cocaine, 
aconitine, veratrine, pilocarpine, muscarine or phosphorus. (Murrell.) 

MANGO (Unofficial), — is the bark of Mangifera indica, an Indian tree of the nat. 
ord. Guttiferae. It is supposed to be an astringent with special tonic action upon mucous 
membranes. It is highly recommended by its vendors for nasal catarrh, hemorrhages 



MANNA MATRICARIA. 



377 



and muco-purulent discharges from the intestines, uterus, vagina and bronchi. A fluid 
extract is sold, which may be used in doses of Tr\x-gj. 

Mango-Fruit, or Mangosteen, is the fruit of Garcinia mangostana, nat. ord. Gutti- 
ferae, also from India. It is a powerful astringent, and is used for nasal catarrh, diarrheas, 
dysentery, leucorrhea, etc. 

MANNA, — is the concrete, saccharine exudation of Fraximts Ornus, or Flowering 
Ash, a tree of the nat. ord. Oleacese, growing in Southern Europe. Manna is produced 
also by several other trees, and substances resembling it are exuded by many plants. It 
contains from 40 to 90 per cent, of Mannit, C 6 H u 6 , or Manna-sugar, which does not 
undergo vinous fermentation, and is chemically allied to the alcohols and to glycerin. 
It also contains glucose, mucilage, some acrid resin, and a small quantity of the fluores- 
cent glucoside Fraxin, C ]6 H 18 O 10 . There are no official preparations, but Manna itself 
may be given in doses of ^j-ij. 

Manna is a mild laxative, with some tendency to produce flatulence and colic. It is 
usually combined with other purgatives, as Senna, Rhubarb, Magnesia, etc., to disguise 
the taste and increase the effect. It is a constituent of the official Infusum Sennae Com- 
positum. Manna may be eaten by children if of good quality, or may be readily dissolved 
in milk and so administered. 

MARRUBIUM, Horehound, — the leaves and tops of Marrubium vulgare, a plant 
of the nat. ord. Labiatee, native in Europe, but naturalized in America. It contains a 
bitter principle named Marrubiin, also a volatile oil, resin, tannin, lignin, etc. There are 
no official preparations. Dose, ^ss-j. 

Horehound in large doses is laxative, diuretic and diaphoretic, and in ordinary dosage 
it is a gentle tonic and stomachic. It is generally used in catarrhal states of the air- 
passages, over which it seems to have a soothing effect, and is much employed in confec- 
tionery as an ingredient of "cough drops." 

MASTICHE, Mastic, — is a concrete, resinous exudation from Pistacia Lentiscus, 
a tree of the nat. ord. Anacardieae, growing in the island of Scio. Alcohol dissolves 
about 90 per cent, including the resin Mastichic Acid, the remainder consisting of another 
resin, Mastichin, which is soluble in ether and resembles copal. There are no official 
preparations, but Mastic is an ingredient of the official Pil. Aloes et Mastiches. 

Mastic was formerly used for supposed properties analogous to those of other oleo- 
resins, but now its application is confined to dentistry, being employed as a temporary fill- 
ing for carious teeth. A solution of ether is applied on cotton with moderate pressure, 
and remains as a firm plug after evaporation of the solvent. 

MATICO, the leaves of Piper angustifolutm, a Peruvian shrub of the nat. ord. 
Piperaceae. It contains a crystallizable acid Artanthic Acid, also resin, tannin, and a 
volatile oil. Its odor is aromatic, and its taste astringent, spicy and somewhat bitter. 

Extractum Matico Fluidum, Fluid Extract of Matico. — Dose, 3 ss-ij . 

Tinctura Matico, Tincture of Matico, — 10 per cent. Dose, § ss-ij. 

Matico is an aromatic tonic and stimulant, also aphrodisiac, vulnerary and hemostatic. 
It acts like cubeb on the urinary passages, and is an excellent alterative stimulant to 
mucous membranes. It has been used with considerable success in mucous catarrhs, as 
gonorrhea, leucorrhea, chronic cystitis, etc., also in epistaxis, hemorrhoids, menorrhagia, 
hemoptysis, hematemesis and other hemorrhages. The under surface of the leaf is so 
formed as to promote coagulation of blood if applied to a bleeding surface, and it is a good 
local hemostatic for trivial cuts or wounds. 



MATRICARIA, German Chamomile, — the flower-heads of Matricaria Chamo- 
milla, a European annual plant of the nat. ord. Compositae. They contain ]l per cent, 
of a blue Volatile Oil (the color of which is due to Azulen), also a bitter extractive, 
tannin, etc. There are no official preparations, but the flowers may be eaten or a decoc- 
tion used almost ad libitttm. 



37$ MEL MELISSA MENISPERMUM. 

Matricaria is a mild tonic, in large doses emetic, anthelmintic and antispasmodic. It 
is much used in Germany, and in this country is a popular domestic remedy among Ger- 
man people, who use it in infusions as a diaphoretic. This plant is the Chamomilla 
of the homeopaths, who find in it remarkable power over morbid impressionability of 
the sensory and excito-motor nerves, and administer it in pains aggravated at night and 
by heat, clonic spasms of pregnancy, irritability of teething children, flatulent colic, etc. 



MEL, Honey, — is a saccharine secretion deposited in the honey- 
comb by Apis mellifica, the honey-bee ; occurring as a pale-yellowish, 
syrupy liquid, gradually becoming crystalline and opaque, of peculiar and 
heavy odor, and a very sweet, faintly acrid taste. It is a strong aqueous 
solution of several sugars (cane and grape sugar, levulose), with wax- 
pollen, coloring and odorous matters, etc. The sugars, which may be 
resolved into Levulose and Dextrose, amount to 70 or 80 per cent. 
Honey is frequently adulterated with starch and artificial glucose, which 
may be detected by the official tests (see U. S, Phar.). Dose, indefinite. 

Preparations. 

Mel Despumatum, Clarified Honey, — is honey heated, skimmed and strained, with 
Glycerin added in the proportion of 5 per cent. It is an ingredient of Confectio Ros?e, 
Mel Rosae, and Massa Ferri Carbonatis. Dose, indefinite. 

Mel Rosae, Honey of Rose, — Fluid Extract of Rose 12, Clarified Honey to 100. 
Dose, indefinite ; generally used as a local application to the throat for its astringency 
and flavor, in combination with more active agents. 

Honey is emollient, nutritive and laxative, in some persons giving rise 
to pyrosis, flatulence and colic, and in others to an eruption of urticaria, 
but generally constituting an agreeable article of diet. It is sometimes 
actually poisonous from the presence of toxic agents extracted by the bee 
from certain plants, in this country generally the Mountain Laurel {Kalmia 
latifolia). Honey is chiefly used as an emollient in diseases of the throat, 
to relieve dryness, pain, cough and dysphagia. A mixture of Honey 8 
parts to 1 each of Acetic Acid and Water is official in the Br. Phar. 
under the title Oxymel, and forms a pleasant addition to gargles or a 
vehicle for expectorant medicines. Honey of Rose is somewhat astringent, 
and is used in gargles and in washes, for the treatment of inflammation 
and ulceration of the mucous membrane of the nasal passages, the mouth 
and the throat. 

MELISSA, Balm, — the leaves and tops of Melissa officinalis, a European plant of 
the nat. ord. Labiatae, growing also in America. It contains gum, tannin, bitter extrac- 
tive, and a fragrant essential oil in very small quantity [y% to J5^ per cent.). There are 
no official preparations. Balm has little or no action, except to flavor hot water for use 
as a beverage or a mild diaphoretic. 

MENISPERMUM, — is the rhizome and rootlets of Menispermum canadense, the 
Yellow Parilla, or Canadian Moonseed, a woody, climbing plant of the nat. ord. Meni- 
spermaceae, native of the eastern U. S. It contains starch, Berberine, and a white alka- 
loid, which is soluble in alcohol and in ether. 



MENTHA PIPERITA. 379 

Extractum Menispermi Fluidum, Fluid Extract of Menispenmwt, — is %rds 
alcohol. Dose, TTLv-xx. 

Menispermum is reputed to have tonic properties, and is used in some of the Southern 
States in domestic practice as a substitute for Sarsaparilla in scrofulous conditions. Little 
is known about it of a definite character. 



MENTHA PIPERITA, Peppermint,— the leaves and tops of 
Mentha piperita, a perennial herbaceous plant, of the nat. ord. Labiatse, 
a native of Britain, but largely cultivated elsewhere. They contain i to 
i^ per cent, of a Volatile Oil, which is official, and a little tannin. 

Menthol, C 10 H 19 OH, — is a stearopten (having the character of a sec- 
ondary alcohol), obtained from the official oil of peppermint, or from 
Japanese or Chinese oil of peppermint (from Mentha arvensis and Men- 
tha canadensis}', by deposit therefrom on exposure to cold. It occurs in 
colorless, acicular crystals, of the odor of peppermint, and a warm, 
aromatic taste, followed by a sensation of cold when air is drawn into 
the mouth. Soluble only slightly in water, freely in alcohol, ether, 
chloroform, carbon disulphide or glacial acetic acid. Dose, gr. ss-iij, in 
pill or spirituous solution, several times a day. 

Preparations. 

Oleum Menthae Piperitae, Oil of Peppermint, — is the volatile oil distilled from the 
fresh herb ; a colorless or pale yellow fluid, having the odor of peppermint, and a strongly 
aromatic taste followed by a cold sensation when air is drawn into the mouth. It consists 
of a liquid terpene and the stearopten Menthol (see above) . Dose, TT\j— v. 

Aqua Menthae Piperitae, Peppermint Water,— has of the oil 2 parts in 1000 of Dis- 
tilled Water. Dose, indefinite. 

Spiritus Menthae Piperitae, Spirit of Peppermint, Essence of Peppermint, — is an 
alcoholic solution containing 10 per cent, of the oil and I per cent, of the powdered 
herb. Is an ingredient of Mistura Rhei et Sodse. Dose, TT^x-xxx. 

Trochisci Menthae Piperitae, Peppermint Troches, — each troche contains I per cent, 
of the Oil, with Sugar and Mucilage of Tragacanth. Dose, indefinite. 



Physiological Action and Therapeutics. 

Peppermint is an aromatic stimulant, also carminative and antispas- 
modic. The oil possesses these qualities in greater degree and is also a 
local anodyne and anesthetic when applied locally, especially if its evap- 
oration be prevented. The Chinese oil contains a large quantity of 
Menthol and is particularly anodyne. Menthol is antiseptic and locally 
anesthetic, but not corrosive, and acts also as a vascular stimulant when 
applied to the surface. 

Peppermint is used internally for the relief of nausea and colic, and to 
expel flatus by its local stimulant and after sedative action on the bowels. 
It is an agreeable corrigent for combination with purgatives to prevent 
griping, and efficiently covers the taste of many nauseous substances. 
The spirit is the best form for internal use. The oil is used locally to 



380 MENTHA VIRIDIS METHYLENE BLUE. 

relieve the pain of superficial neuralgia, a cloth being wet with it, laid 
along the course of the affected nerve and covered with oiled silk to 
restrain evaporation. It is also efficient in rheumatism as an anodyne 
and counterirritant. 

Menthol is highly praised as an external application in various neural- 
gias, sciatica, pleurodynia, toothache, etc. For neuralgia it is used in 
saturated alcoholic solution painted over the affected nerve. For tooth- 
ache a crystal introduced into the carious cavity is promptly anodyne. 
As an antiseptic it promises well as an application in parasitic skin diseases. 
As the Chinese have used their oil of peppermint for ages as an applica- 
tion in neuralgias, and as this oil contains a large quantity of Menthol, 
the latter preparation will probably prove a very efficient agent in these 
affections if the cupidity of the manufacturers will allow of its being 
obtained pure. A spray containing 5 to 20 per cent, of Menthol is highly 
recommended in epidemic influenza, also in tubercular laryngitis. Men- 
thol is of marked value in almost all cases of pruritus, from whatever 
cause. It possesses high power as an anti-emetic, having stopped nausea 
and vomiting after the usual remedies had failed. For this purpose ten 
drops of a 20 per cent, solution in olive oil are given on sugar. 

MENTHA VIRIDIS, Spearmint, — the leaves and tops of Mentha viridis, the 
"mint" of the kitchen garden, a plant of the nat. ord. Labiatse, indigenous to England, 
but naturalized in many countries. Its constituents and properties are identical with 
those of peppermint, but its odor and taste differ therefrom. 

Oleum Menthse Viridis, Oil of Spearmint, — is the Volatile Oil distilled from the 
plant. Dose, ttyj-v. 

Aqua Menthae Viridis, Spearmint Water, — has 2 parts of the Oil in 1000 of Distilled 
Water. Dose, indefinite. 

Spiritus Menthae Viridis, Spirit of Spearmint, Essence of Spearmint, — is an alco- 
holic solution containing 10 per cent, of the Oil and I per cent, of the powdered herb. 
Dose, rr\x-xl. 

Spearmint corresponds in action to Peppermint, but is less powerful. It is employed 
to correct flatulence and to relieve colic, and makes an agreeable flavoring for mixtures. 

METHYLENE BLUE, Tetramethyl-Thionine Chloride (Unofficial),— is an 
anilin derivative, which when pure is seen in small, dark blue, scaly crystals, having a 
copper bronze tinge, soluble in water. Dose, gr. j-iij, four or five times a day. 

This substance imparts a blue color to nerve tissue and to the urine. From the facts 
that it manifests a strong affinity for nerve tissue, especially for the axis cylinders of sen- 
sory nerves, and that it is the best staining agent for the microbe found in the blood of 
malarial subjects, this agent has been expected to possess anodyne power over neuralgic 
and rheumatic affections and to act as an antiperiodic in malaria. It has been employed 
by several observers as an antipyretic and internal antiseptic for rheumatism of the joints 
and muscles, for malarial fever, diphtheria, acute nephritis and cancer, with varying 
results. Its best action in malarial affections has been obtained in children, and being 
tasteless it may be administered to them with greater ease than quinine, besides being free 
from the vomiting and headache which so often result from the latter drug. In diphtheria 
and in simple, non-diphtheritic ulceration of the throat, a ten per cent, solution is used 
locally with great benefit so far as yet reported. It has been employed successfully in 
two cases of chronic cystitis, also in two cases of diabetes mellitus, and has given satis- 
faction in several very obstinate cases of rheumatoid arthritis. In a number of cases of 



MEZEREUM MORRHILE OLEUM. 38 I 

different forms of insanity it has been used by injection for conditions of excitement 
with very satisfactory results (Bodoni). 

MEZEREUM, Mezereum (Mezereon), — is the bark of Daphne Mezeretim and of 
other species of Daphne, plants of the nat. ord. Thymelceacese, growing in mountainous 
districts of Europe and Asia and cultivated as a garden shrub in Britain. It contains an 
inert, fixed oil, an inactive glucoside, Daphnin, and an acrid Resin, which is the anhy- 
dride of a resinous acid named Mezereinic Acid. Mezereum is an ingredient of the com- 
pound decoction and the compound fluid extract of Sarsaparilla. Dose, gr. j-x. 

Extractum Mezerei Fluidum, Fluid Extract of Mezereum, — is too acrid for inter- 
nal use. It is an ingredient of the Linimentum Sinapis Compositum. 

Mezereum is a sialogogue, and an intensely acrid, irritant poison, producing violent 
vomiting, purging, nephritis and gastro-enteritis. In small doses it is laxative and diu- 
retic, and has had considerable reputation as an alterative. Externally the recent bark is 
a powerful local irritant, speedily producing vesication. 

Mezereum is rarely used internally by itself, but is employed in mixtures with Sarsa- 
parilla, etc., as an alterative in syphilis, rheumatism and some skin diseases of chronic 
type, but with doubtful efficacy. It has been used with good effect in toothache and as a 
masticatory in paralysis of the tongue. Its principal use is as a local irritant to keep up 
the discharge from issues or blisters, and to stimulate indolent ulcers. 



MORRHUiE OLEUM, Cod-liver Oil, Oleum Jecoris Aselli — 
is a fixed oil obtained from the fresh livers of Gadus Morrhua (Cod-fish) 
or other species of Gadus. It is a colorless or pale yellow, thin, oily 
liquid, of slightly fishy odor and taste, and faintly acid reaction, soluble 
in ether. It consists chiefly of Olein and Margarin, with a peculiar prin- 
ciple named Gaduin, also Trimethylamine, free fatty Acids (oleic, palmitic, 
stearic), traces of Iodine, Bromine, Sulphuric and Phosphoric Acids, the 
ordinary inorganic salts of animal tissue and products, and perhaps bile 
constituents. When saponified it does not yield glycerin, but Oxide of 
Propyl. Three kinds or varieties are found in the market, the pale, the 
light-brown and the dark. The pale is the official oil and the purest. 
Dose, 3j-ij on a full stomach, increased as assimilated. 

Unofficial Preparations. 

Glyconin Emulsion of Cod-liver Oil, — 01. Morrhuse ^iv, Glyceritum Vitelli ^ix, 
Aromatic Spirit of Ammonia gj, Sherry Wine ^ ij, Diluted Phosphoric Acid ,^iv, Es- 
sence of Bitter Almond (3) of the Volatile Oil in Oss Alcohol) 3 ij. The Cod-liver Oil 
is to be added to the Glyconin very slowly with brisk stirring, and the other ingredients 
added in the order named. 

Hydroleine, Hydrated Oil, — is said to contain, in each dose of gij, Cod-liver Oil 
TT\8o, Distilled Water rr\j5, Pancreatin gr. 5, Soda gr. }{, Salicylic Acid gr. }(. 

Physiological Action. 
The action of Cod-liver Oil is that of any other fat, except that it is 
more easily assimilated than any member of the class. Fats in small 
quantity are necessary for the digestion of nitrogenous food and form 
the molecular basis of the chyle, being prepared for absorption by the 
pancreatic juice and the bile, especially the latter. Fat is an essential con- 



382 MORRHILE OLEUM. 

stituent of the products of tissue formation, whether physiological or 
pathological, and is the principal material concerned in the production 
of force. After oxidation it is excreted as carbonic acid and water. 
Locally applied fats reduce the body-temperature. 

Cod-liver Oil is the most easily digestible of fats, penetrating animal 
membranes with comparative ease after being emulsified by the pancreatic 
and biliary secretions, hence entering the lacteal vessels readily and ap- 
pearing to carry with it the oily and nitrogenous elements of the food. 
The result is facilitation of the digestive process, increase of the red 
blood-corpuscles and of the body-weight, and stimulation of healthy cell- 
formation throughout the tissues. The properties of this oil have been 
ascribed to its biliary constituent, to iodine, free oleic acid, etc., but no 
satisfactory explanation has been offered until recently for the difference 
between its action and that of other animal or vegetable oils. 

Gautier and Mourgues of Paris have made an exhaustive series of analytical researches 
upon Cod-liver Oil, and find that it contains — (i) Fixed Bases, Aselline and Morrhuine, 
the latter constituting about y z of the total alkaloids, and being probably one of the most 
efficient principles in the oil. (2) Volatile Bases, Butylamine, l /(, of the total bases ; 
A??iylamine, l /$ of the whole ; Dihydrotoluidine, -^ of the total alkaloids ; Hexylamine, 
a small amount. (3) Acids, Morrhuic Acid, \y z per cent., also a mixture of For?nic 
and Butyric Acids ; and a small proportion of Phosphoric Acid, derived from the phos- 
phates, phospho-glycerates and lecithins of the extracts. As to the properties of these 
constituents they state that Butylamine, Hexylamine, and particularly Amylamine in- 
crease the urinary secretions. Dihydrotoluidine is a convulsivant toxic base. Aselline 
in sufficient doses produces dyspnea, stupor, convulsive disturbances, and if continued 
death. Morrhuine, the most important of the extractive principles, is a powerful stimu- 
lant of the functions of nutrition and assimilation, promoting metabolic changes ; it pro- 
duces a rapid circulation of the extractive residues of cell life towards the excretory organs, 
where they are eliminated, provoking in their way indirectly a powerful movement of 
assimilation correlative of the losses consequent upon the inverse movement of de-assimi- 
lation. This is considered to be proved by the super-excitation of appetite in animals 
brought under its influence. The physiological experiments with these substances dem- 
onstrate that cod-liver oil is a reconstituent of the tissues through its richness in phos- 
phates, phospho-glyceric acid, and organically combined phosphorus. Bromine and 
iodine, which are present in small quantities, also contribute to the reparative action, but 
chiefly to the active principles butylamine, amylamine, and especially morrhuine and mor- 
rhuic acid does the oil owe its true medicinal value. 



Therapeutics. 
The value of Cod-liver Oil is wholly that of a nutrient, its action being 
most marked in wasting diseases. In high febrile states or catarrhal con- 
ditions of the gastro-intestinal tract its use is contraindicated, but in 
phthisis a slight degree of fever will not interfere with its beneficial em- 
ployment. It is found to be of most value in the chronic forms of phthisis, 
in chronic bronchitis and emphysema, chronic rheumatic disorders, 
atheroma of the arteries, strumous skin diseases and diarrhea, syphiloder- 
mata, neuralgia, chorea and epilepsy. In many disorders referable to 
exhaustion or debility of the nervous centres it is of great value as a nerve 
tonic, and in convalescence from acute diseases it is of marked benefit. 



MOSCHUS. 383 

It should always be considered as a supplementary food, and if its use 
endangers the appetite for other food it should be abandoned. 

The administration of this valuable agent is a serious matter, as many 
patients cannot overcome their repugnance to its taste and smell. Various 
emulsions are on the market, but they are objectionable because in no case 
do they conceal the taste, and the efficacy of the oil is seriously impaired 
by the processes used in their preparation. Moreover, the temptation is 
very great to employ an inferior grade of the oil or to adulterate it with 
other fish-oils in the manufacture of these preparations, and when the 
commercial spirit of gain is remembered one can never be sure of the 
quality of the oil so prepared. The oil itself is the best form for use, in 
small doses, say a teaspoonful thrice daily for an adult, after meals, in 
black coffee, beer or lemon-juice. The essential oil of eucalyptus in the 
proportion of 1 part to 100 of cod-liver oil will effectually extinguish the 
odor and taste to many persons. Alkaline stomachics given before meals, 
the oil after, and a teaspoonful of Liquor Pancreaticus given half an hour 
afterwards, would be a good routine in most cases, the latter agent pre- 
venting the fishy eructations which often give so much trouble. Extem- 
poraneous emulsions may be prepared with glyconin (see ante, page 381), 
white of egg, mucilage of tragacanth, extract of malt, or any syrup, and 
flavored with lemon, cinnamon or bitter almond. The addition of n^iv 
of Ether to each 3 of the oil promotes its digestion by stimulating the 
pancreatic secretion, and enables a patient to take it with whom it had 
previously disagreed. 

Inunction by Cod-liver Oil is a method of value in the wasting diseases 
of children. A tablespoonful may be rubbed into the skin of the abdo- 
men twice a day, and covered with a flannel binder having oiled silk or 
mackintosh-cloth outside. It readily passes through the skin and is 
absorbed, producing valuable and lasting results. 

MOSCHUS, Musk, — is the dried secretion from the preputial follicles of Moschus 
moschiferus (the Musk Deer), an animal inhabiting the mountainous region of Central 
Asia. It occurs in irregular, unctuous grains, of a reddish-brown color, peculiar and 
penetrating odor and bhterish taste, contained in oval sacs about 2 inches in diameter, 
membranous on one side, hairy on the other. About 10 per cent, is soluble in alcohol, 
50 per cent, in water. Chinese Musk in the pods or sacs is the most valuable, but all 
varieties are adulterated, the price of the drug being high. The odor is destroyed by 
drying, but returns again on the addition of moisture. Trituration with Camphor or 
Hydrocyanic Acid destroys it. The odorous principle has not been isolated, but is prob- 
ably a product of decomposition which is constantly being formed. The constituents of 
Musk are a bitter resinous substance, ammonia, fat, cholesterin, etc. Dose, gr. ij-x. 

Tinctura Moschi, Tincture of Musk, — 5 per cent. Dose, Tr^xx-gjss. 

Musk is a very diffusible stimulant, acting directly on the nervous and circulatory 
systems, but without much energy. It is also an antispasmodic, and is employed with 
benefit in general prostration of the system with nervous agitation or irregular muscular 
action. It has been used with advantage in laryngismus stridulus, insomnia, the collapse 
of typhoid and typhus fevers, spasmodic affections of the stomach, obstinate hiccough and 
convulsions of children due to intestinal spasms. The pure Musk is very difficult to 



384 MYRCIiE OLEUM MYRISTICA. 

obtain, and its high price makes it an extremely expensive medicine, so that it is seldom 
used except as a perfume. 

MYRCIA OLEUM, Oil of Myrcia (Oil of Bay),— \s a volatile oil distilled from 
the leaves of Myrcia acris, or Bayberry, a tree of the nat. ord. Myrtacese, native of the 
West Indian Islands. It is a yellowish-brown liquid, of aromatic odor, pungent taste, 
slightly acid reaction, and soluble as a slightly turbid solution in an equal weight of 
alcohol. It contains a hydrocarbon and Ettgetiic Acid. Used only as a perfume. 

Spiritus Myrcise, Spirit of Myrcia, Bay Bum, — contains Oil of Myrcia 16, Oil of 
Orange-peel I, Oil of Pimenta I, Alcohol 1220, Water to 2000. 

The Oil of Bay is an agreeable perfume used to prepare bay-rum and in other cosmetic 
preparations. The spirit, known as " Bay-rum," is used principally as a refreshing per- 
fume, and is thought to relieve headache, faintness, etc., by application to the forehead 
or to the nostrils. 



MYRISTICA, Nutmeg, — is the seed of Myristica fragrans, de- 
prived of its testa. The Nutmeg-tree is cultivated extensively in the East 
and West India Islands, belongs to the nat. ord. Myristicaceae, and is a 
native of the Banda Islands in the Malayan Archipelago. The nutmeg 
contains 4 to 9 per cent, of the official Volatile Oil, and 30 per cent, of 
a concrete oil, commonly called Oil of Mace, which is a compound of 
fluid glycerides of oleic and butyric acids, and the solid glyceride of 
Myristic Acid, some resin and volatile oil. Dose, gr. v-xx. 

Macis, Mace, — is the arillode (or fleshy covering) of the seed of 
Myristica fragrans, the Nutmeg-tree. It occurs in narrow bands about 
an inch long, branched and lobed, of brownish-orange color, fragrant 
odor, warm and aromatic taste. It yields a fixed oil by pressure and a 
volatile oil by distillation, the latter being probably identical with Oil of 
Nutmeg. Dose, gr. v— xx. 

Preparations. 

Oleum Myristicse, Oil of Nutmeg, — is the volatile oil, and consists chiefly of a ter- 
pene and an oxygenated oil, Myristicol. It is colorless or pale-yellow, of hot, spicy taste 
and neutral reaction, and is soluble in alcohol. Dose, rry-v. 

Spiritus Myristicae, Spirit (or Essence) of Nutmeg, — is a 5 per cent, solution of the 
oil in alcohol. Dose, 3J-ij. 

Nutmeg is an ingredient of Acetum Opii, Pulvis Aromaticus, Tinctura Lavandulae Co. , 
Trochisci Cretse, and Trochisci Sodii Bicarbonatis. 

Physiological Action and Therapeutics. 
Nutmeg is an aromatic stomachic of agreeable flavor. In small doses 
it stimulates the production of gastric juice and thus promotes digestion 
and increases appetite. It also relieves intestinal spasm and flatulence. 
In large doses it is powerfully narcotic, acting directly on the cerebrum, 
and producing stupor and delirium. It is used chiefly for flavoring pur- 
poses, and generally in substance grated as required, but has been 
employed as a carminative, anodyne and astringent in diarrheas and dys- 
entery, as well as to relieve nausea and vomiting. Strangury is efficiently 



MYRRHA. 385 

treated by small doses of powdered nutmeg given several times a day ; 
and the same remedy is often used in the south of Germany to relieve the 
uncomfortable feeling experienced after drinking an excessive quantity 
of new beer. The Volatile Oil is decidedly rubefacient when used exter- 
nally, and has narcotic powers if used internally in sufficient quantity. It 
is occasionally employed as an external stimulant in paralysis and chronic 
rheumatism. Mace is stimulant, carminative and aromatic. It is used 
solely as a spice or condiment. 

MYRRHA, Myrrh, — is a gum-resin obtained from Commiphora 
Myrrha, an Arabian tree of the nat. ord. Burseraceae. It occurs in round- 
ish tears, having a waxy fracture, a balsamic odor and a bitter taste. 
When triturated with water it forms a brownish-yellow emulsion ; treated 
with alcohol it yields a brownish-yellow tincture which turns purple on 
the addition of nitric acid. It contains Gum, 60 per cent. ; Myrrhin, a 
resin, 35 per cent. ; also Myrrhol, C 10 H n O, an oxygenated ethereal oil, 2 
per cent. Dose, gr. x-xxx. 

Tinctura Myrrhae, Tincture of Myrrh, — 20 per cent. Dose, Tt^x-xxx. 
Myrrh is also contained in Mistura Ferri Co., Pil. Aloes et Myrrhae, Pil. Rhei Co., 
and Tinctura Aloes et Myrrhae. 

Locally applied Myrrh is stimulant and disinfectant to mucous mem- 
branes and ulcerated surfaces. Administered in small doses internally 
it acts as a gastric stimulant, but in large doses it irritates the gastrointes- 
tinal mucous membrane, causing vomiting and purging. It quickens the 
action of the heart, diminishes bronchial secretion, and is a uterine stimu- 
lant and an emmenagogue. Myrrh is used in combination with other 
drugs, as noted above, for anemia, amenorrhea and bronchial catarrh. It 
is believed to diminish excessive secretion from the mucous surfaces of 
the uterus, vagina, bladder and bronchi, also to have an especially bene- 
ficial influence on chronic pharyngitis. Locally used the tincture has a 
good tonic action on diseased mucous surfaces and is applied with benefit 
to spongy gums, relaxed throat, aphthous patches and unhealthy ulcers, 
and diluted with water it makes an excellent gargle for ulcerated sore 
throat. Myrrh has long been employed as an ingredient of dentifrices. 

Binz observed that the internal administration of Myrrh produced a leucocytosis in 
which the white blood-cells were increased to four times their original number. This 
fact has been made the basis of treatment in severe cases of diphtheria by Stroll, who 
reports 80 cases so treated with only one death, and has collected nearly 300 cases in 
which the same treatment was employed with strikingly good results. His prescription 
has of the tincture 4, glycerin 8, and distilled water to 200 parts, of which % j under 2 
years of age, ^ij up to 15 years, and giij-iv for adults, every half hour or hour until the 
symptoms moderate, then every two hours, continued for 48 hours after the membrane 
disappears. 

25 



I 



386 MYRTI OLEUM NAPHTALINUM. 

MYRTI OLEUM, Oil of Myrtle, Myrtol (Unofficial),— is a vola- 
tile oil distilled from the leaves of Myrtus communis, the Myrtle, nat. ord. 
Myrtacese, and consists of a mixture of Pinene, another hydrocarbon, 
and Cineol ; the latter being identical with eucalyptol, and probably 
the active medicinal ingredient. Dose, ftlj-iij in capsules, several times 
a day. 

Myrtol is a very active antiseptic and parasiticide. Applied to a raw- 
surface it is sufficiently irritant to excite inflammation, but it does not so 
affect the unbroken skin. Internally, in small doses, it excites a sense of 
warmth in the mouth, increases the saliva, and acts as a tonic to the 
stomach. Full doses are sedative to the nervous system, but large ones 
act as an irritant. It is eliminated by the lungs and kidneys, acting as 
an expectorant and as an antiseptic and stimulant to the mucous mem- 
branes at the points of elimination. It imparts an odor like that of vio- 
lets to the urine of the person taking it. 

Administered in small doses, Myrtol aids digestion, and is an efficient 
disinfectant and alterative in bronchorrhea, fetid bronchitis and gan- 
grene of the lung; and in cystitis and urethritis it acts similarly through 
the urine on the local mucous membrane. It may be expected to give good 
results in chronic and capillary bronchitis, whooping-cough and humid 
asthma. It has rendered good service in hematuria not due to acute 
congestion, and in passive hemorrhages generally. Locally it has proved 
curative in favus, herpes, pityriasis and parasitic skin diseases; also in 
otorrhea, ozena and other foul discharges from ulceration of the mucous 
membranes. It has been employed successfully against both the round 
and the thread worm. 

Chekan (Unofficial), — the leaves and shoots of Myrtus Chekan, nat. ord. Myrtaceae, 
a native of Chili. They contain a Volatile Oil resembling that of eucalyptus, also 
Chekanine, a volatile alkaloid, and tannin. Chekan is antiseptic, tonic, expectorant and 
diuretic ; and is chiefly used in catarrh of the mucous membranes, especially those of the 
bronchi and the bladder. It has been employed with benefit in cases of phthisis, and in 
bronchitis with thick, purulent expectoration. The expressed juice diluted with water 
makes a good lotion for conjunctivitis, and a decoction of the bark is valued as an astrin- 
gent in dysentery. A fluid extract is marketed, the dose of which is £j-iij. 



NAPHTALINUM, Naphtalin, Naphtalene, C 10 H 8 — is a hydro- 
carbon product formed during the manufacture of ordinary coal gas. 
Chemically, it is one of the benzene derivatives, being formed by the 
union of two benzene groups in an overlapping ring (see ante, page 273). 
When redistilled, it crystallizes in colorless, rhomboid plates, of slightly 
tarry but strong odor, and burning, aromatic taste ; insoluble in water, 
soluble in 15 of alcohol, very soluble in boiling alcohol, ether, chloro- 
form, carbon disulphide, and fixed or volatile oils. It is seen frequently 
in the form of moulded blocks, under such names as Alabastrine and 



NAPHTALINUM. 387 

Camphylene, for preserving furs and flannels from moths, and for placing 
in urinals for disinfectant purposes. 

The dose of Naphtalin is from gr. ij to gr. viij, up to gr. lxxx per diem 
for adults; for children gr. j to gr. iij, every three hours. Being quite 
insoluble in water it must be given in emulsion, or as a powder with sugar 
in wafers or capsules. It is best flavored with oil of bergamot. 

Derivatives. 

Naphtol, Beta- (or Iso-) naphtol, C 10 H 7 OH, — a phenol occurring in coal-tar, but 
usually prepared from Naphtalin. It is one of several naphtols, and occurs in colorless, 
shining, crystalline laminae, or a whitish, crystalline powder, of faint, phenol-like odor, 
and sharp taste. Soluble in 3/jf of alcohol, in about 1000 of water, and in 75 of boiling 
water ; very soluble in boiling alcohol, ether, chloroform, olive oil and petrolatum. Used 
as ointment, I to 5 for adults, but for children it should be not over 2 per cent, strength. 

Hydronaphtol, C 16 H 7 OH (Unofficial), — glistening, micaceous scales, sparingly 
soluble in water, freely soluble in alcohol, oils, etc. Used as an antiseptic, and in oint- 
ment or powder locally, diluted with oxide of zinc, I to 50. 

Naphtolum Camphoratum, Camphorated Naphtol, Naphtol Camphor (Unofficial), — 
is prepared by heating carefully one part of beta-naphtol with two of camphor ; the 
product being a homogeneous, oily fluid, which is insoluble in water, and decomposes 
readily on exposure to light and air. Used as a parenchymatous injection, the undiluted 
fluid being well borne, or in Olive oil, in doses of mjj-v. 

Physiological Action and Therapeutics. 

Naphtalin is destructive to all forms of low life, and hence is antiseptic 
in a high degree, but must be intimately mixed with the substances upon 
which it is to act. Internally it is a stimulant expectorant of decided 
power, and disinfects the contents of the intestinal canal. Being so spar- 
ingly soluble but little of it is absorbed, and hence it does no injury to 
the organism. What is taken up by the blood is excreted by the urine, 
partly unchanged, partly as naphtol and perhaps some as phenol. Naphtol 
is more easily absorbed, anpl may induce vomiting, hematuria, convul- 
sions and unconsciousness. An ointment containing 2 per cent, applied 
with friction for scabies to two brothers, aged 6 and 8 years respectively, 
caused nephritis in both and death in one, the diagnosis of nephritis 
being verified at the autopsy. Hydronaphtol is a powerful and non- 
irritating antiseptic, non-poisonous, non-corrosive, freely soluble in 
alcohol, glycerin, fixed oils, etc., in cold water, 1 to 2,000; and in hot 
water 1 to 100, precipitating as the water cools, but leaving a saturated 
solution of 1 tp 1,000, which is perfectly inhibitive^ of the germs of putre- 
faction in all putrescible fluids. The claims made for it are that it is 1 2 
times as effective as carbolic acid, 30 times as potent as salicylic acid, 60 
times as efficient as boric acid, 600 times as antiseptic as alcohol, and 
that it is entitled, as a true antiseptic, to stand next to mercuric chloride 
in the comparative tables (Levis). 

Naphtalin is employed as an antiseptic for the intestinal canal in typhoid 
fever, diarrhea, both acute and chronic, tubercular diarrhea, dysentery, 



388 NUX VOMICA. 

etc. It renders the urine aseptic and may be employed in vesical catarrh. 
It is also used internally for humoral asthma, verminous affections, and 
the chronic pulmonary catarrh of the aged. It has come into promi- 
nence as an efficient, all-around anthelmintic, having been given for all 
kinds of intestinal worms, with prompt and complete results invariably 
obtained (Mirowicz). In pertussis the best possible results have been 
obtained from the burning of this agent in the patient's room; giving 
force to the belief that the well-known benefit resulting from taking 
children to gas-works for whooping-cough is due to the naphtalin fumes 
rather than to the gas-tar. Locally, Naphtalin has high value as an anti- 
septic for indolent ulcers, sloughing wounds, open cancers, pus cavities, 
etc. Painted over organic remains it effectually prevents the ravages of 
insects. Naphtol is employed like tar for therapeutic action upon the 
skin in hyperidrosis, scabies, eczema and local sweating, in T / 2 to 5 per 
cent, alcoholic solution, or as a 10 per cent, ointment, but is a dangerous 
application. Hydronaphtol is also highly esteemed for antiseptic pur- 
poses generally by those who have used it, and is of benefit as an external 
application in many skin diseases. Its non-toxic and non-irritant qualities 
render it the most useful and most generally available of the three. 

Camphorated Naphtol has been employed hypodermically in tuberculous adenitis, 
with permanent improvement in nine cases, and improvement in six others, out of a series 
of 32 cases so treated by Reboul, of Marseilles. In five cases of tuberculosis of the testis, 
so treated by the same observer, very gratifying results were obtained ; the injection 
appearing to be perfectly harmless, and to act beneficially, both locally and generally. It 
has also been extensively used in the irrigation of joints, bony cavities, tendinous sheaths, 
cold abscesses in the pleural and uterine cavities, and in tuberculosis of the bladder : all 
which localities seem to bear the undiluted fluid well. (Squibb.) 

NUX VOMICA, Nux Vomica, Poison Nut, Quaker Button,— 
is the seed of Strychnos Nux-vomica, a tree of the nat. ord. Loganiaceae, 
growing in India, Cochin-China and the neighboring countries, all parts 
of which are bitter and poisonous. The seeds are flattened and nearly 
circular, about one inch in diameter, ashy-gray in color, covered with 
short, satiny hairs, internally translucent, tough and horny, with a large 
cavity ; inodorous, but of intensely bitter taste. They contain the alka- 
loids Strychnine and Brucine (see below), in combination with Igasuric 
(or Sttychnic) Acid, also the glucoside Loganin, a yellow coloring matter, 
a concrete oil, gum, sdfrch, wax, and earthy phosphates. 

Preparations of Nux Vomica. 

Extractum Nucis Vomicae, Extract of Nux Vomica, — has of total alkaloids 15 per 
cent. Dose, gr. %-}(, up to a maximum in 24 hours of gr ij. 

Extractum Nucis Vomicae Fluidum, Fluid Extract of Nux Vomica, — has 1^ per 
cent, of total alkaloids. Dose, Tt\j-v. 

Tinctura Nucis Vomicae, Tincture of Nux Vomica, — has 0.3 per cent, of total 
alkaloids. Dose, TT^v-xx. 



NUX VOMICA. 389 



Alkaloids and their Salts. 

Strychnina, Strychnine, C 21 H 22 N 2 2 , — is an alkaloid obtained from Nux Vomica, 
Ignatia, and other plants of the order Loganiaceas ; crystalline, intensely bitter even in I 
to 700,000 solution, of alkaline reaction, soluble in 7 of chloroform, 1 10 of alcohol, 6700 
of water, almost insoluble in ether. It is a constituent of Ferri et Strychninae Citras, and 
of Syrupus Ferri Quininse et Strychninae Phosphatum. Dose, gr. -^-j-q. 

Strychninae Sulphas, Strychnine Szdphate (C 21 H 22 N 2 2 ) 2 H 2 S0 4 -f- 5H 2 0, — crystal- 
line, efflorescent, odorless, of intensely bitter taste, even in I to 700,000 solution, neutral 
reaction, soluble in 50 of water, in 109 of alcohol, and in 2 of boiling water, but almost 
insoluble in ether. It contains 75 per cent, of Strychnine. Dose, gr. ^"rV' but a ^ ter 
tolerance is attained much larger doses may be safely used. 

Strychninae Nitras, Strychnine Nitrate (Unofficial), — forms colorless needles of a 
silky lustre and very bitter taste, soluble in 90 parts of cold water, 3 of boiling water, in 
70 of alcohol, and in 26 of glycerin, but insoluble in ether. It contains 84 per cent, of 
Strychnine, and is preferred to the sulphate for hypodermic use, being less irritant. Dose, 
gr. g^-iV > or more a f ter tolerance is attained. The Phar. Ger. gives the maximum single 
dose as gr. A, the daily maximum as gr. \. 

Strychninae Hydrochloras, Strychnine Hydrochlorate (Unofficial), — is used in the 
form of Liquor Strychninae Hydrochloratis (B. P.), which is about a I per cent, solution. 
Dose, nvv-x. 

Strychninae Arsenis, Strychnine Arsenite (Unofficial), — is soluble in 35 parts of cold 
water, in 10 of boiling water, also in alcohol, less so in ether. Dose, gr. ■£$—£$, but as 
it is highly toxic, the initial dose should never exceed the minimum given. 

Brucina, Brucine, C 23 H 26 N 2 4 (Unofficial), — occurs in colorless prisms, pearly flakes 
or masses, bitter, soluble in 850 parts of water and in 1)4 of alcohol. It is separated 
with difficulty from Strychnine, in many samples of which it occurs as an impurity. It 
is seldom used. Dose, gr. j^-j. 

Tests for Strychnine and Brucine. 

Strychnine and its salts dissolve without color in concentrated Sulphuric Acid, but, on 
adding to the solution some deoxidizing substance, a play of colors results, Lead Peroxide 
producing a beautiful blue, passing into violet, then red, and finally yellow (Marchand). 
A minute quantity of Potassium Bichromate produces similar results (Otto), while 
Ceroso-ceric Oxide causes a blue, changing to violet and then to a permanent cherry-red. 
If these tests are carefully applied, as minute a quantity as I part in 900,000 of the solu- 
tion may be detected (Wenzell). 

Brucine is detected by the red color which it yields with Nitric Acid. Neither Nitric 
nor Sulphuric Acid colors Strychnine unless Brucine is present as an impurity, a test 
which distinguishes this alka'oid from several others. Brucine does not decompose Iodic 
Acid, and is thereby distinguished from Morphine. 

Physiological Action. 
The action of Nux Vomica is that of its principal alkaloid Strychnine. 
Externally, the latter is a very powerful antiseptic, but is too poisonous 
for safe use, and in concentrated solution hypodermically it has a decided 
irritant action on the tissues. Internally in small doses its bitter quality 
makes it a good stomachic tonic. Increasing the vascularity of the 
gastric mucous membrane and promoting the secretion of gastric juice, 
also the pancreatic and biliary secretions, it aids digestion and sharpens 
the appetite, but like all other bitter tonics it deranges digestion when 
used excessively or for a long time. It stimulates the muscular coat of 
the intestines increasing peristalsis and thus acts as a purgative, but it 
restrains the fecal discharges when their frequency is due to atony of the 



390 NUX VOMICA. 

bowel. It stimulates the motor nerve-cells of the spinal cord, the cardiac 
motor ganglia, the respiratory and vaso-motor centres in the medulla, 
contracting the arterioles all over the body (though by full doses they are 
relaxed), also the excitability of the sensory nerves and their terminal 
elements. The result is that respiration is deepened and quickened, the 
action of the heart is increased and the blood-pressure raised, the field of 
vision is enlarged, the sight and hearing are sharpened, and the sense of 
touch is rendered more acute, but the cerebral convolutions are not 
affected. Excreted chiefly by the kidneys, it causes increased frequency 
of urination, and when taken in excess produces spasm of the neck of the 
bladder. It probably excites some degree of uterine contraction, but 
undoubtedly promotes menstruation, disposes to sexuality, and provokes 
erections of the penis. 

The most marked feature of the action of Strychnine is the great in- 
crease which it causes in the reflex excitability of the spinal cord and 
other reflex centres, such as the vaso-motor and respiratory centres in the 
medulla. When the dose is large this increase is so great as to induce 
convulsions and cause death by asphyxia. After a full dose (gr. -J^-) the 
pupils become dilated, the limbs take on jerking movements, respira- 
tion becomes spasmodic and the lower jaw stiff, a sensation of cerebral 
tension may be felt, and sudden shuddering and anxiety follow, the face 
taking on an unmeaning smile, the risus sardonicus. A toxic dose 
(gr. \ to gr. ij) produces powerful and characteristic convulsions of a 
tetanic character. Within an hour after its administration, sometimes after 
only a few minutes, the patient feels a sudden sense of suffocation and 
dyspnea, the head and limbs begin to shudder and jerk, the limbs are 
suddenly stretched out rigidly, with hands clenched and feet arched, then 
the head is bent backwards and the whole body becomes stiffly arched 
resting on the head and the heels, the belly tense, the chest muscles fixed 
and the breathing all but arrested. In the height of the paroxysm the 
face is dusky and congested, and the eyeballs project. Nearly all the 
muscles of the body are affected, but those of the jaw are not seriously 
implicated until near the end, and never so powerfully as in tetanus. The 
pulse is very rapid and the body-temperature is above normal, but the 
intellect remains unclouded and the patient often expresses a sense of 
impending dissolution. After the paroxsym has lasted a minute or two 
it usually relaxes for a time. In the interval the patient suffers from sore- 
ness of the muscles, feels exhausted and sweats profusely, but soon 
becomes aware that the spasm is returning and may cry out for some one 
to hold him or to rub his limbs. The convulsions rapidly increase in 
severity, a breath of wind, the slightest noise, even a bright light, being 
sufficient to bring them on, and in one the patient may jerk himself out 
of the bed. At last the respiration stops in the middle of a fit and the 



NUX VOMICA. 391 

heart soon ceases to beat. Death occurs, after two or three hours at 
most, by exhaustion and asphyxia from tetanic fixation of the muscles of 
respiration, consciousness being preserved until carbonic-acid narcosis 
sets in. 

Strychnine exalts all the functions of the spinal cord — reflex, motor, 
vaso-motor, and sensory, the latter being the least affected. It has selec- 
tive action on the large multipolar ganglia in the anterior columns, which 
it first stimulates and finally paralyzes by over-stimulation, in this respect 
illustrating the rule that small and large doses of an active agent act 
antagonistically to each other. A massive dose seems to destroy the 
spinal and medullary functions as by a single blow. The spasms of 
Strychnine may be distinguished from those of tetanus by their intermit- 
tency (the latter being constant), by the meaningless smile, the less marked 
trismus, the absence of a wound, and the rapid course of the symptoms. 
Thebaine, the tetanizing alkaloid of opium, is also a spinal exaltant, and 
acts much the same as strychnine. 

Strychnine does not directly affect the muscular tissue, the motor nerve- 
trunks or nerve-endings, or the cerebral convolutions. Occasionally, 
however, large medicinal doses cause a greatly heightened sensibility of 
the optic and auditory nerves, so that brilliant lights and loud sounds pro- 
duce painful impressions ; and in a few cases there occurs a true cerebral 
intoxication resembling a slight degree of drunkenness. It probably 
affects all the nervous centres in some degree, the sensory, however, much 
less than the motor and vaso-motor ones. It is to some extent oxidized 
and destroyed in the body, the remainder being eliminated by the urinary, 
salivary and cutaneous channels. As it contracts the renal arteries, it 
hinders its own excretion by the kidneys, and being rapidly absorbed it 
may accumulate in the system if even a small dose is frequently and con- 
tinuously administered. It is much more poisonous when injected into 
the rectum than when swallowed. 

The fatal dose of Strychnine is placed by Taylor at gr. \ to gr. ij for 
an adult, but recovery has taken place after larger doses, even 7 and 8 
grains, cases probably of imperfect absorption, due perhaps to the pres- 
ence of fat or tannin in the contents of the stomach. A child, aged 2^ 
years, died in four hours from a dose of gr. -jL.. After death from this 
poison cadaveric rigidity is marked, with opisthotonos, clenched hands, 
and arms flexed across the chest. The muscular rigidity may persist for 
several months after death. The face is usually pale, but sometimes livid, 
the internal organs are gorged with dark blood, and the bladder is gener- 
ally contracted. The cause of death is primarily asphyxia produced by 
rigidity of the muscles of respiration, with possible factors in spasm of the 
heart or exhaustion thereof. 

On animals Strychnine acts as it does upon man, but in different de- 



392 NUX VOMICA. 

grees. Birds, guinea-pigs and perhaps monkeys, are comparatively insus- 
ceptible to it, while ruminants are less easily affected than other quadrupeds, 
and cats resist it singularly. Very minute portions in the soil will destroy 
the life of growing plants. 

Antidotes, Antagonists and Incompatibles. 

The antidotes are Tannic Acid to form the very insoluble tannate, and Iodine in dilute 
solution, or a soluble Iodide. Animal Charcoal should be given freely, also Fats and 
Oils, to retard absorption. Potassium Permanganate has been used successfully after the 
ingestion of gr. ^ of strychnine without any symptom of strychnine poisoning resulting 
(Fahr). Lard is said to be a good antidote. Evacuation of the stomach should follow 
the administration of any antidote, and the bladder should be emptied frequently to pre- 
vent reabsorption. The most reliable antagonist is Chloral Hydrate, of which gr. xxx 
should be given at once, and doses of gr. xx may be repeated at hourly intervals as long 
as reflex exaltation continues. Quiet, as perfect as possible, is an antagonistic measure 
of great importance. Other antagonists are Hydrastinine Hydrochlorate, gr j hypo- 
dermically, Nicotine, Chloroform, Amyl Nitrite, Physostigma (dangerous), Veratrum 
Viride, Oil of Chamomile, and Valerian. Potassium Bromide is antagonistic, but too 
slow of action to be of service. Curare has been recommended, but its antagonistic value 
is doubtful. 

Incompatibles are Bromides, Iodides and Chlorides, which precipitate the strychnine 
as a hydrobromide, etc. Strychnine salts in solution are decomposed by Alkalies and 
their Carbonates, and by Tannic (not by gallic) Acid, but are not affected by ferric salts. 
Oils and fats retard their absorption. 

Therapeutics. 
Nux Vomica and its chief alkaloid, Strychnine, are exceedingly useful 
remedies, having a wide range of therapeutic efficacy. They are chiefly 
employed as stomachic tonics, and as stimulants to the heart, the respira- 
tory apparatus, and the muscular and nervous systems. As the quantity 
of strychnine in nux vomica varies greatly, it is best to use the alkaloid when 
its physiological action is desired, as more definite dosage may be thus ob- 
tained. The tincture in 5-drop doses is excellent in atonic dyspepsia and 
gastric catarrh, especially in drunkards, and in constipation from atony of 
the bowels it may be given in 10-drop doses with good results, not as a 
purgative but to increase peristalsis. The extract is much used in laxative 
pills for habitual constipation. In the vomiting of pregnancy the tincture is 
frequently an efficient remedy, and in the vomiting of phthisis Strychnine 
is one of the very best agents. In the condition clinically known as that 
of torpid liver, where the stools are of pale color and very offensive odor, 
showing absence of bile therein, the tongue coated with a thick, perhaps 
yellowish fur, and the patient complaining of headache, lassitude, anorexia, 
and a bad taste in the mouth, small doses of Strychnine (gr. -^) twice or 
thrice daily will frequently act as well as a mercurial, restoring the bile to 
the stools, and correcting the other symptoms. Epidemic diarrhea and 
dysentery are often controlled by Strychnine, and in anemia and chlorosis 
it is an invaluable remedy, especially when combined with iron and qui- 
nine. In intermittents, as an adjunct to quinine it is always useful, and 



nux vomica. 393 

in neuralgia, especially of the viscera, and infraorbital and other forms 
accompanying anemia and general debility, it is highly efficient, but in 
these affections very small doses (gr. y^-) should be employed. 

Headaches are often controlled by Nux Vomica, especially the sick 
headache of gastric origin, in which minim-doses of the tincture every ten 
or fifteen minutes frequently give marked relief, and a dose of n^x before 
each meal will prevent frontal headache in many persons liable thereto. 
A sense of heat and weight on top of the head, accompanied or not by 
flatulence, and usually occurring in women at the climacteric, will often 
yield to the tincture in doses of n^v before each meal. Its undoubted in- 
fluence on the pneumogastric makes it a valuable remedy for many kinds 
of cough, even those of phthisis, bronchitis, pneumonia or emphysema, but 
it is particularly efficient in coughs of neurotic origin, such as periodical 
cough, night cough, and the paroxysmal laryngeal cough without lung or 
bronchial symptoms, but characterized by a persistent tickling sensation 
in the throat. In all these drop-doses of the tincture frequently repeated 
are more serviceable than larger doses at longer intervals. In bronchial 
asthma and asthma of neurotic origin, in the dyspnea of pulmonary affec- 
tions and that with cardiac palpitation in hysterical subjects, in irregular 
action and over-action of the heart, in functional anesthesia, hypochon- 
driasis, abdominal cramps, nervous movements accompanying pregnancy, 
cold hands and feet due to languid capillary circulation, prolapsus ani 
and urinary incontinence in children, and paralysis of the bladder in old 
people, small doses of Strychnine frequently repeated are remarkably 
beneficial. In many of these affections the therapeutic action of the drug 
is unmistakably that of an antispasmodic, illustrating the opposite effects 
of large and small doses of an active agent, a thoroughly established fact 
in many cases, though not a universal one. 

Nux Vomica is a most efficient remedy in impending cardiac failure 
from almost any cause. Even with the pulse imperceptible, the extremi- 
ties cold, and death apparently imminent, the administration of a drop of 
the tincture every five minutes has frequently given renewed strength to the 
cardiac contractions after five or six doses, and initiated an improvement 
which resulted in eventual recovery. Local paralyses of various forms 
are well treated by the hypodermic injection of Strychnine into the 
substance of the affected muscles, and diphtheritic paralyses are almost 
invariably cured by its internal administration. It may prove useful in 
hemiplegia when degeneration has not set in, and when the paralyzed 
muscles are completely relaxed ; but it is of no avail in recent cases or 
when electrical contractility is lost. If used early in cerebral paralyses, 
especially when due to hemorrhage, it may do serious harm ; and in the 
early stage of organic spinal lesions it may be decidedly injurious, par- 
ticularly if given in large doses. It should never be used in spinal 



I 
i 



I 



394 nux VOMICA. 

paralysis when there are symptoms of congestion or inflammation of either 
the cord or its membranes. In hysterical paralysis and that caused by 
lead it is decidedly beneficial, and also in the form which is limited to 
one or two groups of muscles, especially infantile paralysis of long stand- 
ing, even when the atrophic process has gone so far as to greatly impair 
the electrical sensibility. In multiple peripheral neuritis the hypodermic 
injection of strychnine has proved eminently serviceable. 

Strychnine is very useful in cases of nervous impairment of the sight, 
especially in amblyopia from lead, tobacco or alcohol, from atrophy of 
the optic nerve, and from functional disorders of the retina without ap- 
parent lesion, also in muscular asthenopia. In these affections it may be 
used internally, but it is usually administered by injection into the tissues 
around the temple, beginning with gr. ^L-, and gradually increasing the 
dose up to gr. }i or y£. Improvement may not be apparent until the 
larger doses are reached. 

In acute and chronic alcoholism, Strychnine is undoubtedly of great 
service. In small doses it is an effective remedy for the morning vomit- 
ing and dyspepsia of drunkards, for the tremor of chronic dipsomaniacs, 
in the forming stage of delirium tremens, and for the depression due to 
enforced abstinence from alcohol. The nitrate, in doses of gr. -^ to -^, 
hypodermically three or four times daily for a week, and less frequently 
for two weeks longer, removes the craving for stimulants, counteracts the 
vaso-motor paralysis to which most of the injurious effects of alcohol are 
due, and is probably in other respects a true antagonist to the action of 
that narcotic poison on the human organism. The published reports of 
its efficacy in dipsomania, by Luton, Dujardin-Beaumetz, Portugaloff and 
others, have been fully confirmed by other observers, so that Strychnine 
is now the acknowledged remedy for inebriety, and the efficient con- 
stituent of the numerous "cures" therefor so widely advertised in the 
religious and secular press. 

Strychnine is a physiological antagonist to Chloral, Physostigmine and 
Morphine, and may be used as a respiratory stimulant in poisoning by 
these drugs, also in narcotic poisoning by any agent when the respiration 
is failing. It has been employed in Australia as an antagonist to serpent 
venom with great success in the hands of Mueller and others, and with 
doubtful efficacy in the experience of many observers. From the results 
of experiments made by Dr. Elliot, of the Indian army, it would seem 
that its use in poisoning by cobra venom is of no service whatever and 
may actually hasten death. 

Strychnine Arsenite possesses strong antiperiodic power, and may 
prove to be an efficient remedy for any intermittent disease which proves 
rebellious to the influence of quinine. As it is a highly toxic agent, 
the minimum dose (gr. -g 1 -^) should not be exceeded at its first admin- 



OLIV^E OLEUM. 395 

istration, and its effects should be carefully watched upon repetition 
of the dose. 

Brucine was formerly supposed to have an action analogous to that of 
strychnine though weaker. Dr. Mays has shown that pure Brucine is a 
powerful local anesthetic in 5 to 10 per cent, solutions on mucous mem- 
branes, and in a 20 per cent, solution on the skin. In the latter strength 
its solutions have been employed with satisfaction for chronic pruritus, 
and in a weaker solution (5 per cent.) for inflammations about the exter- 
nal ear, in which Dr. Burnett claims for it more satisfactory results than 
are obtained with cocaine. 

NYMPH^A ODOR ATA, Sweet-scented Water-lily (Unofficial),— is a well- 
known American plant of the nat. ord. Nymphaeaceae, the root of which is very bitter and 
highly astringent, containing much Gallic and Tannic Acids, to which its actions and 
uses are due. A decoction of 3jj to the pint may be used in doses of jf ss-j, or a fluid 
extract in doses of gss-j. For the physiological actions and therapeutics of this vege- 
table astringent see under Acidum Tannicum. 

OLIV^ OLEUM, Olive Oil, Sweet Oil, Salad Oil,— is a fixed 
oil expressed from the ripe fruit of Olea europcea, the olive tree (nat. ord. 
Oleacese), which is cultivated in southern Europe, California and Aus- 
tralia. It is a pale-yellow or greenish-yellow oily liquid, of nutty, oleag- 
inous taste and neutral reaction, sparingly soluble in alcohol but readily 
soluble in ether. Sp. gr. about 0.916. Dose, §ss-j. 

Olive Oil consists of 72 per cent, of Otein (a fluid oil) and 28 per cent, of Palmitin 
(a solid oil or stearopten), which are compounds of the base Glyceryl, C 3 H 5 , with Oleic 
Acid, C 19 H 34 2 , and Palmitic Acid, C 17 H 31 2 , respectively. It is frequently adulterated 
with cheaper fixed oils, especially poppy oil, lard oil, and cotton-seed oil, quantities of 
the latter being exported every year to Italy, whence it is returned to us as Olive Oil 
under a French label. (See Gossypium.) It is an ingredient of Ceratum Cetacei, Em- 
plastrum Plumbi and Unguentum Diachylon, and is the source of the official Soap. 

Physiological Action and Therapeutics. 
Externally used Olive Oil is a good protective from the air, and ren- 
ders the skin soft and flexible. If rubbed into the integument it is ab- 
sorbed by the lymphatics and is directly nutritive in effect. Internally it 
is also nutritious and mildly laxative, and in quantity acts as a protective 
to the mucous membrane against acrid or poisonous substances. Like 
other oils it is partly emulsified, partly saponified in the intestines, its gly- 
cerin being set free and its fatty acids combining with the free alkalies to 
form soap, which with the emulsion forms the molecular basis of the chyle, 
entering the blood through the lacteals and being finally oxidized into 
carbonic acid and water, though an excess will appear unchanged in the 
urine. Oils are therefore a food within certain limits, increase the fat of 
the tissues, furnish heat and force, and lessen the waste of nitrogenous 
tissue, but are unable of themselves to support life. 



396 OPIUM. 

Olive Oil possesses no very marked therapeutic power over any other 
bland oil or fat. It is a good laxative for infants administered internally, 
and may be used as an enema followed by warm water. There is much 
clinical evidence to prove that administered internally it is a very effi- 
cient remedy in both nephritic and biliary colic, but how it acts therein 
has not been explained. It is chiefly employed as a local application. 
Applied to burns and acute inflammatory affections of the skin it is an 
excellent protective, coating the surface and excluding the air ; and as an 
ingredient of liniments it acts as a diluent for more active agents. It is 
used to facilitate friction over enlarged or stiff joints, and in the desqua- 
mative stage of scarlet fever is a very useful and grateful application. As 
an antidote in corrosive poisoning it acts mechanically by protecting the 
mucous membrane of the stomach and preventing absorption. In phar- 
macy its bland, unirritating qualities have procured its common employ- 
ment as an ingredient of liniments, plasters, ointments and cerates, but 
the foreign article is so frequently adulterated with inferior oils that Cot- 
ton-seed Oil is now directed in its place in many official preparations. 



OPIUM, — is the concrete, milky exudation, obtained by incising the 
unripe capsules of the White Poppy, Papaver somniferum, an annual herb 
of the nat. ord. Papaveracese, indigenous to Western Asia, but cultivated 
extensively elsewhere. Its capsules are globular, two or three inches in 
diameter, and are crowned by a sessile, stellate stigma, which distin- 
guishes them from Colocynth and Bael fruits. Opium occurs in irregular 
lumps or cakes, of dark-brown color, sharp, narcotic odor, and bitter 
taste ; and in its normal, moist condition should yield not less than 9 per 
cent, of Morphine when assayed by the official process. 

Composition of Opium. 
Opium contains 17 alkaloids, 2 neutral substances and 2 organic acids, 
together with sugar, gum, resin, pectin, extractives, odorous principles, 
water and other constituents of plants. Its most important alkaloids are 
the following : — 

Morphine, C 17 H 19 N0 3 , — 5 to 20 per cent., — the principal alkaloid, occurring in the 
drug in the form of the tribasic meconate. Its properties are anodyne, hypnotic and nar- 
cotic. From it by a process of dehydration by heat and hydrochloric acid is prepared 
the artificial alkaloid Apomorphine, a powerful emetic and expectorant. 

Codeine, C 18 H 21 N0 3 , — 0.3 to 0.5 per cent., — is calmative and when pure a not very 
active alkaloid, but is frequently contaminated with other alkaloids. Apomorphine may 
be prepared also from it. 

Narcotine, C 22 H 23 N0 7 , — 2 to 10 per cent., — is antiperiodic and a tetanizer, but 
wholly devoid of narcotic properties. 

Thebaine, or Paramorphine, C 19 H 21 N0 3 , — 0.15 to 0.20 per cent., — is a powerful 
spinal exaltant and tetanizer, resembling Strychnine in its action. 



opium. 397 

Narceine, C 22 H 29 N0 9 , — 0.02 percent., — closely resembles Morphine in action, but 
is probably more hypnotic, and is not followed by many of the disagreeable after-effects 
of Morphine. It is extremely difficult to obtain this alkaloid pure. 

Papaverine, C 21 H 21 N0 4 , — I per cent., — is reported inert on man by some observers, 
a narcotic and convulsant by others. 

Other Alkaloids at present acknowledged are — Cryptopine, Pseudomorphine, Protopine, 
Hydrocotarnine, Laudanine, Codamine, Rhoeadine, Meconidine, Laudanosine, Lantho- 
pine and Gnoscopine. Many of them are probably to be regarded as derivatives of 
Morphine. 

Acids and Neutral Principles. 

Acids are — Meconic Acid, C-H 4 7 , 4 per cent., and Lactic Acid, C 3 H 6 3 , \% per 
cent., which exist in combination with the alkaloids as meconates, etc. The second acid 
is generally called Thebolactic, but has been shown to be identical with lactic acid. 

Neutral Principles are — Meconin, C 10 H 10 O 4 , 0.01 per cent., is white, crystalline, 
neutral, but very acrid; Meconoiosin, C 8 H 10 O 2 , also crystalline, and Porphyroxin, which 
is said to be a very complex combination of several opium alkaloids and not a proxi- 
mate principle. 

Official Preparations of Opium. 

Opii Pulvis, Powdered Opium, — is Opium dried at a temperature not exceeding 185 
F., and reduced to a very fine powder. It should contain not less than 13 nor more than 
15 per cent, of crystallized Morphine, when assayed by the official process. Dose, gr. 
ss-iij, an average adult dose being about I grain. 

Opium Deodoratum, Deodorized Opium (Denarcotized Opium), — is powdered Opium 
freed from the constituents thereof which are soluble in Ether, namely Narcotine and the 
odorous principles, which are supposed to cause the unpleasant after-effects of the drug. 
It should yield 14 per cent, of Morphine, and is a good preparation, being a purified 
opium with a fixed morphine standard. The proprietary article named Svapnia is a 
similar preparation. Dose, gr. ss-iij ; an average adult dose being about I grain. 

Extractum Opii, Extract of Opium, — an aqueous extract containing 18 per cent, of 
Morphine, and freed from principles insoluble in water. Dose, gr. %-\). 

Pilulae Opii, Pills of Opium, — each pill contains about gr. j of powdered Opium 
incorporated with Soap. Dose, j-iij pills. 

Tinctura Opii, Tincture of Opium (Laudanum), — Opium-strength 10 per cent., 
average Morphine-strength gr. vj (equalling gr. vijss of the Sulphate) to the fl !| . Has 
about gr. xliv of Opium to the ^ . TT^xj (gtt. xxij) = gr. j of Opium or gr. l /s of Morphine 
Sulphate. Sixty minims yield on the average 120 drops. Dose, TT^v-xxx, according to 
the effect desired. 

Tinctura Opii Deodorati, Tincture of Deodorized Opium, — an aqueous extract is 
prepared and shaken with ether, which being separated the residue is dissolved in water, 
and enough alcohol is added to preserve it. An excellent liquid preparation, being freed 
from all the noxious and useless ingredients soluble in alcohol and ether. Opium-strength 
10 per cent., average Morphine-strength gr. vj to the fl^. Dose, as of Tinctura Opii. 
Drops of this preparation nearly equal minims. McMunn , s Elixir is a similar prepara- 
tion, so also is another proprietary nostrum named Papine. 

Vinum Opii, Wine of Opium (Sydenha??? s Laudanuni), — Opium-strength 10 per 
cent. , with the aromatics Cinnamon and Cloves of each I per cent. , in Alcohol and White 
Wine. A vinous tincture decreased somewhat in strength from the wine of 1870. Dose, 
as Tinctura Opii. Drops of this preparation are larger than those of the tincture. 

Acetum Opii, Vinegar of Opium [Black Drop), — Opium-strength 10 per cent., with 
Nutmeg and Sugar in Dilute Acetic Acid. Is now y z weaker than formerly, having the 
same strength and dose as Tinctura Opii. 

Tinctura Opii Camphorata, Camphorated Tincture of Opium (Paregoric), — has of 
Powdered Opium 4, Benzoic Acid 4, Camphor 4, Oil of Anise 4, Glycerin 40, Diluted 
Alcohol to 1000. ^ss contains nearly one grain of powdered Opium. It is about -^th 
the strength of Laudanum. Dose, for an infant gtt. v-xx, for an adult gj-iv. Is an 
ingredient of Mistura Glycyrrhizse Composita. 



39§ OPIUM. 

Emplastrum Opii, Opium Plaster, — contains of Extract of Opium 6 parts, Burgundy 
Pitch 18, Lead Plaster 76, Water 8. 

Pulvis Ipecacuanhae et Opii, Powder of Ipecac and Opium {Dover's Powder), — 
has of Ipecac 10, Powdered Opium 10, Sugar of Milk 80, rubbed together into a very- 
fine powder. Dose, gr. v-xv ; ten grains equalling I grain each of Ipecac and Opium. 

Tinctura Ipecacuanhae et Opii, Tincture of Ipecac and Opium, — has of Tincture of 
Deodorized Opium 100 evaporated to 80, Fluid Extract of Ipecac 10, Diluted Alcohol 
to 100. Is intended to represent Dover's Powder in liquid form. Dose, TT^v— xv. 

Trochisci Glycyrrhizae et Opii, Troches of Glycyrrhiza and Opium, — each troche 
contains of powdered Opium gr. y 1 ^, with Extract of Glycyrrhiza, Acacia, Sugar and Oil 
of Anise. Dose, j-iv troches. 

[Note. — According to the U. S. Pharmacopoeia of 1890 the official dried Opium should 
contain 13 to 15 per cent, of Morphine instead of 10 per cent, as required by the Phar- 
macopoeia of 1870. The liquid preparations, except Paregoric, are now directed to be of 
the uniform Opium-strength of 10 per cent., and to yield, on being assayed, 1.3 to 1% 
per cent, of crystallized morphine, making the Wine less strong by 2 per cent., the 
Acetum fully y$ less in strength, and the other liquid preparations stronger by l / 2 in 
Morphine than formerly. So that if the full anodyne dose of Tincture (1870) be taken 
at 24 minims, equalling gr. ^ of Morphine Sulphate, the corresponding dose under the 
present system will be 16 minims.] 



Official Preparations of Morphine. 

Morphina, Morphine, C 17 H 19 N0 3 -f- H 2 0, — white, prismatic crystals, or fine needles, 
or a crystalline powder, odorless, of bitter taste and alkaline reaction, almost insoluble in 
water, soluble in 300 of alcohol. Its comparative insolubility makes the salts preferable 
for use, and as a very small proportion of acid neutralizes it, the dosage is about the same 
for the alkaloid and its salts, viz., gr. ^-gr. j. Gr. \-\ is about equal to one grain of 
Opium of medium Morphine-strength. [Compare Morphines Sulphas, below.] 

Morphinae Acetas, Morphine Acetate, — a white, crystalline or amorphous powder of 
faintly acetous odor, bitter taste, neutral or faintly alkaline reaction, soluble when fresh 
in 2% of water and in 47.6 of alcohol at 59 F. Dose, gr. Jg- j. 

Morphinae Hydrochloras, Morphine Hydrochlorate, — white, feathery crystals of 
silky lustre, of bitter taste and neutral reaction, soluble in 24 of water and in 62 of 
alcohol at 59 F. Dose, gr. -^q-]. 

Morphinae Sulphas, Morphine Sulphate, — white, feathery, acicular crystals of silky 
lustre, of bitter taste and neutral reaction, soluble in 21 of water and in 702 of alcohol 
at 59 F. , and in 0.75 of boiling water. Contains about 80 per cent, of Morphine. 
Dose, gr. j-Q-gr. j ; ■%■$-% being a small dose for an adult, %-% a moderate one, ^ to ]/% 
a full dose, and y^-] a large one. 

Pulvis Morphinae Compositus, Compound Powder of Morphine (Tuliys Pow- 
der), — has of Morphine Sulphate I part to 19 of Camphor and 20 each of Liquorice and 
Calcium Carbonate. A similar preparation to Dover's powder minus the Ipecac. Dose, 
gr. v-xv, ten grains containing gr. l /(> of Morphine Sulphate. 

Trochisci Morphinae et Ipecacuanhae, Troches of Morphine and Ipecac, — each 
has gr. -£$ of Morphine Sulphate with gr. y 1 ^ of Ipecac, also Sugar, Oil of Gaultheria 
and Mucilage of Tragacanth. Dose, one every hour or so ; cautiously with children. 

Injectio Morphinae Hypodermica, Hypodermic Injection of Morphine (B. P.), — 
is a solution of the Acetate, containing gr. j in each ten minims, being thrice as strong 
as Magendie's solution. Dose, rr\J-iij. 

Tinctura Chloroformi et Morphinae, Tinchire of Chloroform and Morphine, (B. 
P.), — a substitute for Chlorodyne. See ante, page 261 and also the table on Chlorodyne 
in the Appendix. 

Unofficial Preparations of Opium and Morphine. 

Liquor Opii Compositus, Compound Solution of Opium (Squibb), — has the same 
strength as the official tinctures, namely gr. vj of Morphine (equalling gr. vijss of the 
Sulphate) to each fluidounce. tT\,xvj = gr. ^ of Morphine Sulphate. 



OPIUM. 



399 



Tinctura Opii Composita, Compotmd Tincture of Opium {Squibb' 's Diarrhea Mix- 
ture), — has of Tinct. Opii, Spt. Camphoree and Tinct. Capsici ^j of each, Purified 
Chloroform ^iij, Stronger Alcohol q. s. ad ^v. Each fl g or teaspoonful contains 
about ioo drops or ir^xi], of each of the first three ingredients and n\,ivss or 1 8 drops of 
Chloroform. Dose, for infants gtt. j-x, for children gtt. x-xxx, for adults ^ss-j. 

Liquor Morphinse Sulphatis, Solution of Morphine Sulphate (Magendie' s Solu- 
tion), — has gr. xvj of Morphine Sulphate in each fl ^ , or gr. j in n\xxx, or gr. ^ in 
rr\^vijss. If made with Benzoic Acid, the solution will not spoil, and is not irritant hypo- 
dermically. The same result is attained by adding of Carbolic Acid, TTLiij to the ^ . 

Oleatum Morphinse, Oleate of Morphine, — Morphine-strength io per cent, with 
Oleic Acid 90. For local use. 

Liquor Opii Sedativus, Sedative Solution of Opium (Battley's Sedative), — is about 
50 per cent, stronger than Tinct. Opii. It was formerly a favorite preparation. 

Dalby's Carminative, — contains Opium, about gr. \ to the ounce, also Oil of Pep- 
permint, Nutmeg, Anise, and Magnesium Carbonate. 

Godfrey's Cordial, — contains Laudanum, Sassafras and Treacle, its opium strength 
being gr. \ to the ounce. 

Nepenthe, — is a purified alcoholic solution of Morphine Meconate in sherry wine. 

Chlorodyne, — (see ante, page 261, and Appendix), — contains Morphine in varying 
proportion, that of J. Collis Browne having gr. vj to the ounce. 

Mrs. Winslow's Soothing Syrup, — contains Morphine, with Essence of Anise and 
Syrup of Tolu. After years of persistent denial, its proprietors have admitted that it 
contains \ grain of Morphine in each fluidounce (Squibb). 

Derivatives of Morphine. 

Apomorphinae Hydrochloras, Apomorphine Hydrochlorate, C 17 H 17 N0 2 HC1, — is 
the hydrochlorate of an artificial alkaloid (Apomorphine) which is prepared from mor- 
phine or codeine by the action of strong acids or zinc chloride, the morphine losing in 
the process a molecule of water. The Hydrochlorate occurs in minute, colorless crystals, 
odorless, of bitter taste, and neutral or faintly acid reaction ; soluble in about 45 of water 
and in the same quantity of alcohol at 59 F., almost insoluble in ether or chloroform ; 
decomposed by boiling water or boiling alcohol. Dose, gr. -^ to jq hypodermically, 
gr. Jq to ^ by the mouth. For young children, gr. -^ to -^ s should not be exceeded. 
Solutions should be fresh when used, and as they alter rapidly by keeping should have a 
few drops of hydrochloric acid added to them, to prevent decomposition. 

Peronine, Benzyl-morphine, (Unofficial), — is the hydrochloride of the benzyl ether 
of morphine, and occurs as a white powder, soluble in water, insoluble in alcohol, chlo- 
roform or ether. It produces sound sleep without previous excitement, and has been 
useful in allaying cough, also in relieving rheumatic and neuralgic pains. It is almost 
free from the by-effects of morphine. Dose, gr. y^-] in pill or in aqueous solution. 

Heroine, Diacetyl-morphine, (Unofficial), — is an acetic ester of morphine and occurs 
as a fine, white powder, insoluble in water but soluble in dilute acids. It resembles 
codeine in its effects but has a stronger action on the respiratory centre. It has been very 
efficient in coughs, pain in the chest and catarrhal affections of the respiratory tract 
(Dreser). Dose, gr. ^-\ in pill or powder, or in aqueous solution with a few drops of 
diluted acetic acid. 

Dionine, (Unofficial), — is the hydrochloride of the mono-ethyl-ester of morphine, and 
occurs as a white, crystalline powder, very soluble in water and may be used hypoder- 
mically. It possesses the narcotic properties of morphine without its intensity, and is 
recommended in the treatment of the morphine habit, since tolerance is not established 
by its continued use. It has been employed in phthisis, bronchial affections and pneu- 
monia. Dose, gr. %-]. 



Other Alkaloids and their Preparations. 

Codeina, Codeine, C 18 H 21 N0 3 -f-H 2 0, — white or yellowish- white, rhombic prisms, 
efflorescent in warm air, of bitter taste and alkaline reaction, soluble in 80 of water 
and in 1 7 of boiling water, very soluble in alcohol, chloroform and ether. This alka- 



400 OPIUM. 

loid is official. Dose, gr. X~J SS ' kut S r - i nas caused alarming symptoms in chil- 
dren. Much of the so-called codeine in the market consists largely of morphine. 

Codeinae Phosphas, Codeine Phosphate, (Unofficial), — white crystals of slightly bit- 
ter taste, soluble in 4 of water and in 200 of alcohol. Is the most soluble salt of codeine 
and comparatively unirritant, hence it is well suited for hypodermic use in solution of I 
part in 20 of water. Dose, gr. X~~J SS - 

Syrupus Codeinae, Syrup of Codeine, (Unofficial), — has of Codeine Phosphate gr. 
xxxij, dissolved in Distilled Water 3 ijss, adding Syrup to ^ xvj. Of this 3J contains gr. 
\ of Codeine Phosphate. Dose, 3J-iv. 

Narcotinae Hydrochloras, Narcotine Hydrochlorate , (Unofficial), — Dose, gr. ij-x, 
as an antiperiodic. 

Children bear Opium badly, and for them its proportionate dosage 
should be much below that for other agents. Morphine should not be 
given to children below 10 years of age, and never hypodermically to 
those beneath the age of 15. Opium given to a nursing mother will affect 
the child, being partly excreted in the milk. 

Reactions and Inco?npatibles m 

An aqueous or alcoholic preparation of Opium reddens litmus paper (free meconic 
acid) ; gives a deep red color with Ferric Chloride (meconic acid) ; forms precipitates 
with Lead Acetate, Silver Nitrate, Zinc, Copper, and Arsenic (meconates, sulphates, and 
coloring matter) ; forms a precipitate with tincture of Galls or astringent preparations 
(tannates of morphine and codeine) ; and becomes turbid with the fixed Alkalies, Car- 
bonates, Alkaline Earths, and Ammonia (precipitated morphine and narcotine). 

Tests for Morphine. 

JVitric Acid produces an orange-red color, turning yellow, then disappearing. Test- 
solution of Ferric Chloride gives a blue color changing to green with excess of the 
reagent, and destroyed by free acids or alcohol, but not by alkalies. Iodic Acid liberates 
Iodine which may be tested by starch. Vaughn has shown that certain intestinal 
ptomaines will give the same reactions with these reagents. 

Physiological Action. 

Opium is analgesic, hypnotic, antispasmodic, diaphoretic and narcotic. 
It first stimulates and afterwards depresses the cerebrum, heart and respir- 
atory apparatus, and is classed among the cerebral depressants. 

In medium dose (gr. j) it arrests all the secretions except the milk and 
sweat, the latter -being increased; producing dryness of the mouth and 
throat, retarded digestion from decrease of the gastric juice, and decided 
loss of appetite. The action of the heart is increased, arterial tension is 
raised and the pupils are slightly contracted. The cerebral faculties are 
stimulated to a pleasant activity by increased blood-supply, ideas follow 
each other rapidly through the mind, and an exhilaration bordering on 
mild intoxication is experienced, succeeded by a calm of variable length. 
Sleep generally follows, disturbed by dreams, and after waking, headache, 
malaise, constipation, digestive disturbance and some depression result. 
The conductivity of the nerves is not affected. Frequently the stage of 
mental activity is absent, but in persons habituated to the use of Opium 
it is usually well marked. In some subjects a lengthened period of calm 



OPIUM. 



401 



repose takes the place of sleep, in others neither calm nor sleep occurs, 
but the stimulant action of the drug prevails, the spinal functions as well 
as the cerebral are exalted, and great restlessness results. 

In full dose (gr. iij-v) the same symptoms are produced but in greater 
intensity ; the stage of stimulation is much shorter, digestion is arrested, 
nausea and vomiting produced, also profuse diaphoresis. The conduc- 
tivity of the nerves is more or less impaired, the heart and circulation 
depressed, oxidation being interfered with and the body-temperature 
lowered. The pupils are contracted by stimulation of the motor oculi 
through the basal ganglia, intense pruritus is produced, especially at the 
nose, and often spasmodic retention of the urine. Profound sopor soon 
comes on, with irregular and slow respiration, but in some subjects this is 
replaced by coma-vigil and delirium. After-effects are nausea, depression, 
constipation, racking headache, vertigo, anorexia, nasal pruritus, and fetid 
pathological secretions. 

A toxic dose produces cold and clammy sweat, very slow pulse, slow and 
stertorous respiration gradually becoming feeble and irregular, cyanosed 
face, abolished reflexes, coma gradually deepening, the pupils minutely 
contracted but dilating as the end approaches, and finally death by par- 
alysis of the respiratory centre due to direct action on the medulla. Post- 
mortem examination shows only a wet brain, congested lungs, and 
engorgement of the venous trunks and of the right heart. 

The coma produced by opium-narcosis, when deep and when a history of the case 
cannot be obtained, is almost impossible of differential diagnosis from that due to alcohol, 
apoplexy, uremia, epilepsy, etc. [See under Alcohol, ante, page 137.] The odor of 
the breath may point to laudanum or some other preparation of opium. The pupils are 
very much contracted in opium poisoning (also from physostigma and chloroform), but 
they may dilate just before death (as with chloroform), due to the irritation of the centres 
by the excessive venous condition of the blood. In alcoholic coma they may be either 
contracted or dilated ; and in apoplexy they are generally contracted unequally, though 
in apoplexy of the pons varolii they may be equally and minutely contracted. The rectal 
temperature may be an important sign, for in most cases of apoplexy there is an initial 
fall of temperature with a subsequent rise. A previous history of convulsions points to 
epilepsy, and the presence of albumin in the urine, with sometimes edema of the legs, 
indicates uremia as the cause of the coma. 



The principal action of Opium is exerted upon the nervous system, first 
affecting the cerebral convolutions, which are briefly stimulated and soon 
depressed. Next the perceptive and sensory centres in the higher brain 
are blunted, and the conductivity of the afferent nerves is impaired. Soon 
the ganglia at the base of the brain are involved, evinced by the con- 
traction of the pupils, vomiting, and slowing of respiration ; the cardiac, 
vascular and other centres are depressed, but to a less degree than the 
respiratory and perceptive. The gray matter of the cord, at first stimu- 
lated, as shown by the increase of reflex excitability, is also depressed, 
and locomotion becomes difficult, the motor nerves being paralyzed from 
26 



402 OPIUM. 

the centre outwards, but muscular irritability is never lost. Death occurs 
generally by paralysis of the respiratory centre, rarely by sudden cardiac 
failure. 

Metabolism is greatly reduced in activity by Opium, the quantity of 
urea excreted being markedly lessened, and the biliary and glycogenic 
functions of the liver being affected, resulting in whitish stools, perhaps 
jaundice, and certainly decided decrease of the sugar excreted by diabe- 
tics when the drug is given to them by the stomach. 

The vaso-moter centre is slightly, if at all, affected by small doses of 
Opium, but large doses paralyze it. On the vessels of the skin the first 
effect of the drug is to cause their dilatation, shown by turgescence of the 
vessels of the external ear and a sense of heat therein, and often giving 
rise to a roseolous cutaneous eruption accompanied by itching. The 
long-continued use of opium causes a marked contraction of the capillaries 
and arterioles throughout the body, the skin is excessively pale and the 
subject always feels cold at the ordinary temperature of the atmosphere. 

On the uterine and generative functions Opium exerts a marked influ- 
ence, stopping menstruation if its use be continued, and in men causing 
impotence. Both male and female functions, however, return as soon as 
the drug is discontinued, but the female organs of generation suffer atro- 
phy from its long-continued use. In one case, intra-uterine measurements, 
taken during a period of two years, showed a diminution in the size of 
the cavity from 5.1 to 1.9 inches. 

The hypnotic action of Opium is now believed to be produced by a 
double influence, (1) on the vascular system, causing anemia of the brain, 
(2) on the cerebral cells, diminishing their activity, and consequently les- 
sening their demand for blood. Its constipating action is shown experi- 
mentally to be produced by stimulation of the inhibitory nerves of the 
intestines through the splanchnics. 

Morphine was discovered by Serturner in 181 7. Its action is generally 
similar to that of Opium, it being the principal alkaloid therein, but when 
used by itself its influence is not complicated with the effects of the con- 
vulsive alkaloids (thebaine, codeine and narcotine) which must influence 
the action of opium to a considerable degree. As compared with the 
latter, Morphine acts more quickly, and for a shorter time, has less influ- 
ence on the intestines and skin, is less constipating, less stimulating, less 
convulsant and less diaphoretic, but more sedative, more anodyne and 
hypnotic and produces more intense pruritus. Its elimination commences 
quickly but may not be completed for as much as 48 hours, and is effected 
by the intestines, the urine, and the salivary glands. It is also eliminated 
by the gastric mucous membrane, and constantly reappears in the stomach 
until finally excreted. When injected hypodermically more than one-half 
the amount administered may be recovered by repeatedly washing out 



OPIUM. 



403 



the stomach. It is probably retained in the organism to a great extent 
when the action of the kidneys is defective, and when given continuously 
in renal disease may accumulate with fatal result. 

Apomorphine in dose of gr. -^ given hypodermically is a systemic 
emetic, acting directly on the vomiting centre, and is the quickest, most 
certain and least irritating of all emetics, acting in from five to twenty 
minutes with but moderate nausea. In large dose it is very depressant to 
the heart, gr. Jg- having caused death in a weak adult by cardiac failure, 
and produces paralysis of the motor and sensory nerves, delirium, convul- 
sions, and depression of respiratory power. Small doses (gr. -J^-) given 
by the mouth are expectorant, and the same quantity, administered hypo- 
dermically, is said to have a hypnotic effect lasting from one to two 
hours. Morphine in solution kept for a long time may become changed 
into Apomorphine. 

Codeine differs chemically from Morphine in having the radicle methyl 
(CH 3 ) replacing an atom of hydrogen, and may be considered a methyl- 
morphine. Like all methyl compounds it possesses motor-paralyzant 
power, like that of Curare. On man it has some hypnotic action, but 
far less than that of morphine. It exalts the spinal cord more than mor- 
phine does, producing muscular tremor in excess of its sedative action. 
It has a special sedative influence on the pneumogastric nerve, contracts 
the pupils, and is remarkably analgesic to the nerves of the abdominal 
and pelvic viscera. When administered for several consecutive days it 
lessens the irritability of the digestive tract to such an extent that arsenic 
produces neither vomiting nor purging (Murrell). It markedly reduces 
the amount of sugar excreted by diabetics, but has no advantage over 
morphine in that respect. 

Narcotine should be named Anarcotine, as it has little or no narcotic 
power. It is a convulsant in animals and an antiperiodic in man. 

Narceine is said by some observers to be remarkably hypnotic, and 
free from convulsant action — by others equally deserving of credit it is 
considered almost inert. This alkaloid is difficult to obtain pure, hence 
the samples heretofore used have probably been contaminated with other 
alkaloids. It is said to possess laxative properties. 

Thebaine is a powerful convulsant, exalting the spinal cord almost like 
Strychnine and Brucine. It is not used medicinally. 

Cryptopine is said to dilate the pupils, a remarkable property if true. 

Fatal Doses. 

In a child one day old Try of Laudanum caused death. A medicinal dose given to a 
nursing mother proved fatal to the infant. A few drops of Paregoric have killed a child 
of nine months. In the adult gr. y^ of Morphine in one case, and gr. iv of crude Opium 
in another, have proved fatal. 



I 



404 opium. 

Antidotes, Antagonists and Treatment of Poisoning. 

Potassium Permanganate is the best antidote to Opium or Morphine in the stomach, 
given in dose about one-half greater than the quantity of morphine present, and repeated 
in less quantity from time to time in cases where the poison has been administered hypo- 
dermically so as to neutralize the morphine excreted by the gastric mucous membrane. 
If an Opium preparation has been taken, or the alkaloid Morphine itself, Vinegar should 
be added to the permanganate solution in order to convert the alkaloid into a soluble salt. 
[For other antidotes see Part III.] Atropine antagonizes the cerebral action of 
Morphine, also its action on the pupils, respiration, heart and arterial tension, but if given 
too freely will endanger the case by substituting Belladonna-narcosis for Opium-narcosis ; 
gr. t |q hypodermically every 15 minutes for three doses, is generally sufficient. It is 
unsafe to be guided in this respect by the pupils. Caffeine is also physiologically antago- 
nistic, and is generally used in the form of strong black coffee frequently administered. 

The Chief Indications in opium or morphine poisoning are — to antidote any of the 
poison in the stomach, and to wash out that viscus repeatedly at short intervals, to main- 
tain respiration and keep up the circulation. [See the article on Poisoning in Part III.] 
Strychnine is an efficient antagonist to the respiratory paralysis, and may be used in lieu 
of Atropine, or in connection therewith. Amyl Nitrite should also be used when the 
heart shows signs of failure. Capsicum, the tincture, ^ss-j by injection into the rectum, 
is said to give almost instantaneous results in antagonizing the stupor of opium poisoning. 

Therapeutics. 
The chief indications for the use of Opium are — (1) to relieve pain from 
any cause except acute inflammation of the brain ; (2) to produce sleep, 
particularly in the insomnia of low fevers with delirium, in which the 
combination of Morphine and Chloral is very efficient ; (3) to allay irri- 
tation in the various forms of acute nervous erethism ; (4) to check ex- 
cessive secretion, as in diarrheas, dysentery, diabetes, ptyalism, etc.; 
(5) to support the system in low fevers and other adynamic conditions, 
when sufficient food cannot be retained ; (6) as a sudorific, to produce 
sweating in coryza, etc. It is considered of especial value in any irrita- 
tion of the stomach, bladder or bronchi, in severe vomiting, both forms 
of diabetes, gastralgia, colic and muscular spasm. In diabetes mellitus 
Morphine by the mouth reduces the sugar promptly, but when used hypo- 
dermically it has little or no effect thereon, even in the same case. In 
peritonitis and inflammation of other serous membranes, used freely even 
to narcotism it has often saved life. In cerebro-spinal meningitis it is the 
one remedy if given early, before exudation has set in. Cholera morbus 
and dysentery are efficiently treated by Morphine and Atropine hypoder- 
mically (gr. \ with gr. -^-q) after the ingesta have been removed by purg- 
ing. In acute uremia its use in large doses is recommended by Loomis 
to control convulsions and promote diuresis, but here it is a dangerous 
agent. In muscular rheumatism and acute colds Dover's powder as a 
diaphoretic, conjoined with hot drinks and foot-baths, is old but excel- 
lent treatment. In chronic mania and melancholia, nervous prostration 
and the delirium of fevers, Opium is one of the best hypnotics. In 
acute mania it does not act so well as Hyoscine, and in delirium tremens 
it should be used only in cases which show great prostration, and then 



OPIUM. 405 

for temporary effects alone, as a stimulant. In chronic melancholia 
small doses of Opium three times a day give better results than any other 
treatment. Severe pain from any cause (except cerebritis) is relieved by 
Opium with an efficiency possessed by no other drug, as the pain of sci- 
atica, neuralgia, lumbago, cancer, renal and hepatic colic from calculi, 
etc. Cough of harassing and frequent character with but little secretion 
is best treated by Opium, but when there is profuse expectoration it 
should not be used, as the lowering of excitability of the respiratory cen- 
tre which it produces would be dangerous in such a case. In nearly all 
acute inflammations it is valuable, especially when it becomes advisable 
to lock up the bowels. Its tranquilizing power over the circulation 
makes it invaluable in the various forms of hemorrhage, while in that 
from uterine fibroids and cancer the implanting of the opium-habit is 
deserving of consideration as a beneficial measure, as it checks and 
even stops the bleeding, as soon as established. Dyspnea from any 
cause is relieved by Morphine, especially that of cardiac disease. "It 
gives the power to breathe " (Huchard). In cardiac disease, especially 
aortic stenosis or insufficiency, with dyspnea, paroxysms of angina pec- 
toris, or signs of cerebral anemia, — Morphine hypodermically presents 
the greatest advantages. 

Apomorphine, though a derivative of Morphine, is not narcotic in 
any degree. Administered by the mouth in small doses, gr. -g^--^-, it is 
a valuable expectorant and given hypodermically in doses of gr. -Jg- it is 
a powerful emetic. Its therapeutic value depends chiefly on these two 
properties and has many applications in practice. As an emetic it is of 
much service in poisoning, especially when swallowing is difficult, and it 
may be used with advantage in narcotic poisoning before narcosis has 
blunted the vagus centre. It is a very valuable agent in any case of pois- 
oning where time is of great importance. As an expectorant it is one of 
the most efficient and useful agents at our command. In catarrh of the 
bronchi gr. -^ by the mouth every three or four hours is very beneficial, 
but the drug must be used in all cases with caution, especially in young 
children, who bear it very badly. In hacking coughs without expectora- 
tion it will prove very serviceable, if given in very minute doses, not 
exceeding gr. -^ in the entire 24 hours. In phthisis it may be given in 
combination with morphine with great advantage, especially in cases 
where there are dyspnea, continual and harassing cough, and thick, tena- 
cious expectoration. The two agents do not destroy each other's action, 
but from the combination we get increased secretion from the mucous 
membrane, with diminished irritability of the respiratory centre and con- 
sequently lessened cough (Brunton). Apomorphine has been used success- 
fully, by hypodermic injection, as an antidote to strychnine in dogs ; and . 
in one case, in which it was given in mistake for morphine, it entirely 



\ 



406 opium. 

dissipated an acute and severe attack of sciatica. In small doses, gr. -^ 
hypodermically, it has been used as a hypnotic, and is said to produce a 
sleep lasting from one to two hours (Douglas). 

Codeine is much employed as a palliative for cough, especially the 
irritable, hacking cough of phthisis unaccompanied by much expectora- 
tion. It seems to have a special influence on the nerves of the larynx, 
and will relieve a tickling cough better than any other form of opium, if 
given in one dose of gr. y 2 an hour before bed-time. In vomiting from 
almost any cause, doses of gr. %., repeated two or three times at hourly 
intervals, are usually very efficient. In the milder forms of diarrhea, 
gr. y 2 to gr. j will generally check the disorder without inducing any 
unpleasant after-effects. In diabetes Codeine lessens the amount of sugar 
in the urine and often removes it entirely, but it must be given in large 
doses, beginning with gr. ij-iv, and rapidly increasing to gr. xv or xx. 
It is highly efficient in abdominal and pelvic pain, especially when ovarian 
in origin. 

Applications of the Various Preparations. 

Superficial pain is often alleviated by the plaster or by extemporaneous 
liniments containing laudanum or some other fluid preparation. It is, 
however, very doubtful whether such applications are of direct value, as 
morphine is not absorbed by the unbroken integument ; but the oleate 
is said to be very penetrating. Intense pain, as from the passage of cal- 
culi, is best met by the hypodermic injection of morphine sulphate in 
full doses (gr. ^-J^) with atropine sulphate (gr. y^). Either the solu- 
tion of morphine or the liquid preparations of opium may be given 
by the mouth in corresponding doses for the same purpose. Severe pain 
enables the system to resist the action of opium, which in such cases 
should be repeated at short intervals for effect, regardless of dosage. 

Sedative action is obtained by different preparations for various organs. 
The stomach is best affected by the solution of morphine in effervescing 
mixtures, the extract in a small pill, or morphine given hypodermically 
over the epigastrium. The intestines may be influenced by laudanum 
in an enema of starch, or internally by Dover's powder, pulvis opii, or 
pil. opii, especially the latter with or without calomel, as an astringent 
when the bowel must be quieted, as in peritonitis, hernia, intussuscep- 
tion, etc. The rectum and other pelvic organs are promptly affected by 
a suppository of the extract of opium gr. %, with gr. -^ of the extract 
of belladonna. The ovaries and the abdominal and pelvic organs gener- 
ally are markedly susceptible to the analgesic action of codeine in doses 
of gr. j to gr. ij for an adult in severe pain. 

To produce sleep the most efficient preparations are the tinctures, the 
solution of morphine, pil. opii and Dover's powder, in doses correspond- 
ing to the degree of insomnia and restlessness present. 



ORIGANUM. 407 

Cough is relieved by the two trochisci, the tinctures, and by the solu- 
tion of morphine in small doses with syrup of wild cherry or syrup of 
tolu ; also by codeine in the last-named syrup. Diaphoresis is obtained 
by the use of Dover's powder in either of its forms. 

A dministration . 

Probably no drug in the materia medica is so useful as Opium or has 
so wide a range of application. At the same time no other drug requires 
such careful handling, by reason of the many influences which modify 
its action and uses. As before pointed out, children are extremely sus- 
ceptible to its narcotic action, and women are more easily affected by it 
than men. Many persons are found with idiosyncrasies in respect to 
opium, some being easily narcotized, others being remarkably insusceptible 
to its action, and many suffer from a decided shock after its hypodermic 
administration, which may even produce alarming symptoms of collapse. 
In subjects of kidney disease it may accumulate and act more powerfully 
than expected, and generally it may be said to be contraindicated or to be 
used with great care in alcoholism, congestion of the brain, and advanced 
disease of the respiratory organs, heart and kidneys. 

The conjoint administration with opiates, of the spiritus setheris, spir- 
itus aetheris compositus, or spiritus aetheris nitrosi, an equal part with 
tinctura opii deodorati, will prevent the nausea often excited by the latter, 
and correct the drying-up effects of opium, due to its checking secretion. 
Some of its cerebral effects, as vertigo and mental confusion, are removed 
by a full dose of potassium bromide, others are antagonized by quinine, 
and the general intra-cranial effects of the drug are to some extent 
opposed by digitalis and tartar emetic. 

Morphine and Atropine are sufficiently antagonistic to each other to 
make their combination extremely valuable as a therapeutic measure, and 
their use as mutual antidotes in poisoning by either a most efficient pro- 
cedure if employed with due precautions. When morphine is given as a 
hypnotic or an anodyne, atropine should always be administered at the 
same time in the proportion of gr. T | - x \ -§ of the latter to gr. ^ of the 
former. By this means the anodyne and hypnotic qualities of morphine 
are increased, while the nausea and depression with the subsequent dys- 
pepsia and constipation due to it are avoided. Moreover, as in the doses 
above mentioned atropine is a cardiac and respiratory stimulant, it will 
counteract the depressing tendency of morphine on the heart and respi- 
ration in subjects who have undue susceptibility to its action. 

ORIGANUM, Wild Marjoram (Unofficial), — is the plant Origanum vulgare, 
a perennial herb of the nat. ord. Labiatae, native of Europe and America. It contains a 
Volatile Oil, some tannin, resin, and a bitter principle. The oil was formerly much used 



408 OXYGENIUM. 

and was official, but it is now superseded by the Oil of Thyme. Origanum is an ingre- 
dient of Vinum Aromaticum. Dose, ^j-ij, in infusion. 

Origanum is gently tonic, also carminative, stimulant, and emmenagogue. It was 
formerly much employed as a diaphoretic, etc., but is now rarely administered. 

OXYGENIUM, Oxygen, O. This element is not official though 
it is extensively used in medicine. Its two combinations with Hydrogen, 
Water H 2 0, and Hydrogen Dioxide H 2 2 , are official, as are also nine 
other Oxides, namely — those of Antimony, Barium, Ethyl, Iron, Lead, 
Manganese, Mercury, Silver and Zinc. It enters into the composition of 
most of the acids and their salts, many of the organic bases, and all the 
alkaloids except a few. 

Oxygen is the most universally diffused element in nature, forming about one-fifth of 
the atmosphere, one-third of water, and a great part of the earth and of the tissues of 
plants and animals. It is a colorless, odorless, and tasteless gas, of sp. gr. 1.1057, and 
can be liquefied by subjection to extreme cold and pressure combined. It was discovered 
by Priestley in 1774, and given its name, Oxygen (acid producer) by Lavoisier in 1778. 
It may be obtained pure from many of its combinations, but is usually prepared by heat- 
ing Manganese Dioxide or Potassium Chlorate, or preferably both together. It is 
furnished by manufacturing chemists in all large cities, compressed in iron cylinders 
furnished with a rubber bag and mouth-piece by which to administer it. 

Ozone, 3 (Unofficial), — is an allotropic form or condensed condition 
of Oxygen, three atoms of which are contained in a molecule of the 
former, instead of two as in the molecule of oxygen. Ozone exists in 
the atmosphere in the general proportion of 1 part in 10,000, but it is 
more abundant in the open country and on the ocean than in the air of 
cities. It is formed when an electric spark is passed through air, being 
then manifested by its peculiar odor. In the sick-room it may be pro- 
duced by dissolving in water a mixture of Manganese Dioxide, Potassium 
Permanganate and Oxalic Acid. 

Official Preparations. 

Aqua Hydrogenii Dioxidi, Solution of Hydrogen Dioxide {Solution of Hydrogen 
Peroxide), commercially known as " Peroxide of Hydrogen," — consists of water to which 
nascent Oxygen has been presented, whereby an additional atom thereof has entered 
into combination with the hydrogen, producing H 2 2 . It is officially described as a slightly 
acid, aqueous solution of Hydrogen Dioxide, containing when freshly prepared about 
3 per cent, of the pure dioxide, corresponding to about 10 volumes of available oxygen ; 
and is directed to be prepared by agitating Barium Dioxide in cold distilled water, add- 
ing Phosphoric and Dilute Sulphuric Acids, filtering and diluting to the required strength. 
The commercial article is said to contain about 15 volumes of available oxygen, and to 
be permanent at ordinary temperatures ; but it undergoes decomposition in time, especially 
if agitated. It occurs as a colorless liquid, without odor, slightly acidulous, producing a 
peculiar sensation and soapy froth in the mouth, and liable to deteriorate by age, heat or 
protracted agitation. Dose, gj-iij, diluted with 3 to 4 parts of water. 

Aqua, Water, H 2 0, — is described under its own title. 

Oxides of Antimony, Ethyl, Iron, Lead, Mercury, Silver and Zinc, and the Dioxides 
of Barium and Manganese, are described under the titles of their metallic bases. 

Unofficial Preparations. 
Glycozone is claimed to be a stable compound resulting from the reaction between 
chemically pure glycerin and 15 times its volume of ozone; and not a mixture of hydro- 



OXYGENIUM. 4O9 

gen dioxide with glycerin. It is very hydroscopic, and must be kept tightly corked, to 
prevent deterioration. It is said to act upon diseased tissue in the same manner as 
Hydrogen Dioxide (which see), but more slowly ; and may be used in full strength as 
an application to wounds and suppurating surfaces, to stimulate healthy granulations, and 
generally as an antiseptic surgical dressing. It is mixed with water (I to 10) as a rectal 
injection; and maybe administered internally, in doses of gj-ij in a wineglassful of 
water, in gastric affections, as dyspepsia, pyrosis, ulcer and catarrh of the stomach. 

Pyrozone is the name given by a well-known manufacturer to a concentrated solution 
of Hydrogen Dioxide in Ether. It is said to contain about 50 per cent, of the dioxide, 
and is a very potent and efficient oxidizer, intended for external use only. It has abun- 
dant applications in the practice of surgeons. (Squibb.) 

Sanitas is a proprietary solution for disinfecting purposes, containing Hydrogen Diox- 
ide, and described under Terebinthina. 



Physiological Action. 

Oxygen is essential to respiration, blood-formation, nutrition and tissue- 
change, in fact to life itself, and to fully describe its physiological action 
would involve a complete description of these processes, which would 
be a treatise on physiology. Applied to the unbroken skin it has no ap- 
parent effect, but when applied to a wounded tissue it increases the circu- 
lation therein and acts as a stimulant. Inhaled in the pure state (not as 
air) it causes very little constitutional disturbance. A slight sense of heat 
is felt in the mouth and may extend along the larynx, trachea and bron- 
chi. The pulse is usually quickened, but it may be lessened in frequency, 
the appetite is increased, the temperature is slightly raised and the car- 
diac action is stimulated ; a sense of mental exhilaration and a disposition 
to greater bodily activity are produced, but no constant influence on the 
excretions has been noticed. In some persons it seems to cause nervous 
symptoms similar to those produced by nitrous oxide gas (Brunton). 

Ozone is a powerful oxidizing and destructive agent. It attacks 
metals, destroys organic substances and the coagulability of albumin and 
decomposes blood. It is highly irritant to the tissues, and sets up an 
acute catarrh of the respiratory mucous membrane if inhaled in quantity. 
When present in small quantity in the air it is breathed without unpleasant 
effects and is decidedly soporific (Binz). It is poisonous to low organ- 
isms, and is therefore an energetic antiseptic and disinfectant. In animals 
it sometimes quickens and often slows respiration, and produces excite- 
ment followed by exhaustion, sometimes by convulsions and death. 

Hydrogen Dioxide, in fresh solution, is one of the most powerful oxi- 
dizing agents known, by reason of the facility with which it parts with 
oxygen to oxidizable substances brought in contact with it. It is conse- 
quently a powerful yet non-toxic antiseptic, destroying morbid products 
and organized ferments to which it is applied. In contact with a suppu- 
rating surface it generates a white foam, as the result of its action on the 
pus. This soon subsides, leaving the subjacent tissue cleansed of all 
morbid secretions. One part added to 1000 of water containing sewage 



4IO OXYGEN IUM. 

or infectious microbes is sufficient to destroy the various organisms if 
allowed to act thereon for 24 hours. 



Therapeutics. 

Oxygen is efficient as an application to the surface in atonic, scrofulous 
and syphilitic ulcers, also in cases of senile and other forms of gangrene. 
Its application to the scalp, by means of a rubber cap fitted to the head, 
has restored the hair in a case in which it was lost by reason of alopecia 
areata. Its principal use has been in cases of disease of the respiratory 
apparatus characterized by dyspnea, as emphysema, bronchial dilatation, 
phthisis and gangrene of the lungs, also spasmodic asthma, and asphyxia 
from the inhalation of toxic gases or due to opium and chloroform nar- 
cosis. It has been employed with benefit in uremic coma, and in the 
dyspnea of cardiac disease and that of anemia from loss of blood or 
from protracted suppuration. It has given good results in diseases char- 
acterized by defective oxidation, as gout and diabetes ; in the latter affec- 
tion the sugar sometimes disappears entirely from the urine during its in- 
halation. It has been used in the treatment of epilepsy and spasm, and 
is recommended in cholera. 

Ozone has been recommended in cases similar to those for which oxy- 
gen is used j also in infectious diseases, as diphtheria, in which it is ex- 
pected to destroy the pathogenic microbes exposed to its influence. 

Hydrogen Dioxide in solution has long been employed as a bleaching 
agent for delicate fabrics, and on the human hair for the production of 
the "bleached blonde" hue so fashionable lately in certain circles of 
society. As a cleansing agent for foul wounds, ulcers, sores, and the like, 
it is highly efficient ; and has been used with great benefit as a gargle or 
spray to the throat and nasal passages, in quinsy, croup, diphtheria, scar- 
let fever, ozena, and other morbid conditions of these parts. As a diag- 
nostic agent in determining the presence of pus, it is injected into the 
part in which suppuration is suspected, and indicates its contact with pus 
by causing an almost immediate swelling up of the part. If such a spot 
is cut into at once, pain is not felt. In this manner a number of suppu- 
rating buboes have been treated with great success. As a disinfectant of 
drinking water suspected of pollution it is highly recommended, as it does 
not impair the taste or other potable qualities of the water in the small 
quantity (1 to 1000 parts) needed for its efficient action. Used internally 
it imparts oxygen to the blood, improves digestion, and relieves spasm of 
the respiratory apparatus, — aborting the paroxysms of whooping-cough. 
It gives great relief in chronic bronchitis with dyspnea, and operates well 
in phthisis by promoting digestion, palliating cough, and giving increased 
activity to chalybeate remedies. 



PARALDEHYDUM PAREIRA. 4 1 I 

PARALDEHYDUM, Paraldehyde, C 6 H 12 3 , a polymeric modi- 
fication of Ethylic Aldehyde C 2 Hfi, — is a colorless liquid at ordinary 
temperatures and is obtained by treating Aldehyde with dilute sulphuric 
or nitric acid ; aldehyde being the oxidation product of alcohol just pre- 
ceding the formation of acetic acid. Paraldehyde is soluble in 8)4 of 
water, and miscible, in all proportions, with alcohol, ether, and fixed or 
volatile oils. 

The dose of Paraldehyde may be placed at ^ss-^ijss, but the latter quantity has fre- 
quently been exceeded without any ill effects, with no digestive or cerebral disturbances 
following, nor any unpleasant symptoms resulting other than a disagreeable odor of the 
breath. Very few cases of poisoning therefrom, acute or chronic, are recorded. One 
case, under treatment by Dr. Mackenzie, of Douglas, in the Isle of Man, recovered from 
a dose of 3% ounces after 34 hours of sleep, furnishing " a striking testimony to the 
safety of Paraldehyde as a hypnotic." The average hypnotic dose for an adult is about 
£jss, given in £] of simple elixir. 

Physiological Action and Therapeutics. 

Paraldehyde is a reliable hypnotic, almost equal in this respect to 
Chloral, though its hypnotic action is not so persistent as that of the latter 
drug, and it requires more frequent repetition to produce sustained sleep. 
It is also antispasmodic and diuretic but not diaphoretic, and is unques- 
tionably safer than chloral, strengthening and slowing the heart's action, 
instead of weakening it. Its administration is followed by a well-marked 
stage of excitement, after which it produces a sound sleep which is de- 
scribed as refreshing. It does not interfere with the appetite or digestion, 
but occasionally causes an erythematous eruption ; and may give rise to 
cerebral congestion and vaso-motor paralysis if used for any long period 
of time. A toxic dose paralyzes the medulla and the respiratory centre 
therein. 

Paraldehyde is used as a hypnotic in fevers, rheumatism, acute mania, 
hysteria and insomnia from various causes, also as an antispasmodic in 
asthma. Several cases of tetanus have been treated successfully with it, 
and it has been found useful as a diuretic and hypnotic in a case of senile 
arterial degeneration with double aortic and mitral regurgitant murmurs, 
mental depression and very marked insomnia and restlessness. 

Cases of Paraldehyde habit are occasionally seen, and exhibit a train of symptoms 
similar to those observed in delirium tremens. There is great emaciation and anemia, 
weak and irregular action of the heart, a soft and intermittent pulse, general muscular 
weakness, tremulousness and restlessness, the gait feeble and unsteady, mental anxiety, 
agitation and confusion, temporary loss of memory and incoherent speech, also hallucina- 
tions of sight and hearing and delusions, all of an unpleasant kind. There is marked 
gastric derangement, but an abnormally large appetite, excessive flatulence and consti- 
pation. The treatment of such a case generally takes about three months, and should be 
conducted in an inebriate asylum. 

PAREIRA, Pareira, Pareira Brava> — is the root of Chondodendron 
tomentosum, a climbing, woody vine of the nat. ord. Menispermacese, 



412 PASSIFLORA INCARNATA PEPSINUM. 

with very large leaves and a grape-like fruit, inhabiting Peru and Brazil. 
It contains Pelosine or Cissampeline, an alkaloid identical with the Ber- 
berine of Nectandra and the Buxine of Buxus sempervirens (Boxwood). 
Several other Pareiras are on the market, that from the West Indies (Cis- 
sampelos Pareira) being the plant formerly official in the Br. Phar. 

Extractum Pareirae Fluidum, Fluid Extract of Pareira. — Dose, £ss-gj. 
Infusum Pareirae, Infusion of Pareira (Unofficial), — I in 17. Dose, ^j-ij. 

Pareira is diuretic and laxative, stimulating peristalsis and the action 
of the kidneys. It is eliminated by the kidneys, and passing over the 
mucous membrane of the genito-urinary tract it acts thereon in a tonic 
and soothing manner, especially on the bladder. It is particularly useful 
in chronic cystitis, suppurative kidney diseases, gonorrhea and gleet, but 
must be used internally, as when injected locally for these affections it 
has not proved successful. Formerly Pareira was considered an efficient 
lithontriptic, and in Brazil it is used as a cure for the bites of poisonous 
serpents, being employed both internally and locally. 

PASSIFLORA INCARNATA, Passion-flower (Unofficial),— is an indigenous 
plant which is highly esteemed by many American physicians as a calmative, analgesic 
and hypnotic remedy. It has been administered with satisfactory results in neuralgia, 
chorea, spasmodic asthma, pertussis, hysteria, dysmenorrhea, insomnia, infantile and 
puerperal convulsions and the opium-habit. A concentrated tincture is prepared from the 
whole plant, the dose of which is 3 ss-j every 2 or 3 hours. 

PEPO, Pumpkin-seed, — is the seed of Cucurbita Pepo, or common Pumpkin (nat. 
ord. Cucurbitaceae). The active principle is a resin contained in the endopleuron or en- 
velope immediately surrounding the embryo. It also contains an alkaloid Cucttrbitine, a 
fixed oil, starch, sugar, etc. There are no official preparations. Dose, of the resin, gr. 
xv ; of the seeds, ^j-ij, beaten up into an emulsion with sugar and water. 

Pumpkin-seed is an efficient agent for the removal of tapeworm, and its use is not 
followed by unpleasant symptoms. The outer coat of the seed should be removed, and 
an emulsion then made by trituration with sugar and water. This, if taken on an empty 
stomach and followed by a brisk cathartic, will generally prove effective. Dr. Squibb 
maintains that the seeds should not be decorticated, but that husks and all should be 
swallowed. According to some observers the expressed oil is equally efficient in doses 
of ^ ss repeated two or three times and followed by a cathartic. 

PEPSINUM, Pepsin, — is the name for the hypothetical digestive 
principle of the gastric juice. As a definite body it is unknown, the 
various preparations, official and unofficial, being mere approximations 
and varying much from each other. It is officially described as a proteo- 
lytic ferment or enzyme, obtained from the glandular layer of fresh 
stomachs from healthy pigs, and capable of digesting not less than 3000 
times its own weight of freshly coagulated and disintegrated egg albu- 
min, when tested by the official process. 

Pepsin is a fine, white, or yellowish- white, amorphous powder, or thin, pale-yellow, 
translucent grains or scales, free from any offensive odor ; soluble in about 100 of water, 
more soluble in water acidulated with HC1, insoluble in alcohol, ether or chloroform. It 



PEPSINUM. 4I3 

usually has a slightly acid reaction, and may be neutral, but should never be alkaline. 
Commercial Pepsin is usually obtained from a solution prepared by digesting the mucous 
membrane scraped from the rennet-bags of sheep or the stomach of the pig in acidu- 
lated water for several days. It is then precipitated by sodium chloride (Scheffer), lead 
acetate (Boudault), or by drying the peptones on glass plates (Beale). It may also be 
precipitated by alcohol. By Scheffer's process it occurs as a tough, gray, leathery sub- 
stance, partly soluble in water, one grain dissolving 3000 grains of albumin in a few 
days. Jensen's Crystal Pepsin, probably prepared after Beale's method, is in yellowish, 
translucent scales, soluble in water, and reputed to be many times stronger than any 
other preparation yet obtained. 

Preparations . 

Pepsinum Saccharatum, Saccharated Pepsin, — is Pepsin I, triturated with 9 of 
Sugar of Milk. One part should digest at least 300 parts of egg- albumin, when tested 
by the official process. Dose, gr. v-^j, shortly after meals. 

Liquor Pepsini, Liquid Pepsin (Unofficial), — contains of Saccharated Pepsin 40 
parts, Hydrochloric Acid 12, Glycerin 400, Water q. s. ad 1000 parts. Dose, 3 ij— iv. 

Every manufacturer of Pepsin has his own preparation and his peculiar name there- 
for, such as Liquid Pancreopepsine, Lacto-peptine, Gluco-pepsine, Golden Scale Pep- 
sin, Peptogenic Milk Powder, etc. They vary considerably in their properties, but all 
have the power in some degree of digesting albumin and fibrin. 

Lactopeptine (Unofficial), — is claimed to contain Pepsin, Diastase or Ptyalin, Pan- 
creatin, Lactic and Hydrochloric Acids, and that gj will digest 2j viij-x of albumin, 
fibrin, casein, or gelatin, will emulsionize ^ xvj of cod-liver oil, and convert ^ iv of 
starch into glucose. A proprietary preparation. Dose, gr. v-xv. 

Peptenzyme (Unofficial), — is prepared from the peptic, pancreatic, salivary, Lieber- 
kuhn's and Brunner's glands and the ferment extract of the spleen and liver, slightly 
benzoated and mixed with sugar of milk and citric acid. It is claimed for it that it con- 
tains the active ferments and undeveloped ("mother") enzymes of all the digestive 
organs or glands, in the same physiological condition as that in which they exist in 
nature ; that it digests food in an acid, an alkaline or a neutral menstruum ; and that it 
will digest all kinds of food. It is best administered before meals. 

Analogous Products. 

Pancreatinum, Pancreatin,— is officially described as a mixture of 

the enzymes naturally existing in the pancreas of warm-blooded animals, 

usually obtained from the fresh pancreas of the hog (Sus scrofa). It 

occurs as a yellowish-white or grayish, amorphous powder, of faint odor, 

and meat-like taste ; slowly soluble in water, insoluble in alcohol. It 

consists of four ferments, viz. : (1) Trypsin, the proteolytic ferment, (2) 

Pancreatic Diastase, the amylolytic ferment, (3) a fat-emulsifying, and 

(4) a milk-curdling ferment. Besides the official form it is sold in 

various preparations, as Pancreatic Emulsion and the following — 

Liquor Pancreaticus, Pancreatic Solution (Unofficial), — prepared by digesting a 
finely-chopped pig's pancreas with 4 times its weight of dilute alcohol. It is a nearly 
clear alcoholic solution, with little taste or smell. Dose, 3J-^ss. 

Ingluvinum, Ingluvin (Unofficial), — is obtained from the gizzard of 
the domestic fowl, and owes its activity to a peculiar, bitter principle, 
and not to any ferment corresponding with pepsin. Dose, gr. x-xxx. 

Unofficial Vegetable Digestives. 

Papain, Papaiva, Papayotin, — is a vegetable ferment obtained from the milky juice . 
of Carica Papaya, a S. American fruit-tree of the nat. ord. Papayaceas. It is soluble in 



I 



4 H PEPSINUM. 

water but not in alcohol, and has active digestive powers. It is composed essentially of 
a mixture of vegetable globulin, albumoses and peptone, with which are associated the 
ferments characteristic of the preparation. It is marketed under the name Papoid. 
Dose, gr. j-iij. Papaw Milk is the milky juice of the fruit, coagulating into two parts, 
a pulpy mass and a liquid serum. When mixed with alcohol an amorphous powder is 
precipitated, which when dried forms Papain. 

Bromelin, — is an active digestive ferment contained in the fresh juice of Ananassa 
Sativa, the Pineapple. It is more nearly related to trypsin than to pepsin, and is de- 
cidedly active in the presence of either acids or alkaline carbonates, but is most energetic 
in neutral solutions, and is a very constant and powerful digestant of vegetable and 
animal proteids. Dose of the fresh pineapple juice, ^ss-j. 



Physiological Action and Therapeutics. 

Pepsin is not a solvent but a ferment, and is a normal constituent of 
the gastric juice, converting albuminoids (casein, albumin, fibrin, etc.) 
into peptones for assimilation, with the aid of the lactic and hydro- 
chloric acids associated with it. This it will do out of the body or in 
cavities as the rectum, if warmth, acidity and moisture are present. Pan- 
creatin, on the other hand, is destroyed by acids and requires an alkaline 
medium in which to exercise its' powers. As the food passes out of the 
stomach in 2 or 3 hours, Pepsin should be administered within and Pan- 
creatin after that period, to be effective. Alcohol destroys the activity 
of pepsin, alkalies and many mineral salts precipitate it. 

Dyspepsia in its various forms is the malady for which Pepsin is chiefly 
employed, but it is also extremely useful in the apepsia of infants, gas- 
tralgia, anemia, chlorosis, gastric ulcer and cancer, the diarrhea of in- 
fants and the vomiting of pregnancy. It is added to nutritive enemata, 
the rectum not being a digestive organ, and is injected into the substance 
of morbid growths which are homologous to the tissues, particularly fatty 
tumors, for the purpose of arresting their growth and promoting their 
absorption. It has been injected into the bladder to break down a blood- 
clot, and has been suggested as an atomized inhalation in diphtheria and 
croup to digest the membrane without injuring the living tissues. 

Pancreatin digests albuminoids and converts starch into sugar and 
proteids into peptones, also emulsifies fats in the presence of an alkaline 
solution (Pepsin requiring an acid one). Prolonged contact with mineral 
acids renders it inert. It is digested by pepsin, and hence probably 
never passes into the duodenum in its own character. Pancreatin is used 
to partially digest (peptonize) milk, gruel, soups, and other foods, before 
their administration in cases of great digestive debility. These peptonized 
foods may be administered by the stomach or the rectum, and are valua- 
ble in intestinal dyspepsia, wasting diseases, and convalescence from acute 
affections. A teaspoonful of Pancreatin solution taken after the adminis- 
tration of cod-liver oil will prevent the disagreeable eructations which 
are so offensive to some patients, and will aid in the digestion of the oil. 



PETROLATUM. 415 

Trypsin, unlike Pepsin, will dissolve mucin, and like pepsin it is inert towards nuclein, 
horny tissues, and amyloid matter. Used as a spray on diphtheritic membrane it has 
proved a very efficient solvent. It affects albuminoids even in a slightly acid solution. 

Ingluvin is particularly useful against vomiting and has been found exceptionally 
efficient in the vomiting of pregnancy, given in 20-grain doses before meals. 

Papain, (Pafioid), has the power of digesting to a greater or less extent all forms of 
proteid or albuminous matter, both coagulated and uncoagulated. It is peculiar in that 
its digestive power is exercised in either acid, alkaline or neutral media, in which respect 
it differs greatly from the other digestive ferments. It acts more rapidly than pepsin and 
at higher temperatures. It is a rapid solvent of false membranes and intestinal worms ; 
and has been injected into neoplasmic tumors, dissolving their tissues in its immediate 
vicinity, but with much pain and considerable febrile reaction. Papoid has been used as 
a paste locally in diphtheria, to destroy and remove the false membrane ; internally, in 
gastric and gastro-intestinal catarrh, the diarrhea of infancy and various dyspeptic con- 
ditions, with very great success. Its power over both gastric and intestinal indigestion 
renders it much more useful than either pepsin or pancreatin in cases of doubtful diag- 
nosis, in which it is difficult to decide as to the location of the trouble. 

Papoid may be obtained in powder or tablets, either alone or in combination with 
sodium bicarbonate, boracic acid, and nux vomica ; also as a glycerole which is said 
to be a permanent liquid preparation. The dose of papoid is from I to 3 grains, but 5 
grains or more may be given in special cases. 

Pineapple Juice is one of the most efficient digestive aids at our command, and has 
the advantage of being pleasant to the patient. The author directs the fruit to be cut 
into slices as required, and the juice to be squeezed out immediately before administra- 
tion. It has long been used by the natives of South Africa as a remedy for diphtheria 
and diphtheritic sore throats with unusual success, according to the testimony of com- 
petent observers ; and has been employed by Dr. Chambers of Calcutta in this disease 
with marked benefit. He had the patient sip the juice all day at short intervals, or else 
masticate slices of the fruit and swallow the juice ; but as he employed Papaya fruit in 
the same cases it is impossible to give all the credit of his success to the pine-apple. 



PETROLATUM,— is a mixture of hydrocarbons, chiefly of the 
marsh-gas series, obtained from Petroleum, by distilling off the lighter 
portions and purifying the residue. It is colorless or yellowish, and in 
the latter case is more or less fluorescent ; amorphous, odorless and taste- 
less, of neutral reaction, insoluble in water or alcohol, soluble in ether, 
chloroform, benzin, fixed and volatile oils, etc. Commercially it is 
known as Cosmoline, Vaselin, Petroleum Ointment, etc., and is largely 
prepared from residuums or sediments deposited in tanks containing 
crude petroleum. It is official in the following three forms, all of which, 
when heated, give off a faint odor of petroleum, viz. : — 

Petrolatum Liquidum, Liquid Petrolatum , — an oily, transparent fluid, of sp. gr. 
0.875 to 0.945. 

Petrolatum Molle, Soft Petrolatum, — a fat-like mass, of the consistence of an oint- 
ment, sp. gr. about 0.820 to 0.840, melting-point between 104 and 113 F. 

Petrolatum Spissum, Hard Petrolatum, — a fat -like mass, of about the consistence 
of a cerate, sp. gr. 0.820 to 0.850, melting-point between 113 and 125 F. 

Petrolatum is a valuable protective dressing, and an excellent basis for 
ointments, having no acridity and no liability to become rancid. It is 
readily miscible with many active agents, as the alkaloids, phenol com- 
pounds, etc., but it does not penetrate the skin so readily as animal fats 



4l6 PHENACETINUM. 

and fixed oils. Uncombined, it forms an excellent bland application in 
all irritated conditions and injuries of the skin. 

Albolene and Glymol are two of the numerous proprietary products of petroleum. 
They are odorless, do not become rancid, and are employed as bases for ointments and 
as lubricants. Liquid Albolene is readily diffused in the form of a spray and is a good 
solvent for drugs intended for application to the naso-pharyngeal mucous membrane. 



PHENACETINUM, Phenacetin, Oxy-ethyl-acetanilid, Para- 
de et-pheneiidin, C 10 H 13 NO 2 , (Unofficial), — is a crystalline substance, closely 
allied in composition to Acetanilid, and produced by the action of glacial 
acetic acid on para-phenetidin, a body obtained from phenol. 

Phenacetin occurs in colorless, tasteless, inodorous, scaly crystals, sparingly soluble 
in cold water, more freely in boiling water, also in about 1 6 of alcohol. Dose, gr. ij- 
xx ; — as an antipyretic, gr. viij-x hourly or every two hours, in powder or tablets ; against 
neuralgia and rheumatism, gr. xv, repeated if necessary up to ^jss in 24 hours. 

Physiological Action and Therapeutics. 

The physiological action of Phenacetin is similar to that of Acetanilid. 
It is probably the safest of the new synthetical antipyretics, yet in suffi- 
ciently large doses it is as poisonous as any of its analogues. Cerna 
reports a case in which a baby, five days old, received seven 2-grain doses 
of phenacetin in three days, by mistake for bismuth, and was deeply 
cyanosed for three days and less so for nearly a month, notwithstanding 
the repeated employment of oxygen inhalations. There was also marked 
jaundice, with grave anemia, and pronounced loss of weight. 

Phenacetin reduces pyrexia gradually and causes perspiration without 
producing collapse. It is also analgesic and hypnotic in action, relieving 
pain and inducing sleep. It has been administered with benefit, in 2- 
grain doses with y 2 grain of citrated caffeine at short intervals, for mi- 
graine; also in epidemic influenza, both as a prophylactic and as a 
remedy. As an antipyretic it is extensively employed in phthisis, peri- 
tonitis, polyarthritis, endocarditis, typhus and typhoid fevers ; and as an 
analgesic in vaso-motor neuroses, for the lancinating pains of locomotor 
ataxia, also in neuralgia and hemicrania. It is highly praised in whoop- 
ing-cough, rheumatic and other fevers, and though slower in action than 
Antipyrin or Acetanilid it is deemed fully as efficient in reducing pyrexia, 
while usually free from the depressant after-effects of the latter agents. 

Lactophenin, Lactyl-para-phenetidin (Unofficial), — is another phenetidin derivative, 
containing a lactic acid constituent instead of the acetic acid one of phenacetin. Its 
action is antipyretic, analgesic and hypnotic, and it has been recommended as a substi- 
tute for phenacetin on account of its greater solubility. It has been used with especial 
benefit in abdominal typhus (Jaksch) ; also in acute rheumatism, chorea and locomotor 
ataxia (Von Roth). Dose, gr. viij-xv or more, up to 3 jss daily, in wafers. 

Methacetin, Oxy-melhyl-acetanilid (Unofficial), — derives its name from its analogy 
to Phenacetin, from which it differs only in containing a methyl group in place of an 



PHOSPHORUS. 417 

ethyl one. From Acetanilid it differs in the substitution of the oxy-methyl group for a 
hydrogen atom. It occurs as lustrous, scaly, colorless, odorless crystals ; soluble in 12 of 
hot water, in alcohol, chloroform, glycerin and fatty oils ; scarcely soluble in cold water. 
Methacetin was introduced as an antipyretic for children and feeble persons, and prom- 
ised at one time to supersede phenacetin. It is well borne, and no malaise, tinnitus, 
cardiac weakness or exanthem follow its ingestion ; but it often gives rise to a violent and 
exhausting perspiration. It has been used successfully in typhoid fever, all forms of 
rheumatism, neuralgias, pneumonia and in most forms of pyrexia, but has not as yet 
equaled the results obtained by either phenacetin or antipyrin. Its employment in phthisis 
was not favorable, chiefly by reason of the profuse sweating induced by it. Its advan- 
tages, over all the other antipyretics of its class, are its lack of toxic properties and its 
comparatively ready solubility in water, being five times more soluble than its rival, phen- 
acetin. Dose, gr. iij-v, or more. 

Malakin, Salicyl-para-phenetidin, — is described under Salicinum. 

Phenocoll Hydrochloride (Unofficial), — is another synthetical antipyretic, closely 
allied to Phenacetin, both chemically and medicinally, and distinguished by its com- 
paratively free solubility. It is produced by the interaction of Phenetidin and Glycocoll 
(amido-acetic acid), and occurs as a white, micro-crystalline powder, soluble in about 16 
of water, therein forming a neutral solution. The pure base, Phenocoll, is precipitated 
from the solution by ammonia, the fixed alkalies and their carbonates. 

Phenocoll Hydrochloride may be looked upon as a soluble Phenacetin, 15 grains dis- 
solving readily in ^j of water. With decided antipyretic, antirheumatic and analgesic 
powers, it possesses a marked advantage over the other members of its class in that it 
has no injurious effect upon the blood corpuscles, even when in direct contact with them. 
It is promptly absorbed, readily excreted, and reduces the hyperpyrexia of fever without 
producing very profuse sweating or other unpleasant by-effects. The fall in temperature 
is very decided and occurs within an hour after the administration of the drug, being 
due to great diminution of heat-production, without any alteration of heat-dissipation. In 
ordinary doses it has no effect on the circulation, but large doses diminish the blood- 
pressure and reduce the pulse-rate, by stimulating the cardio-inhibitory centres. This 
drug has been employed with marked success as an antipyretic in hectic, malarial, 
typhoid and other fevers ; also in acute rheumatism, neuralgia, epidemic influenza, and 
for the neuralgic pains of the latter affection. In combination with Piperazin, 15 grains 
of each daily, in a pint or more of carbonated water, it has rendered excellent service in 
gouty and rheumatic affections, especially when accompanied with pain and fever. The 
same combination has proven of service in a case of obstinate gastric irritability with 
uncontrollable vomiting, which had resisted every known remedy. The dose is gr. v-xxx, 
an average dose being about 12 grains, three or four times a day. 



PHOSPHORUS, PHOSPHITES and PHOSPHATES,— 

are best studied together, as the supplying of the element Phosphorus to 
the body is the aim of the administration of these agents. 

Phosphorus, P, — is a non-metallic element obtained from bones, and 
occurs as a translucent, nearly colorless solid, of waxy lustre, and usually 
the consistence of beeswax, insoluble in water, to which, however, it 
imparts its characteristic odor and taste. It is soluble in 50 parts of any 
fatty oil, in 80 of absolute ether, 350 of absolute alcohol, and freely in 
chloroform and in carbon disulphide. It has a disagreeable odor and 
taste, melts at n i° F., and in the air it emits white fumes which are 
luminous in the dark. On longer exposure to the air it ignites, and 
should be kept under water in a cool place, protected from light. It 
usually contains Arsenic and sometimes Sulphur, the limits of which 
are fixed by the pharmacopceial tests. Dose, gr. y^o--^ thrice 
daily. 

27 



418 PHOSPHORUS. 



Preparations of Phosphorus. 

Pilulae Phosphori, Pills of Phosphorus, — each contains gr. T ^ of Phosphorus, dis- 
solved in Chloroform, mixed with Althaea and Acacia in Glycerin and Water, and coated 
by shaking with a solution of Balsam of Tolu in Ether. Dose, j-v. 

Oleum Phosphoratum, Phosphorated Oil, — has of Phosphorus I part, Ether and 
Expressed Oil of Almond to ioo. Dose, rr\j--v thrice daily. 

Acidum Phosphoricum, Phosphoric Acid, and Acidum Phosphoricum Dilutum, 
are described on page 104. 

Acidum Hypophosphorosum Dilutum, Diluted Hypophosphorous Acid, — a liquid 
composed of about 10 per cent, of the absolute acid (HPH 2 2 ), and about 90 per cent, 
of water. Used in the preparation of Syrupus Hypophosphitum. 

Spiritus Phosphori, Spirit of Phosphorus [Tincture of Phosphorus), — has of Phos- 
phorus 1.2, dissolved in Absolute Alcohol 1000. 

Elixir Phosphori, Elixir of Phosphorus, — has of the preceding 210, Oil of Anise 2, 
Glycerin 550, Aromatic Elixir to 1000. Each cubic cm. represents about y milligramme 
of Phosphorus (each £ contains about gr. J ? ). Dose, ^ss-^ss. 

Tinctura Phosphori [Thompson' 's), Unofficial, — Phosphorus gr. j , Absolute Alco- 
hol 5 v, Glycerin ^jss, Alcohol 3 ij, Spt. Mentha; Piperitse ir^xl. Of this gj contains gr. 
y of Phosphorus. Dose, ^ss-^jss. 

Tinctura Phosphori [Bellevue Hospital), Unofficial, — Phosphorus gr. xxxij, Abso- 
lute Alcohol ^xlvj, Essence of Vanilla ^j, Oil of Orange giij, Alcohol q. s. ad^xlviij. 
Of this gj contains gr. T L of Phosphorus. Dose, gss-}. 

Zinci Phosphidum, Zinc Phosphide, Zn 3 P 2 , — crystalline fragments or a gray-black 
powder, insoluble in water or alcohol, but completely soluble in hydrochloric or sulphuric 
acids with evolution of hydrogen phosphide. Is very irritant. Dose, gr. 3o~2"V 

Preparations of Phosphites. 

Calcii Hypophosphis, Calcium Hypophosphite, Ca (PH 2 2 ) 2 , — colorless prisms, or 
thin, pearly scales, of nauseous taste, soluble in 6.8 of water, insoluble in alcohol. Is an 
ingredient of the Syrupus Hypophosphitum. Dose, gr. x-xxx. 

Ferri Hypophosphis, Fer?'ic Hypophosphite, Fe 2 (H 2 P0 2 ) 6 , — a white or grayish-white 
powder, odorless and tasteless, slightly soluble in water, freely so in hydrochloric acid or 
a solution of sodium nitrate. Dose, gr. v-x. A ferruginous tonic. 

Potassii Hypophosphis, Potassium Hypophosphite, KH 2 P0 2 , — white masses, or a 
white, granular powder, deliquescent, odorless, of saline taste and neutral reaction. 
Soluble in 0.6 of water and in 7.3 of alcohol at 59 F. Dose, gr. v-x. 

Sodii Hypophosphis, Sodium Hypophosphite, NaPH 2 2 -j- H 2 0, — small plates, or a 
white, granular powder, deliquescent, odorless, of sweetish, saline taste, and neutral re- 
action. Soluble in I of water and in 30 of alcohol at 59 F. Dose, gr. v-x. 

Syrupus Hypophosphitum, Syrup of Hypophosphites, — has of Calcium Hypophos- 
phite 4^, of Potassium and Sodium Hypophosphites \]/ z each, per cent. Dose, 3J-^ss. 

Syrupus Hypophosphitum cum Ferro, Syrup of Hypophosphites with Iron, — has 
of Ferrous Lactate I, Potassium Citrate I, in Syrup of Hypophosphites to ioo parts. 
Dose, SJ-^ss. 

Preparations of Phosphates. 

Calcii Phosphas Prsecipitatus, Precipitated Calcium Phosphate, Ca 3 (P0 4 ) 2 , — a 
light, white, amorphous powder, insoluble in water or in alcohol. Dose, gr. ij-x. 

Syrupus Calcii Lactophosphatis, Syrup of Calcium Lactophosphate, — has of the 
preceding 2.y z per cent. The Calcium Phosphate is dissolved by Lactic and Phosphoric 
Acids, but does not form the chemical combination suggested by the title. Dose, 

3J-5 SS - 

Sodii Phosphas, Sodium Phosphate, Na 2 HP0 4 -j- I2H 2 0, — large, colorless, mono- 
clinic prisms, efflorescent, of saline taste and alkaline reaction ; soluble in 6 of water, 
in \y z of boiling water, insoluble in alcohol. Dose, 3J~5J- 



PHOSPHORUS. 4I9 

Sodii Pyrophosphas, Sodium Pyrophosphate, Na 4 P 2 0- -j- ioH 2 0, — colorless, mono- 
clinic prisms, of saline taste and alkaline reaction; soluble in 12 of water, insoluble in 
alcohol. Dose, gss-^ss. 

Syrupus Ferri, Quininae et Strychninae Phosphatum, Syrup of the Phosphates 
of Iron, Quinine and Strychnine, — has of Soluble Ferric Phosphate 2, Quinine Sul- 
phate 3, Strychnine ^, Phosphoric Acid 4.8, Glycerin 10, Water 5, Syrup to 100. A 
powerful tonic. Dose, gj-iij. 

Syrupus Phosphatum Compositus, Compozmd Syrup of Phosphates, Parrish's 
Chemical Food, (Unofficial), — has in each 3, of Ferric Phosphate gr. 2^£, Calcium 
Phosphate gr. j. Dose, gj-iij. 

Melachol (Unofficial), — is a proprietary preparation, advertised to contain in each f £ 
eighty-five grains of Sodium Phosphate with Citric Acid and Sodium Nitrate. Dose, 
j^ss-^j, in water. 

Ferri Phosphas Solubilis, Soluble Ferric Phosphate, and Ferri Pyrophosphas 
Solubilis, — are described under Ferrum, ante, page 317. 



Physiological Action. 

Phosphorus in small doses stimulates the brain and circulation, the 
functions of the stomach and the genital organs, and the growth of bones. 
It aids digestion by irritating the end-organs of the gastric nerves, but 
produces eructations of hydrogen phosphide. Its fumes cause necrosis 
of the upper or lower maxillae especially in those whose teeth are decayed, 
but this may be prevented by the inhalation of the fumes from old acid 
turpentine. In poisonous doses it is a powerful irritant of the gastro- 
intestinal tract, causing vomiting and purging with great depression of 
the vital forces. Reaching the blood as Phosphorus, it is partly oxidized 
at the expense of the oxygen of the red corpuscles, causes acute hemor- 
rhages by producing fatty degeneration of the arterial walls ; also rapid 
steatosis of the stomach, liver and heart, accompanied by deep jaundice j 
then delirium, convulsions, coma and death, the latter usually from 
gradual failure of the respiration and circulation. Acute yellow atrophy 
of the liver resembles phosphorus poisoning so much that it is generally 
impossible to distinguish between them. The effect of Phosphorus on 
metabolism is to increase the nitrogenous products, to diminish the ex- 
cretion of carbonic acid, to reduce the glycogen of the liver to almost 
nothing, and to raise the temperature. While generally increasing me- 
tabolism it so influences that process as to arrest it at the stage of the con- 
version of proteids into urea and oil, instead of allowing it to proceed 
to the final oxidation of oil into carbonic acid and water, and hence it 
induces fatty degeneration of epithelial, glandular and muscular proto- 
plasm throughout the body. 

Calcium Phosphate is an essential ingredient of all the tissues and 
fluids of the body, and forms more than 50 per cent, of the bones. Lac- 
tic and hydrochloric acids dissolve it in small quantities. It increases 
the alkalinity of the blood as well as its power of holding carbonic acid, 
and diminishes the excretion of urea. 



( 



I 



420 PHOSPHORUS. 

Sodium Phosphate acts on the blood and on the excretion of urea sim- 
ilarly to the calcium salt. It increases secretion generally, especially that 
of the bile, being an excellent cholagogue and thereby aiding in the 
digestion of fats. In half-ounce doses it is laxative. It is a normal con- 
stituent of the blood, and possesses the property of increasing the capa- 
city of any fluid to hold carbonic acid in solution. 

The Hypophosphites are generally tonic in action, and are supposed 
to constitute a safer form in which to administer Phosphorus than in the 
unoxidized state. They are probably converted into phosphates in the 
stomach. 

Antidotes and Antagonists to Phosphorus. 

Antidotes are Hydrated Magnesia, Lime-water, powdered Charcoal, Copper Sulphate 
and old acid Turpentine. Hydrated Magnesia as a quickly acting purgative, Lime-water 
or Charcoal to prevent the action of the poison on the tissues. Potassium Permangan- 
ate may have antidotal action. No Oils or Fats should be used, as they dissolve phos- 
phorus and promote its absorption. Opium to antagonize the depression of the heart 
and system. Transfusion has proved efficient when the blood is seriously affected as 
a result of phosphorus poisoning. Copper Sulphate, as an emetic and to form the com- 
paratively insoluble phosphide of copper, also Crude French Acid Ticrpentine , given 
rapidly in an emulsion of gum, are generally placed among the antidotes, but are both 
practically useless. The first has caused death more rapidly than the phosphorus, and the 
second is generally unobtainable, and has proved useless when employed. 



Therapeutics. 

Phosphorus is chiefly used to promote the nutrition of osseous and 
nervous tissue. It is useful in chronic nervous exhaustion when the nerve 
centres are implicated, also in osteomalacia, rachitis and progressive 
locomotor ataxia. In threatened cerebral softening it affects the nerve 
centres as no other drug does, and in paraplegia of myelitic origin from 
excessive venery it is often very efficient. Progressive pernicious anemia 
has sometimes been arrested by Phosphorus in very small doses, while in 
impotence of functional character there is no remedy so effective. In 
wakefulness of the aged and that due to cerebral anemia small doses of 
the pill or tincture are sometimes remarkably beneficial. In certain skin 
diseases (acne, psoriasis, lupus), it is an excellent substitute for arsenic. 
Neuralgia is often cured by Phosphorus, but large doses are necessary, at 
least gr. -^ evei 7 f° ur hours. A solution in Retinol is very stable, 
and is strongly recommended for the external and internal use of the 
drug. 

Calcium Phosphate and the Hypophosphites are used with benefit in all 
diseases of mal-nutrition, and where the repair or development of the 
bones is required. They are particularly useful in protracted suppuration, 
osteomalacia, rachitis, caries, scrofulosis, chronic phthisis, and in the 
anemia and bone-softening of lactation. The Hypophosphites are much 
employed in nervous and general debility and in chronic lung diseases, 



PHYSOSTIGMA. 421 

and are supposed to act in the same manner as free phosphorus, but without 
irritation. They are probably converted into phosphates in the stomach, 
and hence may be expected to promote the growth and healing of bones, 
to stimulate the hepatic and intestinal secretions, and to affect the lymph- 
atic glands and adenoid tissue. The Compound Syrup of the Hypophos- 
phites is an excellent remedy in acne indurata. 

Sodium Phosphate in doses of 3J-1J thrice daily for adults (gr. x-xxx 
for children) is extremely useful as a laxative in conditions depending on 
catarrh of the bile-ducts and duodenum, as headache, jaundice, chalky 
stools, etc. Gall-stones may be prevented from forming by scruple or 
drachm doses before meals for months at a time. It is also an efficient 
agent in obesity, hepatic diabetes, incipient hepatic sclerosis, chronic in- 
fantile diarrhea, cerebral debility, bilious sick-headache, and the pasty, 
white stools of ill-conditioned children. Vichy-water contains this salt 
in the proportion of gr. ^ to the pint, and is considered a valuable water 
in hepatic colic and kindred conditions. Hypodermic injections of So- 
dium Phosphate have been used with highly beneficial results in syringo- 
myelitis and in unilateral astasia-abasia. Drs. Crocq and Luton of 
Rheims advocate the hypodermic use of this salt as a substitute for the 
organic extracts, and maintain that it is equally efficient in all cases in 
which these extracts have proved to be of value. [Compare the article 
on Animal Extracts, page 157.] 

Crocq's solution contains Sodium Phosphate I part, Alcohol 5, Glycerin 20, Distilled 
Water 25 ; the dose of which is 3 cc. (about 45 minims) hypodermically, with aseptic 
precautions, once daily or on alternate days. Luton uses a solution of the crystallized 
Sodium Phosphate and Sodium Sulphate. 

Glycero-phosphates (Unofficial), — have been used during the last few years, espe- 
cially in France. Glycero-phosphoric Acid is prepared by mixing Phosphoric Acid I part, 
with Glycerin ij^, and gradually heating to 374 F. When pure, it is a yellow, odorless 
liquid, of syrupy consistence and acid taste, soluble in water and in alcohol. Dose, 
TT\j-v, three times daily. The salts in general use are — the Glycero-phosphate of Cal- 
cium, dose, gr. ij-v ; of Iron, dose, gr. j-ij ; of Lithium, dose, gr. iij-xv ; and of Sodium 
(in 50 per cent, solution), dose, gr. ij-ivin sodium chloride solution by hypodermic injec- 
tion. 

This acid and its salts are said to accelerate metabolism and the nitrogenous exchanges, 
to promote the assimilation of albuminoids, and to increase the excretion of nitrogen, the 
oxidation of broken-up sulphur compounds and the elimination of sodium chloride. 
They may also favor the assimilation of the phosphates of the food and so protect the 
combined phosphorus of the nervous system from waste (Robin). The acid is highly 
valued as a nervine remedy and has been used with benefit in neurasthenia, locomotor 
ataxia, phosphaturia, lithemia and muscular atrophy. The Iron salt is praised in anemia 
and chlorosis. 

PHYSOSTIGMA, Calabar Bean,— is the seed of Physostigma 
venenosum, nat. ord. Leguminosae, a woody creeper of Calabar, West 
Africa, where it is used by the natives as an ordeal for witches, etc., 
vomiting after its ingestion being held to establish the innocence of the 
accused. It contains two alkaloids, Physostigmine (or Eserine), C 15 H 21 - 



422 PHYSOSTIGMA. 

N 3 2 , and Calabarine, which is antagonistic to the former and is allied 
to strychnine in its action, while Physostigmine resembles gelsemium. 

Preparations . 

Extractum Physostigmatis, Extract of Physostigma, — an alcoholic extract, of 
which the usual dose is from gr. yL to \, but gr. j-iv are used in tetanus. 

Tinctura Physostigmatis, Tincture of Physostigma, — 15 per cent. Dose, TT\v-xx. 

Physostigminae Salicylas, Physostigmine Salicylate {Eserine Salicylate), — color- 
less, columnar crystals, of bitter taste and neutral reaction, soluble in 150 of water and 
in 12 of alcohol. Dose, gr. iho~~io- 

Physostigminae Sulphas, Physostigmine Sulphate {Eserine Sulphate), — a white, 
micro-crystalline powder, of bitter taste, very deliquescent in moist air, very soluble in 



Physiological Action. 

Physostigma is a direct spinal paralyzer, producing complete general 
paralysis and abolished reflexes, but not affecting muscular irritability or 
the cerebral functions. It stimulates secretion, excites nausea and vom- 
iting, salivation and diaphoresis, and is laxative by stimulating the mus- 
cular coat of the intestines to increased peristalsis as well as by increasing 
the intestinal secretions. It first lowers then raises arterial tension, in- 
creases the frequency of the heart-beat, but depresses the power of the 
cardiac muscle though not destroying it. It produces dyspnea by a 
tetanic action on the respiratory muscles, causing carbonic acid narcosis 
and death by paralysis of respiration. It contracts the pupil (how, is 
disputed), also the ciliary muscle, producing marked myosis. It is elim- 
inated chiefly by the kidneys, the urine of the animal affected poisoning 
another. 

The alkaloids of Physostigma have opposite actions, and different or 
even contradictory results may be obtained from the drug according to 
the proportion of each in the preparation employed. Physostigmine 
represents the action of the bean, paralyzing the nervous centres and 
stimulating muscular fibre, while Calabarine causes convulsions like 
strychnine (Brunton). Physostigmine, in its action on the cord is allied 
to gelsemium and antagonistic to strychnine and to picrotoxin, but Cal- 
abarine is allied to both (Murrell). 

Antagonists and Incompatibles. 

Atropine is antagonistic as to the effects on the respiration, heart and pupils. Chloral 
is also antagonistic, and over a greater field of action, but to be effective must be admin- 
istered before the ingestion of the Physostigma. Tannic Acid, the vegetable astringents 
and the caustic alkalies are chemically incompatible. 

Therapeutics. 
The applications of Physostigma are not many. It is efficient in con- 
stipation due to torpor of the bowels, in which condition it is usually 



PHYTOLACCA. 423 

combined with belladonna and nux vomica. In tetanus it has been used 
with advantage to diminish reflex excitability, but large doses (2 to 4 
grains) must be given, and its effects must be carefully watched. In small 
doses it is a useful remedy in many nervous affections, such as locomotor 
ataxia, writers' cramp and the paraplegia due to myelitis, also in pro- 
gressive paralysis of the insane which is apparently retarded by it. The 
extract should be given in these diseases, in doses of gr. -^ in pill every 
three hours ; and if the treatment is kept up for six months or longer the 
results will prove very satisfactory, though the improvement will be slow 
(Murrell). While theoretically antagonistic in poisoning by atropine or 
strychnine, practically it is not of much value therein. 

Physostigmine (Eserine) is used locally by ophthalmologists for many 
purposes in affections of the eye. In a solution of gr. ij to the 5 of 
water dropped into the eye it is efficient in breaking up or preventing 
adhesions of the iris, diminishes intraocular tension, prevents suppuration 
after operations, contracts the pupil, diminishing the entrance of light in 
photophobia, etc., and empties the vessels of the eye. It is very useful 
in keratitis, glaucoma, strumous ophthalmia, and neuralgia of the eye- 
ball. The salts of Physostigmine in neutral solution may be used for 
these purposes, as well as to counteract the effects of atropine on the 
pupil. Gelatin disks medicated therewith maybe obtained in the shops, 
and are a convenient form in which to use the drug for ophthalmic pur- 
poses. In dose of gr. j-J-^ hypodermically it has proved remarkably 
efficient as an occasional substitute for morphine, after the final with- 
drawal of that drug in the treatment of its habitues. 

PHYTOLACCA, Poke,— is official under two forms, the fruit and 
the root of Phytolacca decandra, a plant of the nat. ord. Phytolaccaceae, 
found in all parts of the United States. It contains a neutral principle 
Phyiolaccin, and an acid Phytolaccic Acid, also tannin, starch, fixed oil, 
etc. The official titles are — 

Phytolaccse Fructus, Phytolacca Fruit {Poke Perry), — a depressed- 
globular, dark purple, compound berry, about y$ inch in diameter, 
inodorous, taste sweet, slightly acrid. Dose, gr. x-xxx. 

Phytolaccse Radix, Phytolacca Root {Poke Root), — large, conical, 
branched, fracture fibrous, inodorous, sweetish and acrid. Dose, as an 
emetic, gr. x-xxx, — as an alterative, gr. j-v. 

Preparations . 

Extractum Phytolaccse Radicis Fluidum, Fluid Extract of Phytolacca Root. — 
Dose, rr^ j-xxx. 

Tinctura Phytolaccse, Tinchire of Phytolacca (Unofficial). — Dose, Tt\x-3J. 



424 PICHI — PICROTOXINUM. 

Physiological Action and Therapeutics. 

Phytolacca is an emeto-cathartic, acting slowly but persistently, with 
great nausea and considerable depression. It lowers the rate of respira- 
tion and of cardiac action, and is a motor depressant, paralyzing the 
spinal cord and the medulla, death occurring from paralysis of respira- 
tion preceded by tetanic convulsions. Several cases of poisoning by 
this plant have occurred. Its action is antagonized by Alcohol, Ether, 
Opium, Digitalis, and other motor-excitants. 

Alterative powers have been ascribed to Phytolacca, and competent 
observers have reported curative results from its use in malignant tumors, 
varicose and other ulcers, obstinate eczema, sycosis, favus and other 
skin affections, employing it both internally and externally. It is a very 
serviceable remedy in chronic rheumatism, and given internally has 
undoubtedly cured cases of granular conjunctivitis. Mastitis is some- 
times aborted and suppuration of the breasts prevented by the use of the 
fluid extract internally while a solid extract is locally applied to the seat 
of the impending inflammation. In tonsillitis and diphtheritic sore throat, 
also in chronic follicular pharyngitis, it has been much used with good 
results, especially when there is high fever and pains in the head, back 
and limbs. In true adynamic diphtheria it will do little good. 

Phytolacca has long been known to promote the absorption of adipose 
tissue, and was suggested as a remedy for obesity as early as 1858. A 
resinoid preparation of the berries is on the market as an "anti-fat" 
remedy, under the name Phytoline, the dose of which is ni.x six times a 
day, before and after each meal. 

PICHI, Pichi (Unofficial), — is the shrub Fabiana imbricata, a member of the nat. 
ord. Solanacese and a native of S America. Among the Chilians it has been much 
prized as a remedy in cystitis with calculi and gravel, and in chronic catarrh of the 
bladder. It seems to have considerable power over the hematuria and pain of renal 
calculus. It is also highly praised in dyspeptic disorders. Its medicinal virtues reside 
in oleoresinous constituents which are insoluble in water. An extract is prepared from 
the leaves, of which the dose is gr. v-x in capsules. Dose of the fluid extract, gj, but 
it should not be added to water. 

PICROTOXINUM, Picrotoxin, Picrotoxic Acid, C 30 H 34 O 13 ,— is 
a poisonous, neutral principle obtained from the seeds contained in the 
berries (Cocculus Indicus, Fish-berries), of Anamirta paniculata (Anam- 
irta Cocculus, Menispermum Cocculus), a climbing shrub of the nat. ord. 
Menispermaceae, a native of the East Indies. The berries contain, be- 
sides Picrotoxin, a large quantity of fixed oil and other substances of 
less interest. In the shell are found Menispermin an alkaline principle, 
Paramenispermin which is neutral and crystalline, and Hypopicrotoxic 
Acid. There are no official preparations. 



PICROTOXINUM. 425 

Picrotoxin occurs in colorless, flexible crystals, of bitter taste and neutral reaction, 
soluble in 240 of water and in 9 of alcohol, also in acids and in alkaline solutions. Dose 
by the stomach gr. gV^V' cautiously. For hypodermic use a solution in water of gr. ij 
in J; j may be used, in doses of gr. -gVj-^V °^ tne principle? Tryv equalling gr. Jq. 

Unofficial Preparations of Cocculus. 
Tinctura Cocculi, Tincture of Cocculus, — I in 8. Dose, rryj-xv. 
Extractum Cocculi Fluidum, Fluid Extract of Coccuhis. — Dose, TT\j-iij. 
Planat's Tincture of Cocculus, — 1 in 4. Dose, Try -v. 

Physiological Action. 

Picrotoxin is a cerebro-spinal exaltant, affecting especially the centres 
in the medulla oblongata, and in its action representing the combined 
action of belladonna and nux vomica. It stimulates all the secretions, 
especially the cutaneous, the salivary and the intestinal, produces nausea 
and vomiting, and slows the heart and the respiration after transiently 
accelerating both. It causes muscular twitching, incoordination, stupor, 
delirium, epileptiform convulsions, tonic spasms of the flexor muscles 
alternating with clonic ones, exalted reflexes and trembling, — then coma, 
insensibility and death by paralysis of the heart, which is arrested in 
diastole. The action of the drug is on the spasm and vagus centres in 
the medulla and on Setchenow's inhibitory centre, as well as on the cere- 
bellum and spinal cord, paralyzing the first-named centres and stimulating 
the reflex centres in the cord. It is eliminated by all the excretory chan- 
nels, chiefly by the kidneys. The spasms caused by Picrotoxin are choreic 
and chiefly affect the flexor muscles, — those from Strychnine are tetanic, 
affecting principally the extensors. The order, succession and character 
of the phenomena produced by Picrotoxin resemble in marked degree 
those of the epileptic paroxysm. 

Cocculus berries are used to stupefy fish, being thrown into ponds con- 
taining them. They are also employed to adulterate beer and porter in 
order to make these drinks more intoxicating. 

Antagonists. 

Chloral is antagonistic to its cerebral and spinal actions, but synergistic to its depressant 
power over the heart and the respiration. Acetic Acid gives relief in overdosing, and may 
have some antidotal power. Anesthetics antagonize its spasm-producing action. 

Therapeutics. 
Picrotoxin is used chiefly in nervous diseases. Epilepsy is amenable to 
it, especially when the attacks are nocturnal, and in anemic cases and 
those attributable to onanism. Paralyses of several forms have been 
greatly benefited by it, especially paralysis of the sphincters, hemiplegia 
from cold, glosso-labio-laryngeal paralysis and paralysis agitans. Chorea 
is well treated by it but requires full doses. It is remarkably efficient in 



426 PILOCARPUS. 

controlling the night sweats of phthisis and in flatulent colic, also in dys- 
pepsia with flatulence and severe epigastric pain, and in vomiting with 
giddiness, headache and intolerance of light and sound. Dysmenorrhea 
is often benefited by Cocculus administered for two days before the 
period; and leucorrhea, when the discharge is sero-purulent with lumbar 
pains, is frequently controlled by it. Parasitic skin diseases are well 
treated by an ointment of Picrotoxin (gr. x to the £) which will also kill 
pediculi, but it must be used cautiously and with special care to avoid 
an abraded surface. The tincture of Cocculus may be used undiluted as 
a wash to kill body-lice. 

PILOCARPUS, Jaborandi,— the leaflets of Pilocarpus Selloanus 
and of Pilocarpus Jaborandi, Brazilian plants of the nat. ord. Rutaceae. 
The word Jaborandi is applied in Brazil to any tree or shrub which pos- 
sesses the power of inducing sweating, and a number of plants are so 
designated, but the true leaves are known by their numerous pellucid 
dots, easily recognized when the leaf is held between the eye and a light. 
They contain the four alkaloids Pilocarpine, C u H 16 N 2 2 , a syrupy fluid, 
slightly soluble in water, and forming salts; Jaborine, isomeric with 
pilocarpine, but antagonistic thereto in action, and does not form crys- 
tallizable salts; Pilocarpidine, which acts like pilocarpine; and Jabori- 
dine, which is analogous in action to jaborine. 

Preparations. 

Extractum Pilocarpi Fluidum, Fluid Extract of Pilocarpus. — Dose, TT^v-^j. 

Pilocarpine Hydrochloras, Pilocarpine Hydrochlorate, C n H 16 N 2 2 HCl, — small, 
white, deliquescent crystals, odorless, of faintly bitter taste ; very soluble in water and 
in alcohol, almost insoluble in ether or chloroform. Dose, gr. y^-y^. 

Physiological Action. 
Pilocarpus is a paralyzer of the vaso-motor system, and a stimulant of 
the peripheral terminations of nerves supplying glands and involuntary 
muscular fibre, subsequently paralyzing the latter. It is therefore a 
powerful diaphoretic and sialogogue, a cardiac depressant by stimulation 
of the vagus ends, also myotic, emetic, and under some circumstances 
abortifacient. Its taste is hot and pungent. It causes prompt and pro- 
fuse perspiration (gix-xv in quantity) and salivation (5x-xxvij) after a 
preliminary flushing of the skin. The nasal, bronchial and lachrymal 
secretions are much increased, sometimes watery diarrhea occurs; the 
action of the heart at first increased is afterwards lowered, the arterial 
tension is reduced, and the temperature falls from i° to 4 . Drowsiness, 
pallor, chilliness and debility succeed, and last several hours; the pupils 
are contracted and accommodation is impaired. The elimination of urea 
is greatly increased, but not the quantity of urine. The respiratory power 



PILOCARPUS. 427 

is lowered, and apnea may occur from increase of the bronchial mucus. 
Pilocarpus is rapidly diffused and is eliminated by the skin and the 
salivary glands. Its effects pass off usually in from three to six hours. 
Children are less affected than adults by proportionate doses. It causes 
contraction of the bladder, uterus and spleen, in the latter case whether 
the organ is enlarged or of normal size. The desire to urinate, which is 
experienced after a full dose, is due to the drug causing contraction of 
the bladder. Pilocarpus is not a diuretic but tends rather to diminish 
the quantity of urine as a result of its powerful diaphoretic action. 

Pilocarpine is the principle to which the foregoing actions are due, but 
Jaborine, though chemically identical, is perfectly antagonistic thereto in 
its effects on the heart, pupils, lungs and salivary glands, acting precisely 
like atropine on these organs. The difference is probably due to a dif- 
ferent molecular arrangement in these agents. 

Antagonists and Incompatibles. 

Atropine is the antagonist to Pilocarpine, in dose of grain yi ff for gr. -| of the latter. 
The antagonism between these two alkaloids extends over the whole range of their action, 
and is the most complete known to physiological experimentation. Conversely Pilocar- 
pine is exactly antagonistic to Atropine, but Jaborine acts similarly to the latter drug. 
Morphine controls the nausea and vomiting. Caustic alkalies, the persalts of Iron and 
salts of the metals generally, are chemically incompatible. 

Therapeutics. 

Pilocarpus is used with great benefit in dropsies, especially the renal 
form, also in eclampsia of renal origin, in uremia, pleuritis, meningitis 
and other inflammations of serous membranes, but is contraindicated when 
from any cause there is a weak heart. In diabetes insipidus it reduces 
the quantity of urine remarkably, relieving the kidneys by throwing the 
work on the skin. In the acute and chronic forms of Bright's disease it 
has been used with advantage, but being very depressant it must be em- 
ployed with great caution in this disorder. For alopecia it is the most 
efficient remedy known, stimulating the skin and improving the color and 
condition of the hair. In agalactia it stimulates the secretion of the 
milk, and it often gives prompt relief in parotitis. Ptyalism is frequently 
relieved by minute doses of Pilocarpine (gr. -£$), which, acting specifi- 
cally on the same gland, may correct its morbid action, and similar doses 
used thrice daily will check profuse perspiration. The hypodermic use 
of Pilocarpine will arrest a paroxysm of spasmodic asthma and is equally 
efficient in hiccough. Atropine-poisoning is best combated by the use 
of Pilocarpine hypodermically. 

Diphtheria has been treated with Pilocarpine successfully, Guttmann 
having reported eighty-one cases without a single death ; but other 
clinicians have not found it so efficient, and Lashkewitz and Jacobi con- 
demn it absolutely. In children above the age of five years, in whom 



428 PIMENTA PIPER. 

the condition of the heart does not contraindicate it, this drug often 
gives pronounced satisfaction in detaching the false membrane and pre- 
venting its reformation ; but care must be taken to give full support by- 
food and alcohol throughout its use, and to avoid it altogether in cases 
which manifest cardiac weakness or great depression. In erysipelas it 
is often highly efficient, and for the purpose of breaking up a common 
cold it is one of the best agents at our command. For the latter purpose 
the fluid extract of Pilocarpus may be used in doses of Trix-gj according 
to age, given at bed-time and repeated once or twice during the night if 
necessary. Children bear it well in all its physiological actions. 

Ophthalmologists employ Pilocarpine with most excellent results in the 
amblyopia of alcoholism and that from the abuse of tobacco, in detach- 
ment of the retina, chronic iritis, keratitis, glaucoma, hemorrhage into 
the vitreous, atrophic choroiditis, white atrophy, to promote resolution 
and absorption in inflammatory conditions with exudation, and instead 
of physostigmine as a myotic. 

Pilocarpine is highly efficient as an aid to sorbifacient remedies in 
removing inflammatory exudations and promoting the absorption of effu- 
sions. When iodides and mercurials are being used for these purposes 
their action is greatly aided by this drug administered occasionally for a 
few days at a time. It has been suggested by Waldstein as a remedy in 
phthisis for the purpose of inducing leucocytosis and stimulating glandu- 
lar activity, and is one of the ingredients in a new " cure " for consump- 
tion named Aseptolin. (See ante, page 85.) 

PIMENTA, Allspice, — is the nearly ripe fruit of Pimento, officinalis, a West 
Indian tree of the nat. ord. Myrtacese. The berries contain a Volatile Oil which is 
official, a green fixed oil, fat, tannin, gum, resin, etc. Dose, gr. x-xl. 

Oleum Pimentae, Oil of Pimenta, — the volatile oil, colorless or pale yellow, of aro- 
matic odor, pungent taste and slightly acid reaction. Is a constituent of Bay Rum (Spt. 
Myrciae). Dose, n\ij-yj. 

Allspice is a warm, aromatic stimulant, very useful as a condiment, improving diges- 
tion by increasing the vascularity of the gastric mucous membrane and by stimulating 
the salivary secretion. The oil is an agreeable remedy for flatulence, nausea, and in- 
testinal colic, and is used to prevent the griping of purgatives and to cover the taste of 
nauseous medicines. 

PIPER, Pepper [Black Pepper}, — is the unripe fruit of Piper nigrum, or Pepper- 
vine, a perennial plant of the nat. ord. Piperaceae, growing in India, Siam, Java, Borneo, 
etc. It contains a principle, Piperin, which is official, also a green, acrid, concrete oil, 
a balsamic volatile oil, starch, lignin, gum, extractive, etc. Dose, gr. v-xx. 

Oleoresina Piperis, Oleoresin of Pepper, — contains almost all the volatile oil and 
acrid resin extracted by ether, with but little of the Piperin. Dose, TT\,^-j. 

Piperinum, Piperin, C 17 H 19 N0 3 , — a neutral principle prepared from Pepper, and 
occurring also in other plants of the natural order Piperaceae. Occurs in colorless or 
pale-yellowish prisms, of neutral reaction, almost insoluble in water, slightly so in ether, 
but soluble in 30 of alcohol. Dose, gr. j-x. 

Piperidinum, Piperidin (Unofficial), — is produced by the hydrolysis of Piperin, or 
synthetically by reducing pyridine by nascent hydrogen. It occurs as a colorless, limpid 



PJPEKAZINUM. 429 

liquid, and is a powerful base. The Acid Tartrate is a white, crystalline powder, readily 
soluble in water, the dose of which is gr. x-xv. 

Pepper when applied to the skin acts as an irritant ; internally its effects are similar to 
those of other aromatics, being a warm carminative and stimulant, increasing slightly the 
action of the heart, stimulating the kidneys somewhat, and toning up the mucous mem- 
brane of the urinary and intestinal passages, by which channels it is eliminated. It has 
been thought to possess antiperiodic power, and was formerly much employed in inter- 
mittents. Its chief medicinal use is to correct flatulence, and to excite action of the 
stomach, being very commonly taken as a condiment with food. It is occasionally em- 
ployed in gleet, but more extensively in hemorrhoids and other diseases of the rectum. 
Its active constituents are the concrete oil or resin and the volatile oil, Piperin having 
very slight action on the system except as an antiperiodic and antipyretic, qualities which 
it certainly possesses. 

Piperidin Tartrate increases the solvent power of serum for sodium biurate to a much 
greater extent than Piperazin, Lysidin or Urotropin, and has been introduced as a solvent 
for gouty deposits, uric acid gravel and calculi. 

PIPERAZINUM, Piperazin, C 4 H 10 N 2 (Unofficial),— is a syntheti- 
cal basic compound formed by the action of Ammonia upon Ethylene 
Bromide or Chloride; and occurs as a white, crystalline powder, soluble 
in water and liquefying when exposed to the air, from which it absorbs 
water and carbon dioxide. Dose of the base or its hydrochloride, gr. v- 
xv. It may be injected hypodermically in 3 to 5 per cent, solution. 

Piperazin possesses the valuable property of forming with uric acid a 
very soluble compound, piperazin urate being seven times more soluble 
in water than is lithium urate, the former requiring but 50 parts and the 
latter 368 parts of water for solution. It is non-toxic, and devoid of 
powerful physiological effects, being well borne without ill results, even 
when administered for prolonged periods. It is non-irritant to mucous 
membranes, is readily absorbed from the stomach, and circulates in the 
blood unchanged, reaching the parts affected by gouty deposits in a con- 
dition in which it neutralizes and dissolves the latter, thus facilitating 
their removal from the body. 

The administration of Piperazin in gout promptly reduces the redness 
and swelling of the affected joints, and is frequently followed by a dis- 
charge of gravel. The minimum daily dosage for this purpose is about 
15 grains, which should be dissolved in half a pint of water, and the solu- 
tion should be added to a pint or more of any convenient carbonated 
water, and be taken in divided doses through the day. When there is 
much pain and fever present, an equal quantity of Phenocoll Hydro- 
chloride may be added, — but in preparing them, each agent should be 
dissolved separately and then mixed together, otherwise a precipitate will 
form in the solution. It gives marked relief in the pruritus of the uric 
acid diathesis due to the irritation of imperfect nitrogenous elimination. 
In solution it may be introduced into the bladder in order to dissolve 
vesical calculi of the uric character, and in gout it may be locally em- 
ployed by hypodermic injection. A one per cent, solution, applied 
locally to open gouty sores, relieves the pain and reduces the inflamma- 



430 PISCIDIA PIX. 

tion. It should be tried in rheumatic arthritis of difficult diagnostic 
differentiation. As a solvent for uric acid and urate concretions Piperazin 
has been highly praised by many observers and its efficacy disputed by 
many others. It is patented, which fact, together with its extremely high 
price, prevents its general use. It is supplied in vials containing 10 
grammes (150 grains), which is sufficient for ten days' dosage and may 
be prescribed in ^viij of water, of which solution the daily dose would 
be 3j (equal to 18^ grains), taken in a quart or more of any carbonated 
water during the day in broken doses. 

Lysidin (Unofficial), — is a base obtained by the action of sodium acetate upon 
ethylene-diamine hydrochlorate, and said to possess a solvent power on uric acid five 
times greater than that of Piperazin. It has been tried in cases of chronic gout with ex- 
cellent results. The stiffness of the joints was lessened, and a conspicuous reduction 
occurred in the tophi around the joints, and on the epiglottis in one case. The dose is 
^ss-^ijss of the 50 per cent, alkaline solution in a glassful of carbonated water. 

Lycetol, Dimethyl-piperazin Tartrate (Unofficial), — is a new uric acid solvent, which 
is said to combine the solvent properties of Piperazin with the alkalinizing and diuretic 
effects of a tartrate. The dose is gr. xv-xxx daily, administered in carbonated water or in 
the form of a lemonade. 

Urotropin (Unofficial), — is prepared by the action of ammonia on formic aldehyde, 
and occurs as a white, crystalline powder readily soluble in water. It is used as a genito- 
urinary antiseptic in cystitis and phosphaturia and as a solvent for uric acid. Dose, gr. 
viij, dissolved in water or carbonated water. 

Piperidin Tartrate (Unofficial), — is another powerful solvent of sodium biurate. 
It is described under the title Piper, on page 429. 

PISCIDIA, Jamaica Dogwood (Unofficial), — is the bark of the root of Piscidia 
erythrina, a tree of the nat. ord. Leguminosae, growing in the West Indies. It occurs 
as a tough, fibrous bark, of heavy, narcotic odor, and contains a yellowish, resinoid sub- 
stance named Piscidin. Its active principle has not been isolated. A fluid extract is 
on the market, of which the dose is ,^ss-j, carefully increased. 

- Piscidia has a narcotic effect on many animals, and has been used in Jamaica for many 
years to stupefy fish, that they may be easily taken. It produces muscular relaxation, 
incoordination of movement, lowered sensibility, increased action of the heart and increase 
of the arterial tension by stimulation of the vaso-motor centre. Soon however the 
heart is weakened, vascular tension falls, and a tetanoid state results from stimulation of 
the spinal cord, with reduced reflex action. On the brain its effects resemble those of 
Opium, but it causes deep sleep without any unpleasant after-results. It relieves pain 
in less degree however than Opium does, but its hypnotic action is greater. It also re- 
lieves cough and spasm, produces diaphoresis and salivation and dilates the pupil. From 
toxic doses death occurs by asphyxia in animals. In man its action is probably the same, 
but in decidedly less marked degree. 

Piscidia is used chiefly as a general nervous sedative. Its hypnotic and anodyne 
powers are somewhat uncertain, but have in many cases been very decided. It is useful 
in whooping-cough and spasm, and has proved almost specific in many cases of neuralgia, 
while in others it has caused great gastric distress without the least anodyne effect. 

PIX, Pitch, — is a resinous exudation from the stem of certain trees 
of the genera Pinus (Pines) and Abies (Firs and Spruces), and may also 
be obtained by the evaporation of wood-tar. [See Pix Liquida, p. 431.] 
The first two of the following varieties are official. 

Pix Burgundica, Burgundy Pitch, — the prepared resinous exudation 
of Abies excelsa or Norway Spruce (nat. ord. Coniferae), a native of 



pix. 431 

Europe and Northern Asia. It occurs in hard, brittle, opaque or trans- 
lucent mass, with a shining, conchoidal fracture, almost entirely soluble 
in glacial acetic acid. It is very fusible, and at the body-heat it softens 
and becomes adhesive. It is used for plasters. 

Pix Liquida, Tar, — is an empyreumatic oleo-resin obtained by the 
destructive distillation of the wood of Pinus palustris and other species 
of Pinus (nat. order Coniferse). It is thick, viscid, semi-fluid, blackish- 
brown, of acid reaction, terebinthinate odor, and sharp, empyreumatic 
taste ; slightly soluble in water, soluble in alcohol, in oils and in a solu- 
tion of potassa or of soda. 

By distillation Tar yields an acid liquor named Pyroligneons Acid and an empyreu- 
matic oil called Oil of Tar, (see Oleum Picis Liquidae, below), the residue being pitch. 
Its granular appearance is due to crystals of Pyrocatechin, which occur either in the 
Pyroligneous Acid or in the tarry mixture. Dose, 3J-ij daily, in ten- grain doses. 

Pix Canadensis, Canada or Hemlock Pitch (Unofficial), — is the pre- 
pared resinous exudation of Abies canadensis (nat. ord. Coniferae), the 
Hemlock Spruce of the U. S. and Canada. Its properties are much the 
same as those of Burgundy Pitch. 



Preparations. 

Emplastrum Picis Burgundicse, Burgundy Pitch Plaster, — has of Burgundy Pitch 
80, Olive Oil 5, Yellow Wax 15. 

Emplastrum Picis Cantharidatum, Cantharidal Pitch Plaster, Warming Plaster, 
has of Cerate of Cantharides 8, Burgundy Pitch to 100. 

Oleum Picis Liquidae, Oil of Tar, — a volatile oil distilled from Tar. Dark, red- 
dish-brown (almost colorless when fresh), of tarry odor and taste and acid reaction, 
readily soluble in alcohol. Contains a great variety of compounds, including Hydro- 
carbons, Phenols, Paraffin, etc. , among the phenols being Creosote and Carbolic Acid. 

Syrupus Picis Liquidae, Syrup of Tar, — has of Tar 7^ per cent. ; and is a sweet- 
ened Tar- water. Dose, gij-^ss. 

Unguentum Picis Liquidae, Tar Ointment, — contains of Tar 50 parts, Yellow 
Wax I2^£, Lard 2>lVz- I s irritating unless mixed with finely levigated chalk. 

Infusum Picis Liquidae, Tar Water (Unofficial), — made by shaking Tar I with 
Water 4 frequently during 24 hours, decanting and filtering. Dose, Oj-ij daily. 

Vinum Picis Liquidae, Wine of Tar (Unofficial), — Tar £xvj, Glycerin, White 
Wine, Honey, aa ^viij, Acetic Acid !|j, Boiling Water Ovj, shaken together and di- 
gested in a closed vessel for two hours at 150 to 160 F.,then macerated for a few days, 
frequently shaken, strained and filtered. 

Oleum Pini Sylvestris, Oil of Scotch Fir (Unofficial), — a colorless, fragrant oil, 
distilled from the leaves of Pinus Sylvestris, resembling Turpentine in action. Used by 
inhalation ( 3 ss to Oj of boiling water), or locally. 

Retinol, Resinol (Unofficial), — obtained by the distillation of Burgundy pitch, occurs 
as a yellowish, oily liquid, boiling at temperatures above 536 F. Used as a solvent for 
a number of the newer remedies, as Cocaine, Aristol, Iodol ; also for Carbolic Acid, 
Creosote, Phosphorus and many alkaloids. 

Concentrated Extract of Pinus Canadensis (Unofficial), — is an aqueous, non- 
irritant astringent, prepared from the Abies Canadensis or Hemlock Spruce. It is said 
to have a specific tonic action upon mucous membranes. Two kinds are sold, one being 
called the White Extract, in reality a golden yellow, — and the other the Dark Extract," 
the former intended for use when it is desirable to avoid staining the linen. This prep- 



43 2 PLANTAGO. 

aration received the endorsement of Dr. J. Marion Sims, and has been extensively em- 
ployed, both locally and internally, as a topical application in uterine and vaginal ca- 
tarrhs, and as a systemic remedy in catarrhal inflammation of the gastro-intestinal and 
broncho-pulmonary mucous membranes. 



Physiological Action and Therapeutics. 

Pitch is a gentle rubefacient when applied to the skin, but in some 
constitutions the Burgundy variety causes a vesicular and pustular inflam- 
mation if used extensively. It is generally employed as a basis for plas- 
ters, and is of benefit in lumbago, rheumatism, chronic pleurisy, painful 
joints, superficial neuralgiae, etc., protecting the part from variations of 
temperature, and perhaps by the gentle pressure exercised stimulating the 
lymphatics and promoting absorption. It is supposed to have a special 
influence on the rectum, and in pill with Tar has been employed as a 
remedy for hemorrhoids. In applying adhesive plasters the hair should 
first be shaved off, and when about to be removed the plaster should be 
warmed, and a little oil of turpentine inserted between its edge and the 
skin. Canada Pitch is too soft for plasters, but is employed for the same 
purposes as the preceding. A volatile oil obtained from the same tree 
and named Oil of Spruce or Oil of Hemlock, has been used for abortifa- 
cient purposes, endangering the life of the subject. 

Tar is a complex mixture of resins and hydrocarbons, containing creo- 
sote and carbolic acid, which give to it irritant qualities. Internally it 
is expectorant, and produces gastro-intestinal irritation, sometimes severe 
headache, giddiness and febrile phenomena. It is eliminated chiefly by 
the kidneys, which it stimulates, and may cause their congestion also in- 
creased diuresis. Externally it is a decided stimulant to the skin, often 
giving rise to considerable irritation and pain. It is antiseptic and in 
most of its effects it resembles the turpentines. Tar is used as a local 
application in chronic scaly skin diseases, especially psoriasis and chronic 
eczema. As an atomized inhalation it is of decided benefit in bronchitis, 
pharyngitis, laryngitis and winter cough. Internally it may be employed 
with advantage im these affections, also in hemorrhoids, bronchial catarrh, 
and phthisis. The best preparation for internal administration is the 
syrup, which is a sweetened tar-water, the sugar forming with the Tar a 
soluble compound. 

PLANTAGO, Plantain (Unofficial), — is the leaf of Plantago major and Plantago 
lanceolata (nat. ord. Plantaginacese), the common Ribbed Grass. The pounded leaves 
applied as a paste, or the dry leaf powdered, are actively hemostatic, stopping hemor- 
rhages speedily. Among the ancients it had a good reputation as a remedy for toothache 
and earache, which still adheres to it in Switzerland and other parts of Europe. In 
many other painful affections it is extremely efficient, especially in mastitis, rhus-poison- 
ing, erysipelas, burns, scalds, wounds and bruises. A poultice of the leaves may be 
applied to the affected part, and an infusion administered internally. A fluid extract is 
sold in the shops, of which the dose is TT^v-xv. 



PLUMBUM. 433 

PLUMBUM, Lead, Pb, — is not official, but several of its salts are, 
namely — the Acetate, Carbonate, Iodide, Nitrate and Oxide ; of which 
the Acetate is the only one administered internally, the solutions of the 
Subacetate are the only liquid preparations, the Oxide (Litharge) is used 
as Emplastrum Plumbi, the Nitrate is used as a local stimulant or escha- 
rotic, the Iodide as an ointment for absorbent purposes, and the Carbonate 
as an astringent locally to inflamed surfaces. The metal occurs in nature 
chiefly as a Sulphide named Galena, also as an Oxide rarely, and in 
various other combinations (salts). 



Official Salts of Lead. 

Plumbi Acetas, Lead Acetate, Sugar of Lead, — Pb (C 2 H 3 2 ) 2 -f- 3H 2 0, — colorless, 
shining, prismatic crystals or scales, efflorescent, of faintly acetous odor and acid reaction, 
and a sweetish, astringent and metallic taste. Soluble in 2.3 of water and in 21 of alco- 
hol at 59 F. , in 0.5 of boiling water and in I of boiling alcohol. Dose, gr. ss-v. 

Plumbi Carbonas, Lead Carbonate, White Lead, (PbC0 3 ) 2 Pb(HO) 2 ,— a heavy, 
white, opaque powder, odorless and tasteless ; insoluble in water or alcohol, but soluble 
with effervescence in acetic or in diluted nitric acid. Used locally only. 

Plumbi Iodidum, Lead Lodide, Pbl 2 , — a heavy, bright citron-yellow powder, odor- 
less and tasteless, fusible and volatilizable by heat ; soluble in about 2000 of water at 59 
F., and in about 200 of boiling water. Used externally as an ointment. May be given 
internally in doses of gr. 1 twice daily. 

Plumbi Nitras, Lead Nitrate, Pb(N0 3 ) 2 , — colorless, opaque, octahedral crystals, 
odorless, of sweetish, astringent and metallic taste and acid reaction ; soluble in 2 of water 
at 59 F., almost insoluble in alcohol. Used locally as an astringent and deodorizer in 
solutions up to I per cent., also as an escharotic and a disinfectant. 

Plumbi Oxidum, Lead Oxide, Litharge, PbO, — a heavy, yellowish, or reddish- 
yellow powder, odorless and tasteless ; insoluble in water or alcohol, but almost wholly 
soluble with slight effervescence in dilute nitric acid. When heated in contact with char- 
coal it is reduced to metallic lead. Used as Lead- Plaster and sometimes with oil as an 
external application. 

Preparations. 

Liquor Plumbi Subacetatis, Solution of Lead Subacetate, Goulard' 's Extract, — 
an aqueous solution containing about 25 per cent, of the salt, prepared from Acetate of 
Lead 170, Oxide of Lead 100, and Distilled Water to 1000. It is a clear, colorless liquid, 
of sweetish, astringent taste and alkaline reaction, of sp. gr. 1. 195, and when added to a 
solution of acacia it produces a dense, white precipitate. Used locally as an astringent 
and cooling lotion, diluted usually with an equal quantity of water. 

Liquor Plumbi Subacetatis Dilutus, Diluted Solution of Lead Subacetate, Lead 
Water, — has of the preceding 3, in Distilled Water to 100. Used locally as a mildly 
astringent and cooling lotion. 

Ceratum Plumbi Subacetatis, Cerate of Lead Subacetate, Goulard's Cerate, — has 
of the same solution 20 parts with 80 of Camphor Cerate, freshly prepared as it becomes 
rancid easily. Used as an astringent and protective application. 

Emplastrum Plumbi, Lead Plaster, Diachylon .Plaster, — Oxide of Lead 32, Olive 
Oil 60, rubbed together and boiled with 10 parts of water. Is white, pliable and tena- 
cious, free from greasiness or stickiness, and entirely soluble in warm Oil of Turpentine. 
A protective in abrasions and bed-sores, and the basis of many other plasters. 

Unguentum Diachylon, Diachylon Ointment, — has of Lead Plaster 50, Olive Oil 
49, Oil of Lavender Flowers' I. Used locally in Eczema and other cutaneous disorders. 

Unguentum Plumbi Carbonatis, Ointment of Lead Carbonate, — has of the Carbon- • 
ate in very fine powder 10, Benzoinated Lard 90. Used as a dressing for burns. 
28 



434 PLUMBUM. 

Unguentum Plumbi Iodidi, Ointment of Lead Iodide, — has of the Iodide in very 
fine powder io, Benzoinated Lard 90. Used locally to promote absorption. 

Oleatum Plumbi, Oleate of Lead (Unofficial). — a 20 per cent, solution of Oxide of 
Lead in Oleic Acid. A soft, yellowish ointment, for local use. 



Physiological Action. 

Lead salts are all more or less poisonous, but metallic Lead is inert until 
converted into a soluble salt by the acids of the stomach. The Acetate 
in large doses is emetic, so that acute lead-poisoning therefrom is rare. 
Its chief phenomena are intense gastro-intestinal irritation, vomiting, par- 
alysis, coma and collapse. Chronic lead-poisoning, Plumbism, has its 
principal sources in pure water conveyed by leaden pipes, the use of hair 
dyes, handling of printing-type, working in the smelting of lead ores, etc. 
It produces loss of appetite, emaciation, pallor and constipation, followed 
by slowing of the heart's action, and accompanied by violent colic, mus- 
cular impairment evinced by paralysis of the extensor muscles of the 
forearm (drop-wrist), impaired sensibility and albuminuria. Occasion- 
ally aphonia, vertigo, gastralgia, headache, stupor and convulsions are 
manifested. Rheumatism without fever or tenderness in the joints, 
which however are red and swollen, is a frequent symptom. A blue line 
(sulphide) is seen along the margins of the gums in those who do not 
clean their teeth. Neuralgic troubles may arise and amblyopia often 
occurs from impairment of the optic nerve. The metal becomes depos- 
ited in the affected muscles and other tissues, and probably acts by 
impairing the isolating power of the nerve-fibres, thus enfeebling the 
nerve-currents. It also produces contraction of the smaller vessels, and 
may affect any muscles of the body, also the brain, producing delirium, 
coma, and convulsions. Abortion is a frequent result, either through an 
influence on the muscular tissue of the uterus, or from a toxic action on 
the fetus. Death may occur from extension of the paresis to the muscles 
of respiration, from gradual impairment of nutrition, or from convulsions 
and coma, a form of disease known as Lead-encephalopathy. 

Astringency is -the chief quality of the lead salts; they lessen secre- 
tion, contract muscular tissue and then destroy its contractile power, slow 
both the heart and the respiration, and in time destroy the red blood- 
corpuscles. Lead enters the blood as an albuminate, in which form also 
it is retained by the tissues. It is slowly excreted by the liver, kidneys, 
skin and mammary glands. That which escapes by the bile is reabsorbed 
by the bowel, and is again excreted by the intestinal glands, escaping 
with the feces as a sulphide. It lessens the excretion of uric acid. 

Antidotes, Antagonists and Incompatibles. 

In acute poisoning by lead salts, as by the Acetate, the antidotes are Sodium or Mag- 
nesium Sulphate and Sodium Phosphate. The stomach should be evacuated, and albu- 



PLUMBUM. 435 

minous drinks and Opium given to allay irritation. Chronic poisoning is best treated by 
Atropine and Iodides, the latter to saturation of the system. Sulphurated Potassa Baths 
( 3J or more in water) are also very useful. Incompatibles are Mineral Acids and their 
salts, vegetable acids, alkalies, vegetable astringents, Potassium Iodide, albuminous solu- 
tions, Opium, and all waters containing Lime, Sulphates, Carbonates, and C0 2 . 

Therapeutics. 

Lead salts are chiefly used as astringents and hemostatics. The solu- 
tion of the Subacetate diluted with 4 parts of glycerin and water is locally 
employed in many skin-diseases, especially in eczema, lichen, impetigo, 
and erythema; also in catarrhal discharges of muco-purulent character 
from the ear, vagina, and urethra, particularly gonorrhea and leucorrhea. 
Inflammations of external parts are constantly treated by the lotion of 
" Leadwater and Laudanum" (liquor plumbi subacetatis dilutus 7 parts 
to i of tinctura opii). Though the constituents of this lotion are chem- 
ically incompatible it is a valuable sedative and astringent. The acetate, 
in 5-grain doses every three hours, is an efficient internal styptic in various 
hemorrhages, particularly in hemoptysis, hematemesis, and gastric ulcer, 
lowering the action of the heart and constringing the vessels. Its astrin- 
gent action is well manifested in bronchorrhea and other pulmonary 
affections with excessive secretion. It is well used in diarrheas, gr. ij 
with gr. j of pulverized opium in choleraic diarrhea, and smaller doses 
for the summer complaint of children. In caseous pneumonia the 
Acetate is highly recommended as the best remedial agent, combined 
with opium and digitalis ; and in cardiac hypertrophy it may be used to 
lower the action of the heart. It is also serviceable in whooping-cough 
with profuse bronchial secretion and in humid asthma. 

The Carbonate is only used externally to protect irritated surfaces, as 
erythema, erysipelas, intertrigo, etc., in which it may be dusted over the 
surface if unbroken. The official ointment, or white paint mixed with 
linseed oil, is an excellent application to burns or scalds, but if applied 
on the broken cuticle it may prove rapidly poisonous. The Iodide is 
employed externally as an ointment to enlarged lymphatic glands and 
enlarged spleen, also for chronic eczema and psoriasis. It has been used 
internally to reduce a malarial spleen. 

The Nitrate is an efficient application to fissured nipples, gr. x to g of 
glycerin. In powder, dusted over unhealthy granulations, and sanious 
ulcers resulting from onychia, it gives prompt relief after a brief period 
of pain. It is said to have cured cases of epithelioma when used in the 
same manner. In solution (gr. x to the ^) it is a most efficient deodor- 
izer against the fetor from gangrenous sores, ozena and other offensive 
discharges. Pharmaceutically it is used in the preparation of the Iodide. 
The Oxide is used in the manufacture of plasters and most of the other 
salts of lead. It may be used as an external application mixed with sweet 



43^ PODOPHYLLUM POLYGONUM. 

oil in superficial burns, but care should be taken that it is applied only 
to the unbroken skin. It is not employed internally. 



PODOPHYLLUM, May Apple,— is the rhizome and rootlets of 
Podophyllum peltatum, the Mandrake, an herbaceous perennial of the nat. 
ord. Berberidacese, growing in the woodlands of Canada and the U. S., 
having a pale-green stem, with a single white flower at its summit. Its 
active principle is a Resin which is official and is a compound of several 
resins. It probably contains the alkaloid Berberine, which is also found 
in Berberis, Hydrastis and other plants. Dose, gr. v-xx. 

Preparations. 

Extractum Podophylli, Extract of Podophyllum. — Dose, gr. v-x. 

Extractum Podophylli Fluidum, Fluid Ext. of Podophyllum. — Dose, n\j-xxx. 

Resina Podophylli, Resin of Podophyllum^ (Podophyllin), — is precipitated from a 
concentrated tincture by acidulated water. Soluble in alkaline liquids and partly so in 
ether. Contains Podophyllotoxin and Picropodophyllin, also Podophyllinic and Proto- 
catechuic Acids. Dose, gr. }&-], in pill. Is an ingredient of Piluloe Catharticse Vegetabiles. 

Podophyllum is a tonic-astringent and resin-bearing purgative, having 
action similar to that of jalap but slower, like calomel taking 6 to 10 
hours to produce its cathartic effect. It increases the intestinal secretions 
and the flow of bile, causing copious watery stools, with considerable 
griping pain and some nausea. The powder is irritant to the respiratory 
passages and to the skin. The Resin is an excellent purgative in cases 
of habitual constipation or portal congestion and a useful cholagogue. 
Laxative effects are produced by small doses (gr. }i-%), but grain- 
doses are necessary for its full action. It should be combined with 
hyoscyamus, belladonna or cannabis indica, in order to counteract its 
griping tendency. It is an efficient derivative in cases of catarrhal or 
malarial jaundice, and is recommended in very small doses for prolapse 
of the rectum, remittent fevers of children, dyspepsia, hepatic derange- 
ment, bilious vomiting and headache, and in the vomiting and diarrhea 
of gastro-enteritis. 

POLYGONUM, Smart-weed, Water-pepper (Unofficial), — is the plant Polygonum 
Plydropiperoides, nat. ord. Polygonaceae, indigenous to the U. S., having narrow, lance- 
olated leaves and slender spikes of whitish flowers. It contains Tannin and an active 
principle, Polygonic Acid, which is green, crystallizable, insoluble in water, but soluble 
in alcohol, ether, and chloroform. 

Extractum Polygoni Fluidum, El. Ext. of P. (Unofficial). — Dose, tttx-^j. 

Extractum Polygoni, Extract of Polygonum (Unofficial). — Dose, gr. j-v. 

Smart-weed has a pungent, acrid taste, producing a sensation of heat in the stomach, 
and a peculiar tingling throughout the system. It stimulates the action of the heart, 
raises the arterial tension, increases the warmth of the surface, promotes the cutaneous, 
bronchial and renal secretions and the menstrual flow. It is an efficient diuretic, 
emmenagogue and aphrodisiac. The juice applied to the skin excites inflammation and 
vesication. 



PONGAMIA POTASSIUM. 437 

Amenorrhea from functional inactivity of the uterine system is remarkably benefited 
by this remedy in % ss doses of the fluid extract four times daily for a week before the 
expected period. It has considerable influence over functional impotence, but produces 
aching pains in the hips and loins, and a sense of weight and fullness within the pelvis. 
It has been used with benefit in diarrhea, dysentery and gravel, also locally in mercurial 
salivation and the sore mouth of nursing women. 

PONGAMIA, Kurung Oil (Unofficial), — is a yellow oil expressed from the seeds 
of Pongamia glabra, an Indian tree of the nat. ord. Leguminosae. It has been used for 
many years in India for skin affections, and in professional hands has proven an excellent 
application in pityriasis versicolor, rubbed in twice daily. It promises to be a valuable 
remedy in parasitic diseases of the skin, is not irritating and does not discolor the surface 
to which it is applied. 



POTASSIUM, Kalium, K, — is represented by a number of official 
salts, which are colorless or white, sometimes anhydrous, and generally 
readily soluble in water. The metal itself is not official. The chief 
source of its salts is the ash remaining after the combustion of plants or 
trees, which contains the Carbonate, from which most of the other salts 
are prepared. There are also two subsidiary sources, — the Nitrate 
which is found native, and the Bitartrate, which under the name of 
Crude Tartar or A rgo / is deposited during the fermentation of wine. 
It is distinguished from all other bases (except magnesium, sodium and 
ammonium) by not being precipitated by Ammonium Sulphide or Am- 
monium Carbonate. It is positively known by the violet color it imparts 
to flame, by its very sparing solubility when converted into the Bitartrate, 
and by its precipitation by Platinum Perchloride. 

Potassium Salts and their Preparations. 

Potassa, Potassium Hydrate, Caustic Potash, KOH, — a very deliquescent, white, 
hard and dry solid, of very acrid and caustic taste and strongly alkaline reaction, soluble 
in 0.5 of water and in 2 of alcohol. It is a powerful and deeply-acting escharotic, and 
should be kept in well-stoppered bottles made of hard glass. 

Potassa cum Calce, Potassa with Lime, Vietina Paste, — a grayish-white, deliques- 
cent powder, consisting of equal parts of Potassa and Lime rubbed together. A milder 
and more manageable caustic than the preceding. 

Liquor Potassae, Solution of Potassa, — contains about 5 percent, of Potassium Hy- 
drate, and is prepared by dissolving Potassium Bicarbonate 85, in 400 of Distilled Water, 
40 of Lime in the same quantity of Distilled Water, boiling, mixing the solutions gradu- 
ally, again boiling, and when cold adding Water up to 1000 parts, straining, settling, and 
decanting the clear solution. Or, by dissolving 56 of Potassa in 944 of Distilled Water. 
Is a clear, colorless, odorless liquid, of acrid and caustic taste, and strongly alkaline 
reaction. Dose, n\v-^ss, well diluted with water. 

Potassii Acetas, Potassium Acetate, KC 2 H 3 2 , — a white, satiny, crystalline mass, 
very deliquescent, odorless, of pungent, saline taste, and a neutral or faintly alkaline 
reaction, soluble in 0.4 of water and in 1. 9 of alcohol at 59 F. Dose, gr. v-^j. 

Potassii Carbonas, Potassium Carbonate, K 2 C0 3 , — a white, crystalline or granular 
powder, very deliquescent, odorless, of alkaline taste and reaction, soluble in I.I of 
water at 59 F. , insoluble in alcohol. Dose, gr. ij-xx. 

Potassii Bicarbonas, Potassium Bicarbonate, — KHC0 3 , — colorless prisms of saline 
and alkaline taste and alkaline reaction, soluble in 3.2 of water at 59 F., decomposed 
by boiling water, almost insoluble in alcohol. Dose, gr. v-xxx. 



438 POTASSIUM. 

Potassii Chloras, Potassium Chlorate, KC10 3 , — colorless prisms or plates, of pearly 
lustre, of cooling, saline taste and neutral reaction, soluble in 16.7 of water at 59 F. and 
in 1.7 of boiling water ; slightly soluble in mixtures of alcohol and water, insoluble in 
absolute alcohol. Dose, gr. v-xx. 

Potassium Chlorate should be kept in glass-stoppered bottles, and great caution should 
be observed in handling the salt, as dangerous explosions are liable to occur when it is 
mixed with organic matters (cork, tannic acid, sugar, etc.), or with sulphur, antimonium 
sulphide, phosphorus, or other easily oxidizable substances, and either heated directly or 
subjected to trituration or concussion. It should not be mixed with glycerin in the 
presence of a free acid. [For the combination of this salt with the tincture of the 
chloride of iron, see ante, page 267.] 

Gargarysma Potassii Chloratis, Potassium Chlorate Gargle (Unofficial),— has ot 
the salt 3J, in Glycerin g iv and Water to ,^vj. 

Trochisci Potassii Chloratis, Troches of Potassium Chlorate, — each troche contains 
about 4^ grains of the salt, with sugar, tragacanth, and spirit of lemon. Dose, j-iij, 
slowly dissolved in the mouth. 

Potassii Citras, Potassium Citrate, K 3 C 6 H 5 7 + H 2 0, — transparent, prismatic crys- 
tals, odorless, of cooling, saline taste, and neutral reaction, soluble in 0.6 of water, very 
soluble in boiling water, sparingly soluble in alcohol. Dose, gr. x-xxx. 

Potassii Citras Effervescens, Effervescent Potassium Citrate, — consists of Pot. 
Bicarb. 90, Citric Acid 63, Sugar 47, powdered, mixed to a paste, dried and again pow- 
dered. Dose, ^j-ij, in a glass of water, as an effervescent drink. 

Liquor Potassii Citratis, Solution of Potassium Citrate, Mistura Potassii Citratis, — 
contains about 9 per cent, of the anhydrous salt, together with small amounts of citric 
and carbonic acids. Prepared by dissolving Citric Acid 6, and Pot. Bicarb. 8, each in 
water 40, filtering the solutions separately, and adding in each case enough water to bring 
to 50 parts, then mixing the two together. Dose, ^ss-^j or more. 

Potassii Nitras, Potassium Nitrate, Saltpetre, Nitre, KN0 3 , — colorless, transparent 
prisms or a crystalline powder, of pungent, cooling and saline taste and neutral reaction ; 
soluble in 4 of water at 59 F. and in 0.4 of boiling water; almost insoluble in alcohol. 
Is a constituent of Argenti Nitras Dilutus. Dose, gr. v-xx, well diluted. 

Charta Potassii Nitratis, Potassium Nitrate Paper, — is unsized paper immersed in 
a solution of 20 parts of the salt in 80 of distilled water, and dried. Used for inhalation, 
the fumes from the burning paper being inhaled in asthma. 

Potassii Sulphas, Potassium Sulphate, K 2 S0 4 , — colorless, hard, rhombic prisms, of 
sharp, saline and bitter taste and neutral reaction, soluble in about 9.5 of water at 59 
F. , and in 4 of boiling water, insoluble in alcohol. Dose, gr. xx-^ss, well diluted. 

Potassii Bitartras, Potassium Bitartrate , Acid Tartrate of Potash, Cream of 
Tartar, KHC 4 H 4 6 , — colorless rhombic crystals, or a white, gritty powder, of acidulous 
taste and acid reaction ; soluble in about 201 of water at 59 F. , and in about 16. 7 of 
boiling water, very slightly soluble in alcohol. Is a constituent of Pulvis Jalapae Com- 
positus. Dose, gr. xx-gj (diuretic and refrigerant), ^ss-j (purgative). 

Potassii et Sodii Tartras, Potassium and Sodium Tartrate, Rochelle Salt, 
KNaC 4 H 4 6 -j- 4H 2 0, — colorless, rhombic crystals, or a white powder, of cooling and 
slightly saline and bitter taste, and neutral reaction ; soluble in 1.4 of water at 59 F. , 
very soluble in boiling water, almost insoluble in alcohol. Is a constituent of the follow- 
ing preparation. Dose, ^ss-j. 

Pulvis Effervescens Compositus, Compo7ind Effervescing Pozvder, Seidlitz Pow- 
der, — each powder has of the preceding salt 120 grains, of Sodium Bicarbonate 40 grains, 
mixed in one paper ; and of Tartaric Acid 35 grains in another paper. Dose, I or 2 pair, 
dissolved separately in water and the solutions poured together. 

Potassii Silicas, Potassium Silicate, Soluble Glass, K 2 Si0 3 (Unofficial), — is used in 
solution of a syrupy consistence for the preparation of immovable dressings for fractured 
limbs, etc. [See under Silicates.] 

The Arsenite is described under Arsenum, — the Bromide under Bromum, — the 
Bichromate under Acidum Chromicum, — the Iodide under Iodum, — the Cyanide 
and Ferrocyanide under Acidum Hydrocyanicum, — the Hypophosphite under 
Phosphorus, — the Permanganate under Manganum — the Nitrite under Amyl 
Nitris, — and Sulphurated Potassa under Sulphur. 



potassium. 439 



Physiological Action. 

Caustic Potash, like other caustic alkalies, destroys the tissues by com- 
bining with their water, dissolving the albumin and saponifying the fats, 
and converting the tissue to which it is applied into a moist, gray slough, 
with considerable surrounding inflammation. Internally it acts as a 
powerful corrosive poison, destroying the mucous membrane of the parts 
with which it comes in contact, and giving rise to intense pain, diarrhea, 
convulsions and delirium. Unless speedily rejected or neutralized it 
causes death from inflammation of the larynx, from the gastro-intestinal 
lesions, or after some time from stricture of the esophagus. Liquor 
Potassae, containing over 5 per cent, of the pure Potash, possesses in a 
degree the same caustic properties, and should never be administered 
undiluted. It neutralizes the acids in the stomach, and in the blood exists 
chiefly as the carbonate, being eliminated with the urine which it renders 
alkaline. If its use be continued too long it impairs the blood, and 
renders the subject anemic. 

Potassium Salts in large doses are cardiac poisons, muscular paralyzers, 
poisonous to protoplasm especially nerve tissue, and destructive to the 
ozonizing function of the blood. They increase the saliva, promote 
oxidation and stimulate retrograde metamorphosis, and are therefore 
waste-producers. In small doses on an empty stomach they promote the 
formation of acid gastric juice by favoring the outward osmosis of its 
constituents from the blood ; in larger doses they act chemically on the 
stomach contents, neutralizing its free acids, and disordering digestion. 
The Bicarbonate, given on an empty stomach, enters the blood unchanged, 
meets the neutral phosphate of sodium and is decomposed, acid phosphate 
of sodium being formed which renders the urine more acid. On a full 
stomach it is decomposed by the acids of the gastric juice, increases the 
alkalinity of the blood and makes the urine less acid. The salts of 
potassium with vegetable acids (Acetate, Citrate, Tartrate, etc.) enter the 
blood in their own form, are there decomposed, forming free C0 2 , and 
are converted into alkaline carbonates in which form they are eliminated, 
alkalinizing the blood and the urine. They are diuretics also, increasing 
the urinary water and solids, but decreasing the uric acid by causing in- 
creased oxidation. The mineral salts (Nitrate, Chlorate, etc.) are not 
decomposed in the blood, but are eliminated in their own form, the Ni- 
trate being a most active diuretic, the Chlorate irritating the kidneys, 
depressing the heart, causing albuminuria, and impairing the ozonizing 
function of the blood. In large doses these salts decompose the red 
blood-corpuscles and paralyze the motor ganglia of the heart. The Chlo- 
rate does not part with its oxygen in the system, as generally believed. 



44° POTASSIUM. 

The Sulphate is chiefly purgative in its action, but acts harshly, and in 
overdoses has caused death. 

The action of the remaining Potassium salts is described under the 
titles of their acid and other constituents, to which their effects are chiefly 
referable. 

Antidotes and Inco7npatibles. 

Poisoning by caustic-alkalies is treated by the dilute Vegetable Acids, as vinegar, cider, 
lemon-juice; — then demulcent drinks and oils to protect the mucous membrane, and the 
usual measures to support vitality. The Alkalies and their Carbonates are incompatible 
with the acids and also with metallic salts, and the Caustic Alkalies decompose most of 
the alkaloids. 

Therapeutics. 

Caustic Potash is used locally to destroy morbid or cicatricial tissue, to 
cauterize the wounds resulting from bites of animals or stings of insects, 
to form issues or to open deep-seated abscesses, or to destroy chancres, 
malignant pustules, nevi, warts, etc. Its action is deep and severe, and 
it is best employed in the form of Potassa cum Cake, which is a far more 
manageable preparation. 

Liquor Potassse is used internally as a free alkali to neutralize excess 
of acid in the stomach, blood and secretions, and as an antilithic in the 
uric acid diathesis, also for acne, boils, and obesity. Locally it is em- 
ployed to soften the nail in in-growing toe-nail, and diluted to relieve 
pruritus and to remove scales in various skin-diseases. In small doses 
with a vegetable bitter tonic before meals it acts well in atonic dyspepsia, 
increasing the flow of the gastric juice by direct stimulation of the gas- 
tric mucous membrane. If given after meals in acid dyspepsia large 
doses are necessary for temporary alleviation by neutralizing the food 
acids. These remarks concerning acidity and dyspepsia apply equally 
well to the Bicarbonate, which is used for the same purpose, and while 
possessing all the virtues of the potassium salts is without any corrosive 
or irritant action. It is also useful in simple gastralgia or cardialgia ; and 
in cystitis, gonorrhea, etc., where there is acid urine, it renders the urine 
less irritating and soothes the inflamed surfaces. Acute and chronic 
rheumatism and rheumatoid arthritis are much benefited by an alkaline 
treatment in patients of sufficient bodily vigor to stand its lowering 
effects. The Bicarbonate is also used to alkalinize the blood and secre- 
tions in lithemia, jaundice, many cutaneous eruptions, and in diabetes ; 
also locally as a lotion for fetid perspiration of the feet and axillae, acne, 
and acute eczema. The Carbonate is diuretic, antacid and antilithic, 
but is seldom used internally being too irritant, and the Bicarbonate hav- 
ing all its virtues without its objectionable qualities. Locally a solution 
(3J to the g) is said to be effectual as a remedy for pruritus vulvae, and one 
of half the above strength is used in freckles, sunburn and tan of the 
epidermis, in moist eczema and the itching of urticaria. 



POTASSIUM. 441 

The Acetate, Citrate, and Tartrate are good purgatives in doses of 31J 
to giv, and in smaller doses are much employed as alkalinizers of the 
blood and urine and as diuretics. Of these vegetable potassium salts the 
Acetate is the most certain diuretic, the Bitartrate is the most active 
cathartic, while the Citrate is the most reliable diaphoretic and the best 
agent to use for any length of time to alkalinize the urine, it having the 
least injurious effect on the blood and on the digestion. In lithemia these 
salts are given to promote oxidation, and by keeping the urine alkaline 
they may reduce small calculi of the uric acid variety. In acute rheuma- 
tism and fevers they act as antacids in the blood, as febrifuges by promot- 
ing diaphoresis, and as sedatives to the general nervous system. As an 
agreeable laxative no preparation surpasses the Bitartrate in 2 to 4 drachm 
doses made into a paste with orange marmalade or any other conserve. 
It is also used in infusion of juniper as a diuretic in general cardiac 
dropsy, and without the juniper in acute desquamative nephritis. In 
cases of acute dysentery with scorbutic symptoms, as seen among miners, 
sailors, etc., a full purgative dose of this salt (^ss or more) has acted most 
beneficially as a preliminary to other treatment, and in many cases has 
proven to be the only remedy required. 

Potassium Chlorate is much employed locally in solution (3SS to the j|) 
as a deodorizer and detergent wash in inflamed, ulcerated and aphthous 
conditions of the mouth. On unhealthy mucous membranes generally it 
exercises an alterative action for the better, but if too long used it will 
keep up a state of chronic irritation. In mercurial salivation it is of great 
benefit, and in dilute solution (gr. x to the S;) it is an efficient application 
to unhealthy sores and ulcers, as a wash for foul sinuses or cavities, and as 
an injection in chronic affections of the bladder. The powdered salt may 
be applied to aphthae, and dusted over epithelioma will alter the action, 
diminish the pain, check the growth and promote cicatrization. Inter- 
nally this salt has been administered in the mistaken idea that it parts 
with its oxygen in the system, but it is now acknowledged that it is excreted 
unchanged. Setting up congestion and irritation of the kidneys it is 
highly dangerous in large doses or if used for any length of time, but is 
constantly administered in diphtheria, chronic bronchitis, purpura, hem- 
aturia, ovarian tumor, pseudo-membranous laryngitis, scarlatina, typhoid 
fever and chronic cystitis. When used internally it should be given 
in small doses (gr. xx in 24 hours for an infant, gr. xxx in 24 hours for a 
child of 2 to 4 years, and 3iss for an adult in the same time), and the ac- 
tion of the heart and the kidneys should be carefully watched. It should 
never be prescribed with potassium iodide lest the poisonous Iodate be 
formed, nor with the syrup of the iodide of iron, lest it liberate the 
Iodine, and cause severe gastritis. Strong acids and acid sulphates de- 
compose it, and it forms explosive compounds with easily oxidizable sub- 



44 2 PRINOS PRUNUS VIRGINIANA. 

stances, as sugar, sulphur, tannin, sodium or potassium hypophosphites, 
catechu, glycerin, etc. For the combination of Potassium Chlorate with 
the tincture of the chloride of iron, as a gargle, see under Chlorum. 

The Nitrate has been much employed as a refrigerant diaphorecic and 
diuretic in febrile and inflammatory affections, especially in inflammation 
of the trachea and bronchi, pneumonia and rheumatism, but its action is 
uncertain, and it is now giving place in these disorders to more efficient 
agents. The fumes of burning nitre paper (Charta Potassii Nitratis) are 
a useful inhalation in some forms of spasmodic asthma. The Sulphate 
is used in teaspoonful doses in water as an hepatic stimulant and a mild 
cathartic, increasing the secretions of the intestinal glandular apparatus. 
Its action is sometimes harsh, and death has resulted from overdoses. 
Potassium and Sodium Tartrate, Rochelle Salt, is the chief aperient 
agent in Seidlitz Powders. In doses of ^ss-j it is a gentle and cooling 
laxative, and in drachm doses frequently repeated it is used to render the 
urine alkaline and as an antilithic. 

The therapeutics of the other Potassium Salts are described under the 
respective titles of their more active bases. 

PRINOS, Black Alder (Unofficial), — is the bark of Prinos verticillatus, or Winter- 
berry, a shrub of the nat. ord. Aquifoliaceae, indigenous to Canada and the U. S., having 
small, white flowers, and a globose, six-seeded, bright-red berry, which grows in clusters 
and is persistent all winter. It contains an amorphous, yellow and bitter principle, also 
tannin, sugar, starch, wax, resin, etc. The bark may be given in substance in doses of 
gss, or a decoction ( gij in Oiij boiled to a quart) in doses of j|j— ij- 

Black Alder is astringent and tonic, and has been used in intermittent fever, diarrhea, 
and chronic cutaneous diseases. In the latter class of disorders it may be applied locally. 

PRUNUM, Prune, — is the fruit of Prunus domestica, the Plum tree (nat. ord. Rosa- 
cese), indigenous to Western Asia, but cultivated in most countries of temperate climate. 
Prunes contain sugar, pectin, albumin, malic acid and salts. They are a constituent of 
Confectio Sennae. The root-bark contains a glucoside Phloridzin, which causes glyco- 
suria in animals (see below, under Prunus Virginiana). 

Prunes are laxative and nutritious, and are freely used as a food and sweetmeat, but in 
excess may give rise to flatulent colic from the indigestibility of their skins. Stewed 
prunes is an excellent dish for constipation in children, and may be made more effective 
by the addition of a little Senna. 



PRUNUS VIRGINIANA, Wild Cherry,— is the bark of Pru- 
nus serotina, the Wild Cherry, a large forest tree of the nat. ord. Rosacea^, 
growing in Canada and the U. S. On maceration in water it develops a 
distinct odor of bitter almonds. It contains tannin, gallic acid, resin, 
starch, etc., also Amygdalin and Emulsin, which by their mutual reaction 
in the presence of water, produce Hydrocyanic Acid and a Volatile Oil 
resembling that of Bitter Almond. [See ante, pages 99 and 148.] The 
root-bark contains a glucoside, Phloridzin, also found in the same part of 
the apple, pear and plum trees, which causes glycosuria in animals and 



PULSATILLA. 443 

man when given by the mouth, intravenously or hypodermically. Dose 
of the powdered bark, gss-j. 

Preparations. 
Extractum Pruni Virginianse Fluidum, Fl. Extr. of Wild Cherry. — Dose, gss-j. 
Infusum Pruni Virginianae, Infusion of Wild Cherry, — 4 per cent. Dose, ^ss-ij. 
Should be made with cold water. 

Syrupus Pruni Virginianae, Syrup of Wild Cherry, — 15 per cent. Dose, gj— iv. 

Physiological Action and Therapeutics. 

Wild Cherry is an aromatic bitter tonic, increasing appetite, aiding 
digestion, and thus promoting the constructive metamorphosis. The 
presence of a volatile oil gives it a local stimulating action on the alimen- 
tary canal in common with serpentaria, cascarilla and other members of 
the same class. Hydrocyanic Acid being yielded by it in the presence 
of cold water, imparts a sedative action to its preparations, calming irri- 
tation and diminishing nervous excitability. Very large doses reduce 
the action of the heart. The glycosuria previously mentioned as caused 
by Phloridzin, the glucoside found in the root-bark, differs from that of 
true diabetes in the fact that the sugar of the blood is not increased in 
amount ; hence it is not due to any change in the general metabolism 
of the body, but to some alteration of the renal epithelium, by which the 
blood sugar escapes into the urine instead of being retained in the body 
and used as a source of energy (Cushny). 

The preparations of Wild Cherry are used in catarrhal conditions of 
the bronchial mucous membrane, also in the hectic of phthisis and scrof- 
ula, with palpitation of the heart and a debilitated stomach; a collection 
of symptoms often observed in consumptive subjects, for whom it is a very 
useful palliative. Cough is supposed to be especially amenable to its in- 
fluence, and hence it has become a matter of daily routine to prescribe 
the syrup as an ingredient of cough-mixtures. The infusion is an excel- 
lent stomachic tonic, and may be administered with great benefit in dys- 
pepsia and in convalescence from acute disease. 

PULSATILLA, — is the herb, collected soon after flowering, of Ane- 
??wne Pulsatilla and Anemone pratensis {Pulsatilla nigricans), the Pasque- 
flower or Meadow Anemone, small herbal plants of the Ranunculacese, to 
which order Aconite also belongs. They inhabit Europe and Siberia, and 
have large, purple flowers, which are inodorous and very acrid. Pulsatilla 
contains an acrid yellow oil, which in the presence of water is gradually 
changed into Ane?nonin, C 15 H 12 6 , or Pulsatilla camphor, the active prin- 
ciple, and Anemonic Acid, C 15 H u 7 , a white, crystalline, tasteless and 
apparently inert substance, which may also be formed by the action of 



444 PULSATILLA. 

alkalies on Anemonin. The herb should be carefully preserved and not 
kept longer than one year. Dose, gr. j-v. 

Anemone patens or Pulsatilla nuttaliana , is an inhabitant of the United States, some- 
times has whitish-colored flowers, and was formerly one of the official sources of the drug. 

Preparations. 

The herb alone is official, but a tincture may be prepared according to the pharmaco- 
pceial directions for Tincturae Herbarum Recentium (i. part in 2 of alcohol), the dose 
of which is tt\,To -rr t x ' several times a day. The imported German homeopathic 
tincture contains equal parts of the expressed juice and alcohol, and is an efficient 
preparation ; but tinctures or fluid extracts made from the imported dried plant are not 
trustworthy. 

Anemoninum, Anemonin (Unofficial), — a volatile, unstable, camphoraceous princi- 
ple, crystal lizable, soluble in chloroform and in hot alcohol, almost insoluble in water 
and in ether. Dose, gr. \-\ in pill; but much larger doses may be taken without in- 
convenience, as much as two grains having produced no physiological symptoms in man 
(Schroff). 

Physiological Action. 

Pulsatilla is an active irritant when locally used ; the oil vesicates the 
skin, and the fresh juice produces tingling and burning sensations in a part 
to which it is applied. It may excite a violent dermatitis, with a vesicular 
or pustular eruption, and inflammation and even gangrene of the entire 
limb has followed the application of the bruised root to the calf of the leg 
for rheumatism. Inhalation of its dust has produced itching of the eyes, 
colic, vomiting and diarrhea; and swallowing the fresh herb may cause 
severe irritation of the gastro-intestinal mucous membrane. The fresh 
juice applied to the tongue gives rise to tingling and burning sensations 
followed by numbness, symptoms very like those caused by Aconite. 
Internally administered Pulsatilla is diuretic, diaphoretic and emmena- 
gogue, and also acts as a cardiac and vascular sedative, lowering the action 
of the heart, the arterial tension and the body-temperature. In overdoses 
it strongly affects the mucous membranes, and produces nausea and vom- 
iting, slimy diarrhea, bloody urine, profuse and offensive sweats, coryza 
and cough ; also vesicular and pustular eruptions on the skin, peculiar 
pains in the eyes and dimness of vision. Its primary action is that of a 
spinal irritant, secondarily it produces exhaustion and paralysis of both 
motion and sensation. Stupor, coma and convulsions may be caused by 
a toxic dose, also paralysis of the cord and medulla. Most of these 
effects have been observed on rabbits, and the pharmacology of the drug 
is not yet accurately worked out. The homeopathicwriters credit it with 
specific influence on the synovial membranes, the veins, the ears, and the 
generative apparatus of both sexes. 

Anemonin was discovered in 1771 by Storck, and its effects have been 
studied to some extent on animals. When applied to the conjunctiva 
it caused slight inflammation thereof, and placed on the human tongue it 



PULSATILLA. 445 

left a slight burning sensation. When melted, its vapor produced intense 
inflammation of the eyes and pricking sensations in the tongue followed 
by numbness and white patches. The symptoms following its internal ad- 
ministration in fatal doses were a slow and feeble pulse, slow respiration, 
lowered body-temperature, frequent diarrhea, paralysis of first the hind- 
and then the fore-legs, dyspnea, mydriasis followed by myosis, stupor and 
death without convulsions. The absence of the latter is thought to be 
due to a paralyzing action of this principle on the cerebral motor cen- 
tres, as in poisoning by extract of Pulsatilla convulsions are always pres- 
ent. The autopsies showed congestion and edema of the lungs, also 
marked hyperemia of the cerebral and spinal membranes, especially in 
the vicinity of the medulla. The heart walls were relaxed, and its cavi- 
ties and the great vessels filled with dark and clotted blood, while the 
blood elsewhere was fluid. The liver, spleen, kidneys and abdominal 
viscera were found to be healthy. 

Antagonists and Inco??ipatibles. 

Alcohol, Opium and Digitalis are its physiological antagonists. Tannic Acid, the 
caustic alkalies and the metallic salts are chemically incompatible with preparations con- 
taining Pulsatilla or Anemonin. 

Therapeutics. 
The ancient writers credited different species of Anemone with many 
medicinal virtues, but the modern use of this drug dates from the time of 
Baron Storck and his contemporaries (i 770-1800) who highly praised the 
Pulsatilla nigricans as a remedy for corneal opacities, cataract, paralysis, 
rheumatism, amenorrhea, melancholia, secondary syphilis, old ulcers and 
scaly skin diseases. Later therapeutists differ widely as to the medicinal 
value of this drug, some giving it extravagant praise and others finding 
no efficacy in it. It is quite possible that no effects whatever would be 
obtained if an old preparation or even a fresh one from the dried herb 
were employed. It has proved very efficient in acute catarrhal affections 
of the mucous membranes, especially rhinitis and conjunctivitis, in the 
early stage of the purulent ophthalmia of children and in gonorrheal 
ophthalmia, also in subacute and chronic bronchitis of delicate persons 
accompanied with profuse mucous expectoration, and in chronic catarrh 
of the bladder. It is used with benefit in chronic nasal catarrh with a 
thick though bland discharge, also in acute and subacute inflammation of 
the middle ear and the lining of the external auditory canal so often seen 
in children, where the membrane is red and swollen, with severe pain, 
and later on a thin, acrid discharge, which is often bloody and soon be- 
comes puriform. In these affections medium doses (ti^v) of the tincture 
may be given internally every four hours to adults, and a lotion composed 
°f 3.HJ m .? v j of warm water may be applied to accessible parts. A similar 



446 PULSATILLA. 

use of this agent has been of decided benefit in many cutaneous affections, 
especially eczematous eruptions, syphilides, and indolent ulcers. 

In acute and chronic dyspepsia, characterized by gastric catarrh or 
subacute gastritis with a white-coated tongue, no taste or a greasy sensa- 
tion in the mouth, nausea, flatulence, heart-burn, sick headache, anorexia, 
depression, diarrhea, etc., Pulsatilla is a very efficient remedy, given in 
medium doses, n^vof the tincture every four hours. It does good service 
in intestinal catarrhs, shown by passive, mucous diarrhea with little pain, 
which are frequently seen in the febrile affections of childhood, especially 
measles, mumps, chicken-pox and remittent fever. 

Pulsatilla is generally credited with specific therapeutical action on the 
generative organs of both sexes. Epididymitis and orchitis have been 
often controlled and entirely dissipated by its administration in very 
small doses, a few drops of the tincture in a glass of water, of which "gj 
is given every two hours (Piffard, Sturgis). In more than 24 cases of 
acute uncomplicated epididymitis, doses of two drops of the tincture 
every two hours gave immediate relief,' the patients wearing a suspensory 
bandage but not being confined to bed (Borcherin). Doses of five drops 
aggravated this disorder, while those of ^j-q every three hours proved 
curative (Piffard). In functional amenorrhea, in scanty or delayed 
menstruation, and in suppression thereof from fright or cold, in ovaritis 
and in simple leucorrhea with back-pains and nervous depression, it has 
been found an excellent remedy. Dysmenorrhea has been removed 
in several cases by two-drop doses of the tincture given thrice daily for 
several days before the menstrual epoch (Piffard). Extravagant opinions 
as to its virtues in the puerperal state and during parturition are promul- 
gated by the homeopathists, and their authorities on materia medica 
credit this drug with power to rectify false presentations during labor 
by causing version of the child. 

Besides the catarrhal affections of the ocular mucous membrane already 
mentioned, Pulsatilla has remedial power in certain affections of the eye- 
lids. Its internal administration is said to effectually blight a stye if 
given early, but will not prevent its recurrence. It is an efficient remedy 
in recent blepharophthalmia, with profuse lachrymation and meibomian 
secretion ; and it is said to stop twitching of the lids accompanied by 
photophobia. It has been used with decided benefit in the earache of 
children and in recent catarrhal deafness, also in acute cerebral and spinal 
meningitis, eclampsia from various causes, asthma, subacute rheumatism 
of the small joints, acute rheumatic gout, left-sided clavus, hemicrania 
and infra-mammary pain. Denian used this drug with benefit in several 
nervous affections, and concludes that it is a direct sedative of nervous 
irritability, but only indirectly a sedative to the circulation. Tucker 
found it especially serviceable in the nervous headache produced by over- 



PYRETHRUM — QUASSIA. 447 

taxing the mind. An extract of the root has proved to be an efficient 
teniafuge. Coughs which are loose by day, but dry and tickling in char- 
acter on lying down at night, are greatly benefited by small doses of the 
tincture frequently repeated; and Anemonin, in doses of gr. ss-j, has 
been extremely useful in whooping-cough and coughs of irritative char- 
acter. 

PYRETHRUM, Pellitory, — is the root of Anacydus Pyrethrum, a plant of the 
nat. ord. Compositae, native of Northern Africa, but cultivated in Europe. It contains an 
alkaloid Pyrethrine, also inulin, tannin, mucilage, etc., with a brown Resin and two 
fixed oils. Dose, as a masticatory, ^ss-j. 

Pyrethrum Roseum, Persian Pellitory (Unofficial), — is indigenous to Western Asia, 
and resembles Chamomile in appearance. The flower-heads are used in powder to kill 
insects, 4 grains killing a fly in a vial in 2 or 3 minutes. 

Tinctura Pyrethri, Tincture of Pyrethrum, — 20 per cent. Not used internally. 

Pellitory is an irritant sialogogue. When chewed it causes a pricking sensation in the 
tongue and fauces, with heat, acridity, pungency and a copious flow of saliva and buccal 
mucus. Large doses may cause bloody diarrhea, tetanoid spasms, accelerated pulse, and 
profound stupor. Applied to the skin it acts as a rubefacient, the powder inhaled as a 
sternutatory. It stimulates the local nerves and vessels of the mouth and salivary glands 
by direct irritant action, but soon depresses the nerves and blunts their sensibility. 

Pellitory is chewed as a masticatory and sialogogue in paralysis of the tongue, rheu- 
matic and neuralgic affections of the head and face, and pain from carious teeth. Its 
powder has been recommended as a sternutatory in chronic catarrh of the frontal sinuses. 
As a gargle or lotion (^iij to Oj) it is very useful for relaxed uvula and as a mouth-wash. 
When used for toothache a few drops of the tincture should be inserted into the cavity on 
cotton or wool. Used as a sialogogue it is an efficient agent to secure the rapid elimina- 
tion of Iodine from the system in chronic poisoning thereby. 

QUASSIA, — is the wood of Picrcena excelsa, a tree of the nat. ord. 
Simarubeae, indigenous to Jamaica and other West Indian islands. 
Surinam Quassia, used in Europe, is the wood of Quassia amara. Both 
varieties, as met with in the shops, occur as chips or raspings, of a yel- 
lowish-white color, inodorous but intensely bitter. The wood is turned 
into cups, which are sold under the name of quassia- or bitter-cups. It 
contains a bitter principle, Quassin, C 31 H 42 9 , which is crystalline, solu- 
ble in hot alcohol and in chloroform, slowly in cold water, faster in alka- 
line or acidulated water. Dose of the powdered wood, gr. xx-xxx. 

Preparations. 

Extractum Quassiae, Extract of Quassia, — aqueous. Dose, gr. j-iij. 

Extractum Quassiae Fluidum, Fluid Extract of Quassia. — Dose, 3 ss-j. 

Tinctura Quassiae, Tincture of Quassia, — strength 10 per cent. Dose, Tr\,v-3J. 

Infusum Quassiae, Infusion of Quassia (Unofficial), — made with cold water £x, 
Quassia chips £j, macerated for ]/ 2 hour and strained. Or water poured into a quassia- 
cup and left standing will give a good infusion. Dose, J j-iij. 

Physiological Action and Therapeutics. 
Quassia is a simple bitter, having no flavor, but is intensely bitter and 
less agreeeble than either Gentian or Chiretta. It is fatal to flies and fish, 



44-8 QUERCUS ALBA QUILLAJA. 

and makes an excellent anthelmintic enema against the thread-worm. A 
concentrated preparation is poisonous to rabbits and dogs, and has pro- 
duced very alarming narcotic symptoms in a four-years-old child. Its 
action is that of a bitter stomachic tonic, as described under Calumba. 

The preparations of Quassia contain no tannin and hence may be pre- 
scribed with salts of Iron. It is chiefly employed in atonic dyspepsia with 
pain after eating, and vomiting or regurgitation of food, also in atonic 
diarrhea depending on indigestion or an irritable condition of the intes- 
tinal mucous membrane. It is useful in convalescence to promote the 
appetite and digestion, and with sodium bicarbonate in gastric vertigo. 
It has been used as a feeble antiperiodic, and in hysteria its repulsive- 
ness is an aid to its medicinal action. The strong infusion used as an 
enema is an effective remedy against the thread-worm (oxyuris vermicu- 
laris). 

QUERCUS ALBA, White Oak,— is the bark of Quercus alba, 
the White-oak tree (nat. ord. Cupuliferae). It contains a variety of 
tannin named Quercitannic Acid, C 28 H 24 12 , also Pectin and a bitter 
principle named Quercin, but no gallic acid. There are no official prep- 
arations, but a decoction (gj ad Oj) may be used in doses of ^ss-j. 

Quercus Tinctoria, Black Oak Bark, — formerly official, contains a yellow coloring 
principle named Quercitrin, also Quercitannic Acid, etc. 

Quercus Lusitanica is the source of Galls (see under Galla). 

Oak-bark is astringent and tonic, but is seldom used internally. Its 
actions and uses are those of Tannic Acid. The decoction is much used 
in country practice as a cheap astringent application for injection in 
leucorrhea, prolapsus ani, hemorrhoids, etc., and as a gargle in faucial 
inflammation and prolapsed uvula. It has also been used as an injection 
into dropsical cysts, and as a lotion for flabby ulcers and suppurating 
wounds. The powdered bark as a poultice has proved an excellent appli- 
cation in gangrene, and in finely pulverized state it is a useful ingredient 
of tooth-powders.. A concentrated fluid extract is used in the Heaton- 
Warren operation for the radical cure of hernia, by injection into the 
tissues around the margin of the ring, with the object of exciting inflam- 
mation and occlusion of the opening. 

QUILLAJA, Soap Bark, — is the inner bark of Quillaja Saponaria, a tree of the 
nat. ord. Rosacea?, indigenous to Peru and Chili. It contains calcium sulphate crystals, 
also starch and the glucoside Saponin, C 32 H 54 18 , a white, amorphous, sternutatory 
powder, soluble in water and in dilute alcohol. The Infusion of Quillaja foams like 
soap-water. The only official preparation is the tincture. 

Tinctura Quillaja, Tincture of Quillaja, — 20 per cent. Dose, TTbv-xxx. 

Quillaja in powder is sternutatory and causes the water in which it is macerated to 
froth, making emulsions of oils, and being used instead of soap for washing purposes in 
various affections of the skin, also to stimulate the growth of the hair in alopecia. Its 



RESINA RESORCINUM. 449 

properties are due to the glucoside Saponin, which is found also in Senega and in a 
number of other plants, and is a violent irritant of the respiratory passages, a local anes- 
thetic, an antipyretic, a powerful paralyzant of the heart and respiration, and a poison 
to the voluntary muscles. It has not been made use of in practical medicine. 

A decoction of the bark (5 to 200) has been employed in doses of 5j j-ij according to 
age, as a substitute for Senega in the treatment of diseases of the respiratory organs 
where a pleasant expectorant is indicated. Its expectorant properties are well estab- 
lished, and children take it readily. It does not provoke diarrhea or vomiting, and has 
a sweetish, agreeable taste. 



RESINA, Resin, Colophony, C^H 62 4 , — is the residue left after 
distilling off the volatile oil from Turpentine. It is a transparent, amber- 
colored substance, hard and brittle, with a glossy and shallow conchoidal 
fracture and a faintly terebinthinate odor and taste ; soluble in alcohol, 
ether, fixed or volatile oils, and in its own weight of oil of turpentine. 
Chemically it is considered as the Anhydride of Abietic Acid, C 44 H 64 5 , 
into which acid it is converted by agitation with warm diluted alcohol. 
Silvic, Pinic, and Palmaric Acids are decomposition products, not con- 
stituents of resin as was formerly taught. 

For the definition of a Resin see ante page 25, also the title Resins in Part II. 
Other official resins are Resina Copaibae, Resina Jalapae, Resina Podophylli and Resina 
Scammonii, which are severally described under the titles of the plants forming their 
respective sources. 

Preparations. 

Ceratum Resinae, Resin Cerate, Basilicon Ointment, — consists of Resin 35, Yellow 
Wax 15, and Lard 50 parts. It forms 65 per cent, of Turpentine Liniment. 

Emplastrum Resinae, Resin Plaster, Adhesive Plaster, consists of Resin 14, Lead 
Plaster 80, Yellow Wax 6 parts. Is the common adhesive plaster of surgery, and an 
ingredient of the official Arnica, Belladonna and Capsicum Plasters. 

Resin itself is an ingredient of Cantharides Cerate. 

Resin gives consistence and adhesiveness to plasters and cerates, and 
generally acts as a mild local stimulant, but the writer has seen persons 
with so susceptible a skin that the ordinary adhesive plaster would pro- 
duce on them a high degree of cutaneous irritation. It is never employed 
internally, but in chronic bronchial catarrh the fumes from boiling resin 
are inhaled with considerable advantage. Resin Cerate is one of the 
most commonly used applications to promote the healing of indolent 
ulcers, also to blistered surfaces, burns, scalds and chilblains. 



RESORCINUM, Resorcin, Metadioxybenzol, C 6 H 4 (OH) 2 — is a 
diatomic phenol, isomeric with Pyrocatechin and Hydroquinone, obtained 
by fusing certain resins with a caustic alkali, but best prepared by 
fusing potassium benzol-disulphonate with caustic potassa, the salt 
being decomposed into potassium sulphite and resorcin. It crystallizes in 
colorless, rhombic prisms or plates of neutral reaction, odorless, and of 
sweetish, acrid taste, very soluble in water, also in alcohol, ether, etc. 
29 



450 RESORCINUM. 

Dose, gr. v-xv ; — as an antipyretic 3ss-j not repeated for several hours, 
or gr. v every 2 hours. 

Physiological Action. 
Resorcin is closely allied to Carbolic Acid, but possesses an advantage 
over the latter in that it is odorless, more soluble and almost non-irritant. 
It is equally powerful as an antiseptic and antiferment, arresting decom- 
position and destroying low organisms. Injected beneath the integument 
in solution it produces very little irritation and never causes inflammation 
or abscess. Vesication results from its application to the mucous mem- 
brane. Internally a 30- to 60-grain dose causes a sense of heat, discom- 
fort and oppression, followed by profuse perspiration and languor ; if 
fever be present the temperature of the body is lowered several degrees 
but rises again after a rigor in from 2 to 4 hours. Larger doses (150 
grains) have produced deafness, dizziness, salivation, confused vision, 
vertigo, unconsciousness, general clonic convulsions and tetanic rigidity 
of the muscles of the neck, with no decline of temperature in feverless 
subjects. Toxic doses (gr. xv to each 35 ozs. of weight) cause in animals 
trembling succeeded by epileptiform convulsions, which increase in 
severity and then decline ; the respiration is quickened and enfeebled, 
the heart's action becomes rapid, weak, and irregular, and death results 
from paralysis of respiration, the drug paralyzing the motor tracts in the 
spinal cord but not affecting the general sensibility. It is eliminated 
chiefly by the urine which it colors a bluish-violet hue, and with great 
rapidity, about one hour serving for its excretion. The best test of its 
presence is the solution of the perchloride of iron, which produces with 
resorcin a dark-violet, almost black color. 

Antagonists. 

Atropine and other cardiac and respiratory stimulants, cerebral excitants, and agents 
which raise the arterial tension, are physiologically antagonistic. 

Therapeutics. 
Resorcin is employed as an antipyretic and antiseptic, being preferred 
to carbolic acid for internal and subcutaneous use. A 3 per cent, solu- 
tion gives good results in stomach complaints, as gastralgia, gastric 
catarrh, gastritis, gastric ulcer, gastric cancer and fermentative indiges- 
tion. In ulcer of the stomach its analgesic property is so marked that 
the stomach is enabled to tolerate food. It has given very great satisfac- 
tion in the treatment of diarrhea of children ; and it is highly recom- 
mended by some observers in intermittent fevers and malarial diseases 
generally, while others have been much disappointed with its action in 
these affections. As an antipyretic it has been used in erysipelas, puer- 



RHAMNUS PURSHIANA RHEUM. 45 I 

peral fever, septicemia, and diphtheria, and in the latter disease it has 
been locally employed in crystals with decided benefit. As a local ap- 
plication to tuberculous and other ulcerations of the larynx, in diphtheria, 
tonsillitis, pharyngitis, chronic rhinitis, etc., strong even supersaturated 
solutions are employed with increasing satisfaction, being highly efficient 
and quite painless. Applied to the peri-laryngeal mucous membrane, 
it has proved very useful in the treatment and prophylaxis of pertussis. A 
2 per cent, solution has given satisfaction as a local antiseptic application 
to wounds, parasitic skin diseases, cystitis, gonorrhea, anthrax, and 
syphilitic sores of unhealthy character. As a spray a similar solution is well 
applied to catarrhal or ulcerative affections of the respiratory passages. 
As a caustic it may be applied in undiluted form to chancres, papillomata 
and carbuncles. A saturated ethereal solution is a good application 
where the caustic action of the drug is required. 

A paste consisting of equal parts of Resorcin and Zinc Oxide has been 
applied to the face to promote peeling of the skin in the treatment of acne 
rosacea. In three or four days the skin becomes like parchment, when 
the application must be stopped, in order to avoid the cracking of the 
skin which begins at that stage. A dressing of gelatin, glycerin, zinc 
oxide and hot water is then applied, covered with cotton wool. In a few 
more days the dressing comes off, bringing the epidermis with it. Some 
few dangerous and unfavorable results have followed this method, but a 
number of very satisfactory cases are reported. Freckles and other super- 
ficial spots on the skin may be removed by the same treatment. 

RHAMNUS PURSHIANA, Cascara Sagrada, Chittem Bark, {Sacred Bark),— 
is the bark of Rhamnus Purshiana, the California Buckthorn, a small tree of the nat. ord. 
Rhamneae, growing on the Pacific coast of the United States. It contains a Volatile Oil, 
a neutral crystalline substance, several Resins, with tannic, malic and oxalic acids. It 
has been found very serviceable in the treatment of chronic gout and chronic constipation, 
given in gradually diminished doses. It produces large, soft and painless evacuations, 
and the bowels are said to act naturally and regularly after its disuse. 

Another species of the same order, Rkamnus Frangula, is official under the title 
Frangula, which see. 

Extractum Rhamni Purshianae Fluidum, Fluid Extract of Cascara Sagrada, — 
is made with diluted alcohol. Dose, g ss-jss, two or three times a day. 

Cascara Cordial is a trade preparation, intended as a remedy for constipation, dys- 
pepsia and hemorrhoids, and as a pleasant excipient for nauseous and bitter drugs. A 
similar preparation may be made by combining the fluid extract with the official Elixir 
Aromaticum in the proportion of 5 j to ^ij, of which the dose is 3J or more. 

RHEUM, Rhubarb, — is the root of Rheum officinale, a perennial 
plant of the nat. ord. Polygonacese, a native of Thibet. There are many 
other undetermined species of Rheum, several of which are cultivated in 
Europe and America, their leaf-stalks being used as a fruit. The com- 
monly accepted medicinal Rhubarb is the Chinese variety, and is imported 
from Shanghai and Canton. It imparts its virtues to water and alcohol, 



45 2 RHEUM. 

and contains several substances of greater or less activity, the least im- 
portant being Phceoretin, the rhubarb-resin, Erythroretin, and Chrysophan, 
the latter of which is split by acids into sugar and chrysophanic acid. 
(See Chrysarobinum.) It also contains Rheo-tannic Acid, C 52 H 52 28 , 
Rheumic Acid, C^t^Ojg, and probably a principle which is identical with 
Cathartic Acid (see Senna), on which its purgative activity may depend. 
Dose of Rhubarb as a stomachic, gr. j-vj as a purgative, gr. x-xxx. 

Preparations. 

Extractum Rhei, Extract of Rhubarb. — Dose, gr. j-x. 

Extractum Rhei Fluidum, Fluid Extract of Rhubarb. — Dose, TT^x-gj. 

Pilulae Rhei, Pills of Rhubarb, — are composed of Rhubarb 60, Soap 6, Water to 
IOO; each pill containing about 3 grains of powdered Rhubarb. Dose, j-v pills. 

Pilulae Rhei Compositae, Compound Pills of Rhubarb, — each pill contains of Rhu- 
barb about 2 grains, Aloes 1%, Myrrh I, Oil of Peppermint r ^ grain. Dose, ij-v pills. 

Tinctura Rhei, Tincture of Rhubarb, — has of Rhubarb 10, Cardamom 2, Glycerin 
10, Alcohol and Water to 100. Dose, gj-iv. 

Tinctura Rhei Aromatica, Aromatic Tincture of Rhubarb, — has of Rhubarb 20, 
Cinnamon 4, Cloves 4, Nutmeg 2, Glycerin 10, Alcohol, Water and Diluted Alcohol to 
100. Dose, 3J-iv. 

Tinctura Rhei Dulcis, Sweet Tincture of Rhttbarb, — has of Rhubarb 10, Glycyr- 
rhiza4, Anise 4, Cardamom 1, Glycerin 10, Alcohol, Water and Diluted Alcohol to 100. 
Dose, ^ss-ij. 

Syrupus Rhei, Syrup of Rhubarb, — has of the Fluid Extract 10, Spirit of Cinnamon 
0.4, Potassium Carbonate I, Glycerin 5, W 7 ater 5, Syrup to 100. Dose, for an infant, gj ; 
for older children, gij-iv. 

Syrupus Rhei Aromaticus, Aromatic Syrup of Rhubarb, — has of the Aromatic 
Tincture 15, Syrup 85. Dose, as the Syrup. 

Pulvis Rhei Compositus, Compound Powder of Rhubarb, — has of Rhubarb 25, 
Magnesia 65, Ginger 10. Dose, a teaspoonful. 

Mistura Rhei et Sodae, Mixture of Rhubarb and Soda, — has of Sodium Bicarb. 
2,%, Fluid Extract of Rhubarb iyi, Fluid Extract of Ipecac y£, Glycerin 35, Spirit of 
Peppermint 3^, Water to 100. Dose, gij-^ij. 

Physiological Action and Therapeutics. 
Rhubarb is classed among the tonic-astringent and resin-bearing pur- 
gatives, agents which increase the circulation of the glandular appendages 
of the intestinal canal and stimulate the muscular layer of the bowel. In 
small doses (gr. j-v) its action is that of a gastric tonic and an intestinal 
astringent, the influence of the bitter principle and the rheo-tannic acid 
probably predominating. In larger doses (gr. xxx-lx) its cathartic action 
prevails, producing in 6 to 8 hours copious yellow, pultaceous stools, with 
some griping and considerable hepatic stimulation. After the cathartic 
principle is expelled, the astringent quality of its tannin asserts itself and 
constipation is likely to result. The yellow color of the stools is partly 
due to the rhubarb pigment and partly to excess of bile, the drug having 
marked cholagogue properties, probably due to its resin, Phaeoretin. Its 
pigment stains the milk, urine and sweat, the milk acquiring a bitter 
taste and purgative properties. The cathartic action of Rhubarb may 



RHINACANTHUS RHUS. 453 

be obtained from its application locally to ulcers, by being rubbed into 
the moist skin, or applied to the abdomen as a poultice. 

Rhubarb is highly esteemed as* a cathartic for children, from the mild- 
ness of its action ; though occasionally producing quite severe griping, 
it never inflames the gastro-enteric mucous membrane. The tonic and 
astringent action following its catharsis makes it a valuable agent in diar- 
rheas due to the presence of irritating matter in the bowel, and to correct 
atonic indigestion accompanied by diarrhea. For hemorrhoids with 
constipation its gentle action makes it peculiarly suitable, its astringent 
after-effect being entirely overcome by 2- to 4-drachm doses of olive oil 
nightly. It may be combined with a mercurial or with sodium bicar- 
bonate, the latter being supposed to overcome its astringent action and 
to disguise its taste in some degree. In small doses the tincture is a very 
efficient stomachic tonic, improving appetite, increasing the flow of the 
gastric juice, assisting digestion, and promoting the action of the liver 
without producing any cathartic results. The preparations most in use 
for children are the Aromatic Syrup and the Mistura Rhei et Sodae. 

RHINACANTHUS (Unofficial), — the leaves and root of Rhinacaiithus communis^ 
a shrub of the nat. ord. Acanthaceae, indigenous to India and China. The root contains 
a quinone-like body named Rhinacanthin, C u H 18 4 , which forms with alkalies intensely 
red compounds which are decomposed by benzin. It is known in China as Hong-Pang- 
Chong, and is employed as a local remedy for ringworm and parasitic skin diseases, the 
leaves being bruised and mixed with lime-juice. Used internally a tincture of the root 
has some reputation as a feeble tonic and antiperiodic. The same preparation is applied 
locally in chronic eczema, tinea and psoriasis. 

RHUS AROMATICA, Sweet Sumach (Unofficial),— is an indigenous shrub of 
the nat. ord. Terebinthaceae, growing about 5 feet high, and having yellow flowers in 
spikes. The root-bark contains a volatile oil, several resins, fat, tannin, etc. A fluid 
extract is prepared from the bark of the root according to the general pharmacopceial rule, 
and may be given in doses of TTLx-xxx, every 2 or 3 hours. 

Rhus Aromatica has astringent properties, and seems to possess a selective action upon 
the urinary tract. Its action is not yet clearly made out. Therapeutically it has been 
used with advantage in cystitis, night-sweats, hematuria, menorrhagia, diabetes insip- 
idus, diarrhea and dysentery. As a remedy for incontinence of urine in children it has 
attracted considerable attention, having been extremely efficient in doses of TT\,xv of a 
good fluid extract four times daily, administered in glycerin and water, or any other suit- 
able excipient. It is reported to be equally effective in hysterical enuresis of adults, but 
larger doses (rr^xx-xxx several times a day) are required. Diabetes insipidus is remark- 
ably benefited by its continued use, and even in diabetes mellitus its employment has 
occasionally seemed to have been followed by curative results. 

RHUS GLABRA, Smooth Sumach, — is the fruit of Rhus glabra, an indigenous 
shrub of the nat. ord. Anacardiecz, growing in rocky and barren soil to a height of 8 to 
12 feet. The leaves and bark have an astringent and bitter taste, and are also used 
medicinally. It contains tannin, coloring matter, also potassium and calcium malates. 

Extractum Rhois Glabrae Fluidum, Fluid Extract of Rhus Glabra. — Dose, ^j-ij. 

Sumach-berries form a useful acidulous and astringent drink or gargle in catarrhal 
pharyngitis, stomatitis, aphthae, etc. An infusion (^j to the pint) or the official fluid ex- 
tract may be used as a wash and dressing for ulcers and wounds. Internally they are 
useful remedies for mild catarrhal affections of the stomach and bowels. 



454 RHUS TOXICODENDRON. 

RHUS TOXICODENDRON, Poison Ivy,-^-is the fresh leaves 
of Rhus radicans, a plant of the nat. ord. Anacardieaz, indigenous to 
Canada and the greater part of the eastern United States. This climbing 
plant is not by itself a distinct species, but a variety of the erect shrub, 
Rhus Toxicodendron, the Poison Oak, formerly official as a source of the 
drug ; both of which when wounded exuding a poisonous, acrid, milky 
juice which turns dark on exposure. The poisonous principle of the plant 
is Toxicodendric Acid, which is volatile, and also exists in Rhus venenata 
or Swamp Sumach, Rhus pumila, and Rhus diversiloba, the first of which 
is probably the most poisonous of the four. The dose of the leaves is 
generally placed at gr. j-iv, but if old and dry they will generally prove 
to be inert. There are no official preparations. 

Tinctura Rhoi's Toxicodendri, Tincture of Rhus Toxicodendroti (Unofficial), — may 
be prepared according to the formula of the Pharmacopoeia for Tincturse Herbarum 
Recentium (Tinctures of Fresh Herbs), one part of the fresh leaves to two of Alcohol. 
Dose, TTt T V-Tlflij. 

Extractum Rhois Toxicodendri, Extract of Rhus Toxicodendron (Unofficial), — 
has been used in France in large doses. It is probably inert. 

Physiological Action. 
The effects of Rhus Toxicodendron upon the skin are familiar to all 
who have suffered from contact with poison-oak or ivy. Some persons 
are so susceptible to this poison that the exhalations from the plant will 
produce on them its characteristic action. Others are apparently insus- 
ceptible to its influence, and can with impunity rub the juice into their 
skin, or even chew its leaves. The action of the plant when locally 
applied is that of a cutaneous irritant, causing redness and swelling of 
the affected parts, with a vesicular eruption and intolerable itching, 
which may spread rapidly over the surface of the body and extend to the 
mucous membranes, producing conjunctivitis, redness and tumefaction of 
the mouth and throat, thirst, cough, nausea and vomiting, vertigo and 
stupefaction. Colicky pains are experienced in the abdomen, are worse 
at night and are aggravated by food and drink. Diarrhea may occur, 
with tenesmus and bloody stools, also diuresis, bloody urine, or even 
complete retention. Fever with delirium is frequently present, and may 
be typhoid in character, or intermittent with profuse perspiration. 
Pains of rheumatoid type are experienced throughout the body, but par- 
ticularly in the joints and lumbar region, apparently intensified by rest 
and heat. The fibrous structures are evidently the seat of its selective 
action, and a sensation of numbness in the lower extremities is frequently 
experienced. Similar phenomena attend its internal administration, but 
fatal results have not followed in any case of poisoning recorded. The 
effects of the poison usually last from ten to fifteen days, and are then 
followed by desquamation of the epidermis. 



RICINI OLEUM. 455 



Antidotes and Antagonists. 

Cocaine Hydrochlorate, in 4 to 8 per cent, solution, is the best lotion to relieve the 
intolerable itching and burning. Grindelia Robusta makes one of the best local appli- 
cations, and a solution of Mercuric Chloride is also a very serviceable lotion ; also Lime- 
water with Linseed-oil, solution of Plumbum Acetate, solution of Chlorinated Soda, and 
Alum-curd are all useful. Rest, low diet and laxatives are appropriate, and Opium or 
strong black coffee to relieve the irritability of the nervous system. 



Therapeutics. 
Rhus Toxicodendron was used medicinally by Dufresnoy in France and 
by Alderson in England about the close of the eighteenth century. The 
attention of the former was attracted to it by the accidental poisoning of 
a student who was afflicted with chronic eczema, which disappeared on 
the subsidence of the Rhus symptoms. It is a favorite remedy with the 
so-called homeopathists, who ascribe to it extraordinary virtues in acute 
cutaneous affections of vesicular type, subacute and chronic rheumatism, 
vesicular erysipelas and typhoid fever. Among regular authorities it 
meets with very little favor as a remedial agent, but Phillips recommends 
it strongly in rheumatic affections of the fibrous tissues, erythema and 
erysipelas, eczema, herpes zoster and pemphigus. Piffard corroborates 
these opinions of its therapeutical value, and states that when rheumatic 
pain is worse at night prompt relief may be expected from Rhus. It was 
used by Dufresnoy in paralyses with some success, and Eberle reports a 
case of paralysis in which it proved curative. It is admitted by many ob- 
servers to be a useful remedy in paralytic affections of the lower extremities 
depending on a rheumatic diathesis, or resulting from exposure to cold and 
wet. As an external application it is efficacious in sprains and other affec- 
tions of ligaments and tendons, also to extensive but superficial burns, 
stings of insects and chilblains. For these affections a lotion of about 3SS 
of the tincture to a pint of water is usually employed. 

RICINI OLEUM, Castor Oil, — is a fixed oil expressed from the 
seeds of Ricinus communis, a tree of the nat. ord. Euphorbiaceas, indigen- 
ous to India, but extensively cultivated in the United States. The oil is 
an almost colorless, transparent, viscid liquid, of faint odor, bland or 
slightly acrid taste, neutral reaction, soluble in an equal weight of 
alcohol. It consists mainly of Ricinolein the glyceride of ricinoleicacid, 
also palmitin, stearin and myristin in small quantities, and an acrid prin- 
ciple. The seeds contain a highly toxic ferment or phytalbumose named 
Ricin, and an alkaloid, Ricinine, which seems to be inert. 

Castor Oil is an ingredient of Collodium Flexile in the proportion of 3 per cent., also 
of Linimentum Sinapis Compositum, 15 per cent., and of Pilulse Antimonii Compositse". 



456 RICINI OLEUM. 



Physiological Action and Therapeutics. 

Used externally pure Castor Oil is perfectly bland. Internally admin- 
istered it is non-irritant until it reaches the duodenum, where it is decom- 
posed by the pancreatic juice setting free the Ricinoleic Acid, which 
produces purgation by a mildly irritant action on the bowel, stimulating 
the intestinal glands and muscular coat, but not the liver. It is a simple 
purgative, acting in four to six hours, producing one or more liquid stools 
without pain or tenesmus, and followed by a sedative effect on the intes- 
tines. The leaves are believed to possess galactagogue properties when 
locally applied as a poultice to the breasts. Ricinoleic Acid enters the 
blood and the tissues, and is excreted with the various secretions of the 
body, imparting its purgative qualities to the milk of the nursing mother. 
Ricin, given either hypodermically or by the mouth, produces violent 
gastro-enteritis, nephritis and cystitis, also inflammation of the mucous 
lining of the biliary duct. To it is ascribed the jaundice and anuria ob- 
served in some cases of poisoning by castor-oil seeds. 

Castor Oil is one of the best of the simple purgatives, and is used 
when a free evacuation of the bowels is alone indicated, or when only a 
laxative action is desired, as in the constipation of typhoid fever, in 
pregnancy and post-partum conditions, diarrhea from the presence of 
irritating matter in the bowels, and after operations on the abdominal or 
pelvic organs. It is often used as a purgative for children, also for the 
aged and infirm. Infants bear a larger relative dose than adults, prob- 
ably from their ability to digest a greater quantity of what is taken. It is 
employed with great benefit as a laxative in irritation or inflammation of 
the bowels, in hemorrhoids, inflammatory or spasmodic affections of the 
genito-urinary organs, nephritis or cystitis, gonorrhea, calculi, and stric- 
ture of the urethra and rectum. In cases of dysentery 10 to 20 drops of 
laudanum may be added to each dose to counteract the pain, tenesmus 
and exhaustion resulting from the frequency of the passages. If much 
depression exists, as shown by lowered arterial tension and a dry, glazed 
tongue, 5 drops of oil of turpentine should also be added. 

Castor Oil is much used in the puerperal state and greatly abused. 
There is considerable evidence in support of the charge that it induces 
hemorrhoids by congesting the rectal vessels. Its purgative action is 
milder in proportion to the purity of the sample employed. Externally, 
the pure oil is employed as a local sedative and protective, as in neutral- 
izing the effects of lime upon the conjunctiva. The leaves of the castor- 
oil plant are used to promote the secretion of milk. They may be applied 
to the breast in poultice, and a decoction or fluid extract given internally 
at the same time. 



rosa. 457 



Adm in 1st ration. 



The nauseous smell is best concealed by the Essential Oil of Bitter Almonds. Emul- 
sions are not a success. Capsules containing the requisite dose are easily obtained. In 
the absence of these the best way to administer a dose of oil is to smear the sides of a 
clean wineglass with very thick cream, then to pour in the oil, covering it with a little 
more cream. A teaspoonful of cream being then taken into the patient's mouth, he is 
directed to bolt the dose at one gulp. Some prefer it floated on orange-juice, strong 
coffee, gruel or wine. One of the best vehicles for it is foaming beer. Glycerin increases 
its purgative power, when given conjointly. If the mouth be chilled by broken ice im- 
mediately before taking the oil, the taste of the latter will be imperceptible. 

ROSA, Rose, — is represented in pharmacy by the petals of two 
species and the volatile oil from a third. 

Rosa Centifolia, Pale Rose, — is the petals of Rosa centifolia, the 
Cabbage Rose, a well-known cultivated shrub of the nat. order Rosa- 
cese. The odor is due to a minute quantity of a volatile oil, besides 
which the petals contain tannin, fat, resin, sugar, etc. If it is desired to 
keep Pale Rose fresh for any length of time, it should be mixed with 
one-half its weight of sodium chloride and pressed into a jar, which 
should be kept in a cool place, well closed. 

Rosa Damascena, Damask Rose, — is the source of the official Oil 
of Rose, which is distilled from the fresh flowers. This variety of the 
nat. order Rosacese is largely cultivated in Roumelia, on the southern 
slope of the Balkan mountains, from which section comes nearly all of 
the oil supplied to commerce. 

Rosa Gallica, Red Rose, — is the petals of Rosa gallica, collected 
before expanding. They contain an aromatic oil, tannic and gallic 
acids, Quercitrin, coloring matter, salts, etc. 

Preparations of Rosa Damascena. 

Oleum Rosae, Oil of Rose, Attar of Rose, — is a volatile oil distilled from the fresh 
flowers of Rosa damascena. It is a pale-yellowish, transparent liquid, having a strong 
odor of rose, a sweetish taste and a slightly acid reaction, but slightly soluble in alcohol. 
It consists of an aromatic oxygenated elaeopten and an odorless solid stearopten (rose- 
camphor). Being very expensive it is much adulterated with other volatile oils. It is 
used chiefly for perfuming cosmetic preparations, ointments and lotions, and as the basis 
of the following : 

Aqua Rosae Fortior, Stronger Rose Water, Triple Rose Water, — is water saturated 
with the volatile oil of Rose petals, obtained as a by-product in the distillation of Oil of 
Rose. An agreeable excipient and flavoring agent. Dose, ^ss-j. 

Aqua Rosae, Rose Water, — consists of equal volumes of the preceding and distilled 
water, mixed together immediately before use. It is an ingredient of Mistura Ferri Com- 
posita. Dose, 5jj-ij. 

Unguentum Aquae Rosae, Ointment of Rose Water, Cold Cream, — has of Stronger 
Rose Water 19, Expressed Oil of Almond 60, Spermaceti 12^, White Wax 12, and 
Sodium Borate y z . For local use. 

Preparations of Rosa Gallica. 

Extractum Rosae Fluidum, Fluid Extract of Rose, — prepared with glycerin and 
diluted alcohol. Dose, tT^v-^j. 



45^ ROSMARINUS RUBIDIUM. 

Confectio Rosae, Confection of Rose, — has of Red Rose 8, Sugar 64, Honey 12, 
Stronger Rose Water 16, beaten together into a mass. Dose, gr. x-^j. 

Mel Rosae, Honey of Rose, — has of the Fluid Extract 12, and Clarified Honey- 
to 100. Dose, gj— ij. 

Syrupus Rosae, Syrup of Rose, — has of the Fluid Extract 12^, with Syrup 87^. 
Dose, 3J-ij, for flavoring. 

Red Rose is an ingredient of Pil. Aloes et Mastiches. 

Pale Rose petals are used only for odoriferous purposes. Rose Water has 
no strictly medicinal properties, but is an agreeable excipient for lotions, 
collyria and urethral injections. The ointment, commonly termed cold 
cream, is a pleasant emollient and protective agent, generally used for 
chapped hands and other superficial skin affections. Red Rose is classed 
among the astringents, as it contains an appreciable amount of tannic 
and gallic acids. A compound infusion, containing sugar and dilute 
sulphuric acid, was formerly official, and is used as an agreeable gargle 
for the throat and mouth in inflamed and ulcerated conditions. The 
chief uses of the rose preparations are as vehicles for other agents, or to 
impart flavor and odor to extemporaneous prescriptions. 

ROSMARINUS, Rosemary, — the source of the official Oil of Rosemary, is the 
leaves of Rosmarinus officinalis, a shrub of the nat. ord. Labiatae, cultivated for the sake 
of its large, pale-blue flowers. They are pungently aromatic and somewhat camphor- 
aceous, and contain the volatile oil, a little tannin, some resin and a bitter principle. 

Oleum Rosmarini, Oil of Rosemary, — is the volatile oil distilled from Rosemary, a 
colorless or yellowish liquid, having the characteristic odor of the plant and a camphor- 
aceous taste ; readily soluble in alcohol. It consists of a terpene, isomeric with Turpen- 
tine, C 10 H 16 , and a body allied to camphor. It is an ingredient of Linim. Saponis, Spir- 
itus Odoratus and Tinct. Lavandulae Comp. Dose, TT\j-v. 

Rosemary was formerly considered emmenagogue, galactagogue and diuretic, but is 
now never employed in substance. Its Oil is somewhat stimulant and carminative, and 
in excessive quantity has caused death. It is chiefly used as an external stimulant in 
liniments and lotions, especially to the scalp in alopecia, where it is supposed to increase 
the blood-supply to the hair bulbs and is usually combined with cantharides. Inhaled it 
reduces the body-temperature and gives the urine a violaceous odor. 

RUBIDIUM, Rubidium, Rb, (Unofficial), — is one of the rarer metals, belonging 
to the group of alkaline metals of which potassium and sodium are typical. It has a 
molecular weight of 85, that of Potassium being 39, and that of Sodium 23. Its salts are 
supposed to act more promptly and efficiently than those of the latter, upon the theory 
that the physiological, action of salts is as much a periodic function of the atomic weights 
of their elements as are their physical and chemical characteristics. Its principal salt is — 

Rubidii Iodidum, Rubidium Iodide, Rb I, (Unofficial), — occurs in white, non- 
efflorescent crystals, odorless, of milder taste and greater solubility in water than Potas- 
sium Iodide. Dose, gr. v-xxx or more. 

Rubidium Iodide has generally the same physiological and therapeutical action as 
Potassium Iodide, but has a far less toxic action upon the cardiac muscle. It is well 
borne by the stomach, does not disturb the appetite or give rise to digestive derangements, 
and does not affect the circulation. It rarely produces iodism, and even when the iodo- 
derma and catarrh were present as the result of the administration of potassium iodide, 
the change to the rubidium salt has resulted in decrease of these symptoms. It has been 
employed in lieu of the potassium salt, with greater efficiency and less disturbance, in most 
of the affections for which the iodides are indicated. In eye affections requiring an 
absorptive treatment it is employed internally and externally as a 5 percent, vaselin oint- 
ment or in the form of 5 per cent, drops (gj to 3 ijss). 



RUBUS RUMEX RUTA. 459 

RUBUS, Blackberry-Bark, — is the bark of the root of Rtibus villosus the common 
Blackberry, Rubus canadensis the Dewberry, and Rubus trivialis the Bush Blackberry 
of the Southern States, all of the nat. ord. Rosaceae. It contains over 10 per cent, of 
tannin. Dose, gr. xv-xxx. 

Extractum Rubi Fluidum, Fluid Extract of Rubus. — Dose, TTLx-^j. 

Syrupus Rubi, Syrup of Rubus, — has of the Fl. Extr. 25, Syrup 75. Dose, ,^j-^j. 

Syrupus Rubi Aromaticus, Aromatic Syrup of Rubus (Unofficial), — contains Rubus, 
Cinnamon, Cloves and Mace. Each fl^ has 30 grains of the drug. Dose, ^j-^j- 

Blackberry-bark derives its virtues from its tannin. It is strongly astringent, and may 
be used in decoction, wine or the above-named preparations. It is highly esteemed in 
summer and infantile diarrheas. 

RUBUS IDjEUS, Raspberry, — is the fruit of Rubus id&us the Raspberry bush, 
nat. ord. Rosaceae. It contains sugar, malic and citric acids, proteids, pectin, etc., also 
a Volatile Oil consisting of compound ethers, to which the odor is due. Its sole use in 
medicine is to prepare a pleasantly flavored syrup. The closely allied, light-red fruit of 
Rubus strigosus the wild Red Raspberry, and the purplish-black fruit of Rubus occident- 
al the Thimble-berry, may be employed in place of the raspberry. 

Syrupus Rubi Idaei, Raspberry Syrup, — has of Raspberries and Sugar any convenient 
quantity, boiled (but not in tinned vessels) and strained. Dose, ad libitum. It has a 
bright-red color, a fruity, agreeable odor, a pleasant, acidulous taste and an acid reaction. 
It has no special medicinal virtues, but forms an agreeable flavoring for mixtures, and 
mixed with water a pleasant drink in febrile conditions. 

The leaves of the wild Red Raspberry {Rtibus strigosus) are considerably astringent, 
and in infusion, ^j to the pint, are a popular domestic remedy for diarrheas. 

RUMEX, Yellow Dock, — is the root of Rumex crispus, and of some other species of 
Rumex, plants of the nat. ord. Polygonaceae, growing as common weeds along roadsides. 
Several species of Rumex have sour leaves, and are popularly called Sorrel to distinguish 
them from the others which are called Dock. The official root contains tannin, mucilage, 
starch, calcium oxalate, and two principles named Rumicin and Lapathin, which are 
shown to be identical with Chrysophanic Acid. Its constituents are nearly identical with 
those of Rhubarb. Dose, gr. xv— ^j. 

Extractum Rumicis Fluidum, Fluid Extract of Rumex. — Dose, V(\xv-£). 

Decoctum Rumicis, Decoction of Rumex (Unofficial), — ^ ij of the fresh root or ^j 
of the dry root to Oj of water. Dose, ^j-ij. 

Rumex is astringent, tonic and laxative. It has also been considered alterative and 
anti-scorbutic. It is employed in chronic cutaneous disorders, glandular swellings, and 
other symptoms of the strumous diathesis. It seems to possess a selective action on the 
mucous membrane of the larynx, and in many cases of laryngeal irritation with catarrhal 
symptoms, dry, violent cough, and a sense of soreness behind the sternum, it will give 
relief. The Rumex Acetosa has a popular reputation as a local application for cancer. 

RUTA, Rue (Unofficial), — the leaves of Ruta graveolens, an herba- 
ceous perennial of the nat. ord. Rutaceae, growing wild throughout 
Southern Europe, and frequently cultivated in gardens for its yellowish 
flowers. The fresh leaves only should be used, and as drying impairs 
their qualities the oil is generally employed in medicine. 

Oleum Rutae, Oil of Rue (Unofficial), — the volatile oil distilled from Ruta graveo- 
lens ; a colorless, or greenish-yellow liquid, of disagreeable but aromatic odor, pungent 
acrid taste and neutral reaction, soluble in an equal weight of alcohol. Dose, TT\J-v. 

Physiological Action and Therapeutics. 
Rue is an active irritant, the oil applied locally producing heat, inflam- 
mation and vesication. Administered in full medicinal dose it causes a 



460 SABINA. 

sensation of heat in the stomach and skin, increases the action of the 
heart, and stimulates the bronchial, cutaneous and renal secretions. The 
odor of the oil is distinctly perceptible in the breath, sweat and urine. 
After a toxic dose of the oil violent gastro-enteritis results, with extreme 
prostration, convulsions, strangury and suppression of the urine, and the 
symptoms of a narcotic poison ensue if the dose is large enough. Abor- 
tion may be produced by large doses, but with great danger to life. Rue 
is an efficient emmenagogue, and in men aphrodisiac ; it is also considered 
antispasmodic and carminative. 

The Oil of Rue is employed internally in amenorrhea, menorrhagia, and 
metrorrhagia, hysteria, convulsions and flatulence. As an emmenagogue 
it is very efficient when the condition is one of functional inactivity of 
the uterus and ovaries. In small doses it has been well used in metror- 
rhagia from debility and after abortion. A decoction of the fresh leaves 
is often employed by injection against thread-worms, and internally to 
remove lumbricoid worms. Externally the same preparation has been 
applied to the chest in chronic bronchitis, also in various scaly eruptions 
and glandular enlargements. Used as an abortifacient it has frequently 
caused death, preceded by symptoms of irritant and narcotic poisoning. 
Even in poisonous doses its abortifacient action is very uncertain, so that 
only the most ignorant criminals employ it with such purpose. It was 
formerly official but has been dismissed from the pharmacopoeia. 

SABINA, Savine, — the tops of Juniperus Sabina, a small evergreen 
shrub of the nat. ord. Coniferae, growing in Northern Europe, Asia and 
America. It closely resembles Red Cedar {Juniperus virgimana), but is 
distinguished from the latter by its smaller size and by its larger fruit. 
It contains a Volatile Oil (which is official), also tannin, resin, extractive 
matters, chlorophyll, etc. Dose, gr. v-x. 

Preparations. 

Extractum Sabinae Fluidum, Fluid Extract of Savine. — Dose, TiLy-xv. 

Ceratum Sabinae, Savine Cerate (Unofficial), — may be prepared by incorporating 
the Fluid Extract 25 in Resin Cerate 90, melted and cooled. Formerly official. 

Oleum Sabinae, Oil of Savine. — a volatile oil distilled from Savine, existing in the 
fresh tops in the proportion of 2^ per cent., and in the berries 10 per cent. It is a 
colorless, or yellowish liquid, isomeric with oil of turpentine, C 10 H 16 , having a peculiar, 
terebinthinate odor, a pungent camphoraceous taste and neutral reaction ; soluble in an 
equal volume of alcohol. Dose, rnj-v. 

Physiological Action and Therapeutics. 

Externally the action of Savine resembles that of Turpentine, except 

that it is more irritant, the oil producing vesication if applied sufficiently 

long. Internally a full medicinal dose causes heat sensations, nauseous 

eructations, flatulence, increased cardiac action, stimulation of the cuta- 



SACCHARINUM. 461 

neous, bronchial and renal secretions, irritation of the kidneys, hyper- 
emia of the ovaries and uterus and increased menstrual activity. In large 
doses it produces hematuria, dysuria, and intense gastro-enteritis, with 
violent vomiting and purging. Toxic doses produce the symptoms of an 
irritant and narcotic poison. It may originate uterine contractions in 
the pregnant female, but its abortifacient effect can only be produced by 
a quantity sufficient to endanger life. The oil diffuses into the blood 
and is excreted by the various excretory channels. 

As an emmenagogue Savine is highly esteemed by many authorities, 
Phillips considering it " one of the most certain and powerful" agents 
of this class, "with the additional advantage that it can be given with 
perfect freedom from risk of doing harm." So irritant an agent, however, 
requires the exercise of great caution in its use. It has been found ex- 
tremely efficient in dysmenorrhea when not due to mechanical causes ; 
also in menorrhagia and hemorrhage after abortion. In chronic gout 
and the joint affections of chronic rheumatism, it was formerly much em- 
ployed. Externally the Cerate is used to prolong the discharge from 
blisters, setons or issues, and to stimulate the healing of indolent ulcers. 
For these purposes it is considered safer than cantharides, as its prolonged 
employment does not bring on strangury or vesical irritation. As a 
caustic it is efficient for the destruction of warts and other excrescences, 
and the moistened powder is used as a paste on venereal condylomata, in 
combination with burnt alum or cupric subacetate. The Oil is the most 
efficient preparation for internal administration. 

SACCHARINUM, Saccharin (Unofficial),— is a sweet imide de- 
rivable from a coal-tar product, Toluene, from which it is prepared by a 
complicated process. It has the chemical title B enzoyl-sulphonic-imide , 
and the formula C 6 H 4 (CO)(S0 2 )NH. It occurs as a white, amorphous 
powder, with a very sweet taste, a faint flavor of bitter almonds, and is 
official in the Br. Phar. under the title Glusidum, Gluside (Glucus- 
imide). The pure product is a white, crystalline powder, about 500 
times sweeter than sugar and giving a distinct flavor to 70,000 times its 
weight of water, but the commercial article is standardized to about 300 
times the sweetening power of sugar. Dose, gr. ss-ij. 

Saccharin is soluble in 400 of water, 28 of boiling water, 30 of alcohol, 48 of glyc- 
erin, 500 of chloroform and in 100 of ether. [Sugar is not soluble in ether.] It is 
very soluble in a dilute solution of ammonia, also in solution of sodium bicarbonate 
where it acts the part of an acid, displacing C0 2 . 

Preparations. 

Saccharinum Solubile, Soluble Saccharin (Unofficial), — is prepared by neutralizing 
a solution of sodium bicarbonate with saccharin. It is a soluble sodium saccharinate, 
containing about 90 per cent, of Saccharin, and is soluble in 15 of water. 



4^2 SACCHARUM. 

Elixir Saccharini, Elixir of Saccharin (Unofficial), — has of Saccharin gj, Sodium 
Bicarbonate ^ ss, Alcohol ^ ijss, Distilled Water to ^ xx. Each drachm contains 
gr. iij of Saccharin. 

Saccharin is from 300 to 500 times sweeter than sugar and is also an 
efficient antiseptic. It is not a food and has no injurious action on man. 
It is eliminated in the urine and the saliva without change. It is used as 
a substitute for sugar in the food of diabetics and subjects of hepatic 
disease and corpulence ; also to cover the taste of nauseous drugs and as 
an internal antiseptic in cases of cystitis with decomposing urine. A 
grain of Saccharin sweetens 6 to 8 fluidounces of liquid. It may be used 
to a maximum quantity of 30 grains per diem. It is rendered soluble by 
mixing with it two-thirds its quantity of sodium bicarbonate. 

Dulcin, Sucrol, Para-phenetol-carbamide (Unofficial), — is a urea derivative of phene- 
tidin and occurs in colorless crystals which are soluble in 800 of water, 55 of boiling 
water, 25 of alcohol, also in ether. Its sweetening power is about 200 times that of 
sugar. In reasonable doses it is harmless, does not cause any decomposition of the blood, 
or give rise to the great disgust engendered by Saccharin on prolonged use. Its great 
insolubility is its chief disadvantage. Dose, gr. ss-ij, up to a daily maximum of 30 
grains. 

Saxin, — is a similar product of English manufacture, said to be 600 times sweeter 
than sugar. 

SACCHARUM, Sugar, Cane sugar, C 12 H 22 O n ,— is the refined 
sugar obtained from Saccharum officinarum, the Sugar-cane, a perennial 
plant of the nat. order Gramineae, indigenous to India and adjoining 
countries but cultivated in tropical regions throughout the world. It is 
also obtained from various species or varieties of Sorghum (nat. order 
Gramineae), and from one or more varieties of Beta vulgaris, the Sugar- 
beet (nat. ord. Chenopodiaceae). It is present in several other grasses, 
as Zea Mays, Maize, also in the juice of various trees (maple, birch, 
palm, etc.), and in many roots. 

Cane-sugar occurs in white, dry, hard crystalline granules, permanent in the air, odor- 
less, of purely sweet taste and neutral reaction, soluble in 0.5 of water and in 175 of 
alcohol, in 0.2 of boiling water and in 28 of boiling alcohol, insoluble in ether. The 
saturated aqueous solution has the sp. gr. 1. 345, and is miscible with alcohol in all pro- 
portions. Its freedom from Grape-sugar (glucose) and fiom more than a slight quantity 
of Inverted Sugar (glucose plus levulose) is ascertained by dissolving I gramme in 10 
cc. of boiling water, then mixing with the solution 4 or 5 drops of test-solution of Silver 
Nitrate and about 2 cc. of Aqua Ammonia, and quickly heating to boiling, when not 
more than a slight coloration, but no black precipitate, should appear after standing at 
rest for 5 minutes. 

Other Sugars. 

Saccharum Lactis, Sugar of Milk, Lactose, C 12 H 22 11 + H 2 0, — see next page. 

Glucose, Dextrose, Grape-sugar, Starch-sugar, C 6 H 12 6 (Unofficial), also known as 
liver-sugar, diabetic sugar, — forms yellowish nodules or crystals, very soluble in water 
and in alcohol, has a sweet taste less marked than that of cane-sugar, may be obtained 
artificially from cane-sugar or from starch, by boiling with a dilute mineral acid, or by 
the action of diastase, a vegetable ferment formed during the germination of grain. Boil- 
ing solutions of the alkalies convert it into a brown substance (melassic acid). 



SACCHARUM LACTIS. 463 

Levulose, Fruit-sugar, CgH^Og (Unofficial), — frequently found with grape-sugar in 
fruits, also in honey. See also Diabetin, below. 

Inosit, Phaseo-mannit, C 6 H 12 6 -\- 2H 2 (Unofficial), — exists in the juice of some 
meats, in asparagus, etc. Is very sweet, but does not undergo alcoholic fermentation. 

Allied Substances. 

Theriaca, Treacle, Sugar-hottse Molasses (Unofficial), — is the uncrystallizable residue 
of the process for refining sugar, a thick, brown, fermentable syrup, very sweet and of 
sp. gr. about 1. 40. It is official in the Br. Ph., and is used in making up some of the 
official pills of that pharmacopoeia. 

Amylum, Starch, C 6 H ]0 O 5 , — when boiled with dilute mineral acids or when sub- 
jected to the action of diastase, ptyalin, or pancreatin, it is converted into glucose. (See 
ante, article Amylum.) 

Preparations. 

Sugar is an ingredient of Pil. Ferri Carbonatis, Pil. Ferri Iodidi, Ferri Carbonas Sac- 
charatus, Mistura Ferri Composita, Pulvis Cretse Compositus, Pulvis Glycyrrhizae Com- 
positus, also the Troches, Syrups, Compound Syrups, etc. 



Physiological Action and Therapeutics. 
Sugar is employed in pharmacy and therapeutics chiefly as a vehicle, a 
corrigent, a preservative and an antiseptic. Syrups protect the active 
ingredients against putrefaction, but not always against fermentation. 
They also protect certain ferruginous preparations against oxidation. As 
an ingredient in troches, powders and extemporaneous mixtures sugar is 
used to cover the taste or to make insoluble substances more easily mis- 
cible with water. It increases the solubility of Lime in water. As a food 
it possesses well-known properties, being a nutrient to adipose tissue and 
a respiratory fuel, and is decidedly diuretic in its action upon healthy 
kidneys. Sugar and sugar-forming food constitute more than one-half of 
the nourishment needed by a healthy person, and when withheld or 
diverted as in diabetes, the patient is actually starved and undergoes pro- 
gressive and rapid emaciation. Levulose is found to be more easily con- 
sumed in the system than cane-sugar, and in the treatment of diabetic 
patients may be used with benefit for some time. Heretofore its cost has 
been very great, but it is now being manufactured in large quantities and 
sold at a reasonable price, under the trade-name Diabetin. 



SACCHARUM LACTIS, Sugar of Milk, Lactose, C^H^O^ + H 2 0,— is one 

of the constituents of the milk of mammals, and is officially described as a peculiar, 
crystalline sugar obtained from the whey of cow's milk by evaporation and purified 
by re-crystallization. Occurs in white, hard, crystalline masses, yielding a gritty, white 
powder, odorless, permanent in the air, of faintly sweet taste and neutral reaction, solu- 
ble in about 6 of water and in I of boiling water, insoluble in acohol, ether or chloroform. 
On adding to a solution of sugar of milk in an equal weight of boiling water some solu- 
ution of soda, the liquid turns brownish, and on further addition of test-solution of cupric 
sulphate a brick-red precipitate separates. 

Sugar of Milk is the least soluble of all sugars in water and is soluble in alcohol. It 
enters into alcoholic fermentation with difficulty. In the presence of decomposing albu- 
minous matter and under certain other influences, it undergoes the lactic fermentation, 



464 SALICINUM. 

which results in the formation of Lactic Acid, Carbon Dioxide and Alcohol. It readily 
reacts with the reduction tests. 

Lactose has been shown to act as a powerful diuretic, especially in cardiac dropsy, in 
which See considers it " the best and most certain diuretic we possess, the excretion 
of urine caused by it being greater than that due to any other drug." He found that it 
acts similarly to Caffeine though more powerfully, while possessing none of the disad- 
vantages of the latter. Its diuretic action is but very slight in cases where extensive renal 
disease exists, and it has no power over dyspnea. 

Sugar of Milk is used in the triturations, also in Dover's powder, deodorized opium, 
etc., as a diluent. Being much harder than cane-sugar it is considered a valuable exci- 
pient for powders requiring the minute subdivision of their medicinal constituent. It is 
less sweet than cane-sugar, and being less apt to ferment in the stomach and bowels is 
better than the latter for use with infants' food. 



SALICINUM, Salicin, C 13 H 18 7 , — is a glucoside obtained from 
several species of Salix, the Willow, and Populus, the Poplar, trees of the 
nat. ord. Salicacese. It is found also in Gaultheria procumbens, the Win- 
tergreen (nat. ord. Ericaceae), and in Betula lenta, the Sweet Birch (nat. 
ord. Betulaceae), the volatile oils of which, distilled from the leaves of 
the former and from the bark of the latter, consist almost entirely of 
methyl salicylate (see next page). 

Salix Nigra, the Pussy Willow, grows along streams in the Southern 
States. A fluid extract is on the market, and maybe used in doses of ^ss 
thrice daily, as a sexual sedative. 

Salicin occurs in colorless or white and silky, shining crystalline needles, or a crystal- 
line powder, odorless, of very bitter taste, permanent in the air, of neutral reaction ; 
soluble in 28 of water and in 30 of alcohol, in 0.7 of boiling water and in 2 of boiling 
alcohol; almost insoluble in ether or chloroform. Dose, gr. x-^j. 

Acidum Salicylicum, Salicylic Acid, HC 7 H 5 3 , — is an organic acid, 
existing naturally in combination in various plants, but most largely pre- 
pared synthetically from carbolic acid. It occurs in light, fine, white, 
prismatic needles, or a crystalline powder, odorless, of sweetish, after- 
wards acrid taste and acid reaction, permanent in the air ; soluble in 
about 450 of water, but readily soluble in water containing 8 per cent, of 
Borax or 10 percent, of Sodium Phosphate. It is soluble in 2^ of alco- 
hol, in 14 of boiling water, in 2 of ether, in 80 of chloroform, and is very 
soluble in boiling alcohol. Dose, gr. v-gj. 

Salicylic Acid is a derivative of Salicin, probably by double oxidation ; but may also 
be considered as a substitution-derivative of Benzene, formed by replacing 2 atoms of its 
hydrogen, the one by hydroxyl, and the other by carboxyl. It is obtained therefore 
either synthetically by combining the elements of Carbolic Acid with those of Carbonic 
Acid, and subsequent purification, — or from natural Salicylates as the Oil of Wintergreen 
and Sweet-Birch, — or from Salicin, by heating with caustic potash and treating with 
hydrochloric acid. The acid prepared from natural sources is purer and more efficient 
than that prepared artificially, and will often be tolerated by a patient who cannot bear 
the latter. 

Official Prepai-ations. 

Salol, Salol, Phenyl Salicylate, C 6 H 5 C 7 H 5 3 , — is the salicylic ether of phenol, now 
obtained from salicylic acid by heating at from 320 to 464 F. excluding the air ; by 



SALICINUM. 465 

which process the acid is converted into Salol, Water and C0 2 . It is a white, crystalline 
powder, odorless and almost tasteless, nearly insoluble in water, soluble in 10 of alcohol, 
and very soluble in ether, chloroform and oils. On being warmed with an alkali it splits 
up into Salicylic Acid 60, and Carbolic Acid 40. Dose,gr. v-xv, frequently repeated, in 
compressed tablets or in cachets, or suspended by mucilage of acacia or of tragacanth. 

Lithii Salicylas, Lithium Salicylate, LiC-H 5 3 , — a white, or grayish- white powder, 
odorless, sweetish, deliquescent, very soluble in water and in alcohol. Dose, gr. v-gj. 

Sodii Salicylas, Sodium Salicylate, NaC 7 H 5 3 , — a white, amorphous powder, soluble 
in ^ of water and in 6 of alcohol, also in glycerin. Dose, gr. v— ^j. 

Physostigminae Salicylas, Physostigmine (Eserine) Salicylate, — is described 
under Physostigma. Dose, gr. xtyo~^V 

Methyl Salicylas, Methyl Salicylate, Artificial [Synthetic) Oil of Wintergreen, CH 3 - 
C 7 H 5 3 , — is a colorless liquid, having the characteristic odor and taste of Oil of Gaulthe- 
ria, with the essential constituent of which it is identical. It is wholly identical with 
Oleum Betulse Volatile, and is soluble in all proportions in alcohol, carbon disulphide, or 
glacial acetic acid. Dose, rr\v-xv, suspended in water or in sugared water. 

Oleum Betulae Volatile, Volatile Oil of Betula, Oil of Sweet Birch, — is a volatile 
oil distilled from the bark of Betula lenta, the Sweet Birch. It is identical with Methyl 
Salicylate (see above), and nearly identical with Oil of Gaultheria. Russia leather 
derives its odor from this oil. Dose, TT\v-xv. 

Oleum Gaultheriae, Oil of Gaultheria, Oil of Wintergreen, — consists almost en- 
tirely of Methyl Salicylate, and is nearly identical with the preceding. It is described 
under the title Gaultheria. 

Unofficial Preparations. 

Salophen, Para-amidophenol Salicylate, — contains the equivalent of nearly 51 per 
cent, of Salicylic Acid, and occurs as minute, white, crystalline scales, odorless and 
tasteless, insoluble in water, soluble in alcohol ; decomposed by alkalies into salicylic 
acid and acetyl-para-amidophenol ; also decomposed by the organism as demonstrated 
in the urine. Dose, gr. v-xv, up to gj or jss in the 24 hours. 

Salipyrin, Antipyrin Salicylate, C 18 H ]8 N 2 4 , — is produced by the combination ot 
Salicylic Acid 57.7, and Antipyrin 42.3 parts. It is a white, crystalline, odorless powder, 
very soluble in alcohol, insoluble in water. Its claims to preference are based upon its 
comparative harmlessness ( ^ ijss having been taken within 3 or 4 hours without the 
slightest ill effect) ; also its freedom from unpleasant after-results. Dose, gr. x— xxx 
every hour or 2 hours until 3 ij have been taken. It is best administered in wafers, as a 
powder, or in mixture, rubbed up with glycerin and flavored with raspberry syrup. 

Malakin, Salicyl-para-phe7tetidin, — is a condensation product of salicylic aldehyde 
and p-phenetidin, occurring in bright yellow needles, almost insoluble in water or alco- 
hol, and decomposed by dilute mineral acids. Its action is that of salicylic acid, but its 
effects are very mild, — hence its name (from malakos, mild). It has proved valuable 
in acute rheumatism and other febrile affections, as an antipyretic and analgesic. As it 
may be given for a long time without causing any disturbance, it is of especial service 
in habitual headaches. Dose, gr. viij-xv, repeated about six times in 24 hours. 

Physiological Action. 
Willow-bark is highly astringent, antiperiodic and feebly tonic, but is 
never employed medicinally owing to its bulk. Salicin is a bitter tonic, 
also antifermentive, antiseptic and highly destructive to low organisms. 
It has slight antiperiodic power and is feebly antipyretic. It prevents 
the reaction between amygdalin and emulsin, also that of ptyalin, etc., 
on starch. It seems to be devoid of toxic power on man, and is mainly 
excreted as salicylic, salicyluric and salicylous acids, being first changed 
in the bowel into saligenin and glucose. Salicin is well borne by the 
stomach. 
30 



466 SALICINUM. 

Salicylic Acid has properties similar to Salicin, but it is much more 
energetic in its action, being a powerful antipyretic and antiseptic. It is 
also anhydrotic, checking local perspiration when locally applied. Inhaled 
it causes irritation of the respiratory passages, producing sneezing and 
cough. In small doses it stimulates the stomach, heart and respiration, 
but moderate quantities derange the stomach, causing nausea and vomit- 
ing ; while large doses depress the heart's action and the respiration after 
a primary excitation of both, lower the arterial tension, relax the vessels, 
produce free perspiration, and reduce the temperature in fever. It causes 
vertigo, dilated pupils, tinnitus aurium, a sensation of tension in the 
frontal cerebrum, delirium, and may produce bed-sores from depression 
of the circulation, but does not affect the peripheral nerves as to either 
motion or sensation. In the blood it is first changed to sodium salicylate, 
but a portion is again set free and uniting with glycocoll forms salicyluric 
acid, coloring the urine green. It is slowly excreted with the secretions 
generally, especially in the urine, sweat, saliva and bile. It stimulates 
the kidneys, at the same time disinfecting them and increasing the acidity 
of the urine, but may so irritate the kidneys as to produce albuminuria 
and hematuria. 

Salicylic acid is destructive to the torula and prevents alcoholic fermenta- 
tion, also that caused by the organic ferments (pepsin, ptyalin, etc.). In 
solutions containing bacteria it will prevent their development if in the 
proportion of 1 per cent., and in that of 1 in 60 it will destroy them. 

Sodium Salicylate is remarkably antipyretic in doses of gr. xv, given 
4 or 5 times in 24 hours. It is a powerful diaphoretic, and an efficient 
cholagogue, and is supposed to possess the curious property of increasing 
the fluidity of the bile, at the same time that it promotes its secretion, — 
other cholagogues increasing the proportion of solids therein. (Brunton.) 
It has no antiseptic power, unless in association with a strong mineral 
acid which will liberate the salicylic acid. 

Salol is antiseptic, antipyretic, and germicide, in a higher degree than 
either of its constituents. As an antipyretic in fever it stands next after 
antipyrin, and it acts with force sufficient to depress the temperature a 
degree or two below normal. It is sedative to the cerebrospinal system 
and somewhat analgesic. It causes profuse sweating, and in a few cases 
depression has accompanied its antipyretic employment, but it is not 
toxic, and may be used freely in its proper dosage, which ranges from 5 
to 60 grains, up to 2 or 3 drachms in the 24 hours. In large doses it is 
liable to induce the symptoms of carbolic acid poisoning. 

Therapeutics. 
Salicin and its derivatives are chiefly used in acute rheumatism, to 
lower temperature, relieve pain, and reduce articular swelling. They 



SALICINUM. 467 

are most suitable to strong, vigorous patients, and if not promptly effi- 
cient they should be abandoned. The acid is much used as an antipy- 
retic in fevers, especially those of septicemic character. It is a useful 
local application in gangrenous wounds, eczema of the hands or feet, 
cancer, burns, and in fetid perspirations, in the last affection being used 
in solution with borax. 

Sodium Salicylate is more soluble than the acid and less irritant to the 
stomach, while in doses about 50 per cent, larger it is equally efficient. 
It is employed in 3- to 5-grain doses internally after meals, to arrest gas- 
tric fermentation and to prevent acidity and flatulence. It is used instead 
of the acid in acute and chronic rheumatism, to relieve headaches, and 
for phlegmasia alba, in which it is considered very efficient. It is con- 
sidered an effective remedy to cut short an attack of tonsillitis, a " bad 
cold " and other acute affections of the respiratory mucous membrane, 
also in urticaria, diabetes, gout and cases having a tendency to the forma- 
tion of gall-stones it has many advocates. Lithium Salicylate is not 
irritant and is supposed to act towards uric acid in the same manner as 
the other salts of this metal. It is said to be of especial value in acute 
rheumatism and rheumatic gout. 

Salol is one of the most efficient remedies for duodenal catarrh, catarrh 
of the bile-ducts and catarrhal jaundice ; also in the bilious form of sick- 
headache, and in some forms of neuralgia. Its therapeutic value depends 
chiefly upon its property of splitting up in the alkaline fluids of the in- 
testine into Salicylic Acid and Phenol compounds, whereby it effects the 
thorough antisepsis of the intestinal tract and performs the work of its 
constituent elements upon the organism. In all affections associated with 
micro-organisms in the intestines, as acute diarrhea, cholera, dysentery, 
etc., it has done most excellent service, even in Asiatic cholera. It is 
highly praised in epidemic influenza (grippe), having proved itself re- 
markably efficient in recent epidemics of that affection. 

Salol is a remedy of very great value in typhoid fever; disinfecting the 
ulcerated intestine it promotes the healing process therein, and hinders 
reinfection. It is highly recommended in dysentery, in cholera, and in 
infantile diarrhea. Given in the latter affection, a dark staining of the 
child's diapers is often noticed, which is due to the development of car- 
bolic acid from the remedy. Its greatest power is manifested over acute 
rheumatism, in which disease many clinicians maintain that it has no 
superior, if given in 15- to 30-grain doses, up to 2 drachms in the 24 
hours, and continued for some time after the acute symptoms have 
subsided. In large doses, however, it is liable to induce symptoms of 
carbolic acid poisoning, which may be met by administering sodium 
sulphate or any other sulphate. It proves to be an efficient disinfectant, 
in catarrh of the bladder, its constituents being excreted with the urine, 



SALVIA — SAMBUCUS. 

and coming in contact with the vesical mucous membrane for a consider- 
able length of time. It is much quicker in its action upon the urine than 
ammonium benzoate, as in a day or two ordinarily the urine loses its 
foul odor and alkalinity and becomes clear. Dissolved in Retinol, it is 
considered especially useful in subacute cystitis, having conquered cases 
in which other remedies had proven ineffectual. 

Externally, Salol is employed as an antiseptic and deodorant powder 
against impetigo, eczema, sycosis and other skin diseases; and has done 
good service as an insufflation in the treatment of ozena. In spirituous 
solutions (5 per cent.) it is used with various flavoring agents in the prepa- 
ration of mouth-washes and dentifrices, and it enters into the composition 
of soaps, face powders, and other toilet articles. A mixture of equal parts 
of Camphor and Salol, heated together, has given good results in the 
treatment of suppuration of the middle ear, giving no pain and setting 
up no inflammation of the part. 

Salophen is considered non-toxic in its action upon the organism, while aftording all 
the medicinal qualities of Salol. It has been employed with success, in dosage of 3J to 
^jss daily, in the treatment of acute rheumatism, acute rheumatic arthritis, typhoid fever, 
cholera and allied conditions ; also in neuralgia and sciatica, gastro-enteritis, pyelitis, and 
cystitis. In intestinal dyspepsia with flatulence and in gastrectasis it has been used with 
decided benefit, in the latter affection chiefly for the relief of the fermentive disturbances 
to which the dilated stomach is liable. 

Salipyrin has been employed with excellent results in acute and chronic rheumatism, 
rheumatic sciatica, neuralgia and influenza. In rheumatic fever 15-grain doses are given 
at short intervals [y z hour to I hour), until about gij have been taken, continuing with 
smaller doses for a long time after convalescence to prevent relapses. A dose of 8 grains 
is often sufficient against neuralgia. It was extensively used during the epidemic of in- 
fluenza in 1891, and highly extolled for efficiency therein, as well as for its freedom from 
cardiac action. It has proved highly efficient in the treatment of metrorrhagia, especially 
in that following labor or abortion. Orthmann employed it with most excellent results in 
50 cases of metrorrhagia from various causes, giving gr. xv thrice daily up to a total of 
^ ijss in some cases. In no instance were unpleasant effects observed. 

As it is not obtainable in this country, by reason of a legal conflict between its paten- 
tees and those of Antipyrin, and as it is a very loose combination at best, Dr. Squibb sug- 
gests that there is no reason whatever why just as good results should not be obtained 
from the administration of its constituents in conjunction, in proper doses to suit each in- 
dividual case, and in the proportion of about 3 of Salicylic Acid to 2 of Antipyrin. 



SALVIA, Sage, — the leaves of Salvia officinalis, the common garden Sage, a peren- 
nial plant of the nat. ord. Labiatse, native in Southern Europe but cultivated in our gar- 
dens for its strong, fragrant odor. They contain tannin, resin, etc., and a volatile oil 
which consists of Salviol (C ]0 H ]6 O), camphor and terpenes. There are no official prep- 
arations. Dose of the powdered leaves, gr. xx-xxx, in infusion. 

Sage is aromatic, stimulant, tonic, astringent and a vulnerary. It was highly esteemed 
in ancient times, and even yet is popular as a domestic cure-all with many people. In 
infusion it may be used as a beverage in febrile conditions and to check sweating, also for 
the night-sweats of phthisis. Like other members of the same class it has a slight influ- 
ence over enteralgia and flatulence. It makes a good astringent and stimulating gargle. 



SAMBUCUS, Elder, — the flowers of Sambucus canadensis, the common Elder, a 
shrub of the nat. ord. Caprifoliaceae. The plant contains a small quantity of a volatile oil, 
also a resin and valerianic acid. The common Elder of Europe (S. nigra) is more of a 



SANGUINARIA. 469 

tree, and is official in the Br. Phar. There are no official preparations. Dose, gr. xxx- 
gj, in hot infusion. 

Elder- flowers are stimulant and diaphoretic, also diuretic in some degree. The berries 
are diaphoretic and laxative, while the inner bark is a hydragogue cathartic and in large 
doses emetic. Formerly the inspissated juice of the berries was employed as an altera- 
tive in rheumatism and syphilis, but the flowers are now used only for flavoring purposes. 
Elder-flower Water (Aqua Sambuci, B. P.) is an excellent vehicle for collyria and lotions. 

SANGUINARIA, Blood-root, — is the rhizome, collected in 
autumn, of Sanguinaria canadensis, a perennial plant of the nat. ord. 
Papaveraceae, which grows abundantly throughout the U. S., being one 
of the earliest and most beautiful of the spring flowers. It has a single 
white flower on an erect stalk, the petals often tinged with rose or purple. 
It contains 3 alkaloids, — Sanguinarine, C n H 15 N0 4 , which is probably- 
identical with Chelerythrine (see Chelidonium), Porphyroxine, and Puc- 
cine, combined with Chelidonic and Sanguinarinic acids ; also resin, gum, 
albumin, sugar, etc. The salts of its alkaloids are of brilliant red and 
orange colors and are all soluble, in water. Dose of the powdered root as 
an expectorant, gr. j-v ; as an emetic, gr. x-xxx ; best given in pill. 

Preparations. 

Extractum Sanguinariae Fluidum, Fluid Extract of Sanguinaria. — Dose, TT\j-v 
as an expectorant and stimulant ; rtVx-lx as an emetic, cautiously. 

Tinctura Sanguinariae, Thvcture of Sanguitiaria, — strength 15 percent. Dose, as 
an expectorant, W\v-;5J, as an emetic ^j-iij. 

Sanguinarina, Sanguinarine, C^H^NO^ (Unofficial), — is the chief alkaloid and 
probably the active principle of the plant. Dose, as an expectorant, gr. j^-j ; as an 
emetic gr. y z repeated in 10 minutes will produce vomiting after the second or third dose. 

Physiological Action. 
Sanguinaria is sternutatory, sialagogue, expectorant and emmenagogue, 
a systemic emetic, a cardiac paralyzer, a violent irritant, an acro-narcotic 
poison and an alterative. Its taste is bitter and acrid. It causes violent 
sneezing when inhaled, increases secretion by irritating the secretory 
organs as it is eliminated, and in full doses produces salivation, catharsis 
and vdmiting with great depression. Overdoses are violently irritant, the 
heart's action being at first increased, together with the arterial tension, 
then markedly depressed, and finally paralyzed by stimulation of its in- 
hibition. The reflexes are lowered by paralysis of the spinal centres, 
muscular contractility -is impaired, the pupils are dilated, the temperature 
is lowered, cold sweats, great thirst and collapse supervene, and death 
occurs by paralysis of the cardiac and respiratory centres, often preceded 
by convulsions. Locally used, Sanguinaria is a feeble escharotic. 

Antagonists and Incompatibles. 

Amyl Nitrite, Opium, Atropine, etc., to antagonize the depression of the circulation 
and the local irritant action. Incompatibles are alkalies, Tannin, and most of the metal- 
lic salts. 



47° santalum album. 

Therapeutics. 

As a tonic to the stomach and a stimulant to the liver Sanguinaria or 
its active principle is well employed in small doses (gtt. iij of the tincture 
or gr. -ij of the alkaloid) for atonic dyspepsia, duodenal catarrh and 
catarrh of the biliary ducts with jaundice. Respiratory affections are 
often remarkably amenable to its influence, particularly chronic nasal 
catarrh, asthma and acute bronchitis. In these affections expectorant 
doses are the best, namely gtt. x of the tincture, and in the former the 
powder locally as a sternutatory. A decoction is a very efficient gargle 
in the sore-throat of scarlet fever. Sanguinaria is a very serviceable 
remedy in chronic bronchitis and in amenorrhea of functional character, 
also in functional impotence from irritability of the organs, with daily 
seminal losses and relaxation of the genitalia. By many practitioners it 
is considered a specific emetic in croup, but others look upon it with dis- 
favor as too uncertain and harsh in its action. It has been thought to 
have alterative properties, and hence is frequently used with Stillingia and 
other plants in the treatment of strumous and syphilitic affections. In 
pneumonia of typhoid type and in pleuro-pneumonia it has undoubtedly 
been of great service in many cases. 

Locally, the powdered root is well employed as an application to foul 
ulcers and fungous granulations, also by insufflation to nasal polypi, and 
for chronic hypertrophy of the nasal mucous membrane. 

Sanguinarine has been used with good results in pneumonia, bronchitis 
and atonic dyspepsia. Doses of gr. ^ to -J- are expectorant without irri- 
tating the stomach, and still smaller doses (gr. -£$ to I 1 u -) are stimulating 
to the gastric and intestinal secretions. 

SANTALUM ALBUM, White Sandalwood,— the source of 
the official Oil of Santal, is not itself official. It is a tree of the nat. 
ord. Santalaceae, having its habitat in India but now nearly exterminated 
there. Santalum citrinum, the yellow Sandalwood, from the Hawaiian 
and Fiji Islands, is more commonly met with in commerce. 

Oleum Santali, Oil of Santal, Oil of Sandalwood, — a volatile oil distilled from the 
wood of Santalum albiwi ; a pale-yellow liquid, soluble in alcohol, of peculiar and aro- 
matic odor, pungent taste and acid reaction. Dose, TT^x-xxx, in emulsion or capsules. 

Extractum Santali Fluidum, Fl. Extr. of Santal (Unofficial). — Dose, 3J-iij- 

Sandalwood is a very agreeable perfume. The Oil is astringent to 
mucous membranes, producing dryness of the fauces, thirst, colic, and a 
sense of fulness in the renal regions. In concentrated form it is a local 
irritant, but the effects of large doses have not been studied. It is exten- 
sively used in chronic bronchitis and in gonorrhea, forming the contents 



SANTALUM RUBRUM SANTONICA. 47 I 

of proprietary capsules which are sold for the cure of the latter disease in 
all drug stores. As found in the shops it is extensively adulterated with 
oil of cedar and is a very unreliable remedy. 

SANTALUM RUBRUM, Red Saunders, — is the wood of Pterocarpus santalinus, 
a tree of the nat. ord. Leguminosae, native in India. It comes in chips or as a coarse 
powder, nearly inodorous and tasteless, not imparting any red color to water when mac- 
erated in it, but coloring alcohol, ether and alkaline solutions a bright red. The wood 
has no medicinal properties and is employed solely for the purpose of coloring alcoholic 
preparations. It is a constituent of Tinctura Lavandulae Compositus. 

SANTONICA, Levant Wormseed, — is the unexpanded flower- 
heads of Artemisia pauciflora, a small, perennial plant of the nat. ord. 
Compositae, which grows in Asia Minor, and contains a volatile oil and 
the peculiar, crystalline principle Santonin. Dose, gr. x-lx. 

Santoninum, Santonin, C 15 H 18 3 , — the neutral principle obtained 
from Santonica. Occurs in colorless, prismatic crystals, turning yellow 
on exposure to light, odorless, of bitter after-taste, and neutral reaction, 
nearly insoluble in cold water, but soluble in 250 of boiling water, in 40 
of alcohol, 3 of boiling alcohol, 140 of ether, 4 of chloroform, also in 
solutions of the caustic alkalies. Dose, gr. *^-j for a child, gr. j-v for 
an adult, not repeated soon as the action of the drug is slow. 

Trochisci Santonini, Troches of Santonin, — each troche contains about ]/ z grain of 
Santonin, with Sugar, Tragacanth, and Stronger Orange Flower Water. Dose, j-v. 

Santonin and its preparation are sensitive to light and should be kept in amber-col- 
ored bottles tightly corked. 

Physiological Action and Therapeutics. 

Santonin is anthelmintic to the round-worm (Ascaris lumbricoides), 
also but in less degree to the thread-worm (Oxyuris vermicularis). It is 
taken into the blood as Sodium Santoninate, and affects the cerebral 
faculties and the vision ; objects appearing at first blue, green, or red, then 
yellow (chromatopsia), often succeeded by blindness for a week or more. 
Toxic doses disturb the consciousness of the patient, produce a sort of 
intoxication, tremors, weakness, with enfeebled respiration and slowing 
of the pulse, coldness of the surface, vomiting, sweating, mydriasis, con- 
vulsions, and death from failure of respiration. A dose of 2 grains is 
said to have proved fatal to a feeble child five years old. It is ex- 
creted by the kidneys, coloring the urine if acid a greenish-yellow, if 
alkaline a reddish-purple, and it produces considerable enuresis. 

As an anthelmintic Santonin is the most certain agent against the round- 
worm, and is best administered in powder with calomel at bedtime after 
a day of fasting, a senna-draught or a dose of castor oil being used the 
following morning. It also acts fairly well in suppository against the 
thread-worm, but is inoperative against tape-worm. Some observers 



472 SAPO. 

consider it more promptly efficient when given in castor oil, and that the 
oil lessens the risk of evil after-effects. It has also been prescribed with 
great benefit for nocturnal incontinence of urine, and for certain eye 
affections, particularly amblyopia from atrophic or inflammatory changes 
in the retina and optic nerve. It should never be given to children 
during a fever, nor when the bowels are constipated, for fear of toxic 
results. 

SAPO, Soap, White Castile Soap, — is Soap prepared from soda and 
olive oil ; a whitish solid, hard, yet easily cut when fresh, of faint, peculiar 
odor free from rancidity, a disagreeable, alkaline taste and alkaline re- 
action ; easily soluble in water and in alcohol. It is an ingredient of 
several of the official pills. 

Sapo Mollis, Soft Soap, Green Soap, — is Soap prepared from potassa 
and linseed oil ; a soft, unctuous mass, of a yellowish-brown color, solu- 
ble in about 5 of hot water and in 2 of hot alcohol. The name Green 
Soap is a misnomer, as it is not green in color. 

Insoluble Soaps are combinations of the oily acids with earths and 
metallic oxides. Two are official, — the Soap of the Monoxide of Lead 
(Emplastrum Plumbi) and the Soap of Lime (Linimentum Calcis). 

Saponification is a process of double decomposition between a fat (stearate, palmitate 
or oleate of glyceryl) and an alkali, in which glycerin and the metallic salt of the fatty 
acid are formed. The glycerin, not being saponifiable, is set free, but the fatty acid 
(stearic, palmitic or oleic) unites with the salifiable base to form soaps, which are therefore 
mixed stearates, oleates and palmitates of various bases. Nearly all soaps are oleates or 
palmitates (or both) of sodium or potassium (or both). Hard soaps are soda soaps, soft 
soaps are potassium soaps. [Compare the articles entitled Olivse Oleum, Adeps, Acidum 
Oleicum, Glycerinum.] 

Un official Soaps. 

Sapo Animalis, Curd Soap, — official in the Br. Phar. , — is made with Soda and a 
purified animal fat, and consists chiefly of Stearin. Used in pills and suppositories. 

Sapo Medicatus, — official in the Fr. Codex, — is a Soda soap prepared from expressed 
Almond Oil. 

Preparations. 

Emplastrum Saponis, Soap Plaster, — has of Soap 10, Lead Plaster 90, Water q. s. 

Linimentum Saponis, Soap Liniment, — has of Soap 7, Camphor 4^, Oil of Rose- 
mary 1, Alcohol 75, Water to 100. Opodeldoc is a similar preparation. Soap Lini- 
ment is an ingredient of Chloroform Liniment. 

Linimentum Saponis Mollis, Liniment of Soft Soap, Tincture of Green Soap, — 
has of Soft Soap 65, Oil of Lavender 2, Alcohol 30, Water to 100. 

Physiological Action and Therapeutics. 
Soap is laxative, antacid and antilithic ; externally it is a stimulating 
discutient, and is used for cleansing the skin, removing fatty substances 
and softening the epidermis, but if too long applied if may prove de- 
cidedly irritant. It is a good antidote in poisoning by acids, and should 



SARSAPARILLA. 473 

be administered freely in such cases until more energetic alkalies can be 
obtained. In aqueous solution it makes a useful enema for constipation, 
or a plug of soap may be inserted into the rectum. 

Soft Soap is a powerful detergent stimulant and is much employed in 
skin diseases, especially eczema rubrum, in which the tincture is rubbed 
on, the diseased skin well washed and then covered with a bland oint- 
ment. The tincture is the most elegant form for use, and may be diluted 
with three parts of alcohol for shampooing the scalp. 

The Liniment is used with friction in sprains, bruises and stiff joints, 
being a little more stimulating than camphor-liniment. It makes a good 
basis for extemporaneous liniment prescriptions. 

SARSAPARILLA, — is the root of Smilax officinalis ; Smilax medica, 
and of other undetermined species of Smilax, plants of the nat. ord. 
Liliacese, growing in Mexico, Brazil, etc. There are six commercial 
varieties on the market, which are put up in differently formed bundles. 
It contains starch, resin, calcium oxalate, an essential oil, and an acrid 
neutral principle named Parillin or Smilacin, which when acted on by 
dilute sulphuric acid affords another principle, Parigenin. 

Preparations. 

Extractum Sarsaparillae Fluidum, Fluid Extract of Sarsaparilla. — Dose, gss-j. 

Extractum Sarsaparillae Fluidum Compositum, Co?npound Fluid Extract of 
Sarsaparilla, — has of Sarsaparilla 75, Glycyrrhiza 12, Sassafras 10, Mezereum 3, Glycerin 
10, Water and Alcohol to 100. Dose, 3 ss-j. 

Syrupus Sarsaparillae Compositus, Compoitnd Syrup of Sarsaparilla, — has of 
the Fluid Extract 20, Fl. Ext. of Glycyrrhiza 1^, Fl. Ext. of Senna l l / 2 , Sugar 65, Oils 
of Sassafras, Anise and Gaultheria, each 0.01, Water to 100. Dose, 3J-^j. 

Decoctum Sarsaparillae Compositum, Compozind Decoction of Sarsaparilla , — 
has of Sarsaparilla 10, Sassafras 2, Guaiacum Wood 2, Glycyrrhiza 2, Mezereum I, 
Water to 100. Dose, ^j-iv. 

Syrup of Sarsaparilla (Unofficial), — much used in flavoring soda-water, is a mixture 
of the oils of sassafras and gaultheria in syrup. 

Physiological Action and Therapeutics. 
Those who believe that Sarsaparilla has any action ascribe to it prop- 
erties as a diuretic, diaphoretic, tonic and alterative. Careful physiolog- 
ical experiments with the drug and its principle have so far given negative 
results. It has been used as a so-called "blood-purifier" in scrofula, 
chronic abscesses, necrosis, old ulcers, many cutaneous diseases, etc., but 
is generally combined with other agents of undoubted activity. The 
compound decoction" is considered a good agent in tertiary syphilis, 
especially in debilitated subjects; while the other preparations are com- 
monly employed as vehicles for potassium iodide and mercuric chloride 
in syphilis of any form. Whenever used, the compound decoction will 



474 SASSAFRAS SCAMMONIUM. 

give the best results, the hot water and its other constituents having 
medicinal value if the principal ingredient has none. 

SASSAFRAS, — is the root-bark of Sassafras variifolhwi, an indigenous tree of the 
nat. ord. Laurineae. The volatile oil is official, and contains as its principal constituent 
Safrol, which is largely used to disguise the odor of the fatty bases in soap manufacturing. 

Sassafras Medulla, Sassafras Pith, — is the pith of the above-mentioned tree. 
Macerated in water it forms a mucilaginous liquid which does not give a precipitate on 
the addition of alcohol. 

Mucilago Sassafras Medullae, Mucilage of Sassafras Pith, — has of the pith 2, in 
water ioo. Dose, indefinite. 

Oleum Sassafras, Oil of Sassafras , — a volatile oil distilled from Sassafras, — a color- 
less or yellowish liquid, having the odor of Sassafras, a warm, aromatic taste and a 
neutral reaction, readily soluble in alcohol. Treated with cold nitric acid it becomes of 
a dark red color, and is finally converted into a red resin. Dose, TT\j-iv. 

Infusum Sassafras, Infusion of Sassafras (Unofficial), — is a popular " tea" which 
may be taken ad libitum. When made from the bark, and taken internally as well as 
applied locally, it is almost a specific for the rash produced by poison oak (Hinton). 

Sassafras is a constituent of the three compound Sarsaparilla preparations. It acts as 
a stimulant diaphoretic when used in quantity of the hot infusion. It enjoys a popular 
reputation as a "blood-purifier," and has a destructive influence on infusoria. It is 
employed chiefly in combination with Sarsaparilla and Guaiacum in cutaneous disorders 
and rheumatic and syphilitic affections. The mucilage of the pith is an excellent demul- 
cent drink in acute gastritis and enteritis, or in poisoning by irritant and corrosive agents. 
It may also be used in extemporaneous prescriptions to hold insoluble substances in sus- 
pension and for flavoring purposes. The oil is chiefly used for flavoring in mixtures and 
confectionery. The syrup popularly known as "Sarsaparilla" is composed of Oil of 
Sassafras and Oil of Gaultheria, in syrup. 

Dr. J. Bartlett, of Chicago, in a paper on the toxic properties of Sassafras, published 
in the Pharmaceutical Journal, says that it appears to have some resemblance to three 
familiar drugs — opium, strychnine, and ergot ; for it has a narcotic and sudorific action ; 
a property of inducing tetanic and clonic spasms followed by paralysis, and a probable 
stimulant effect on the uterus. 

SCAMMONIUM, Scammony— is a resinous exudation from the 
root of Convolvulus Scammonia, a plant of the nat. ord. Convolvulacese, 
growing chiefly in Syria and Asia Minor. It contains about 80 per cent. 
of Resin, with gum, sugar, starch, etc. The active principle, Jalapin, is 
probably identical with the Convolvulin of Jalap, and is contained in the 
root, the resin, etc. Dose, gr. v-x. 

Resina Scammonii, Resin of Scammony, — soluble in ether. Dose, gr. iij-viij. 
Extractum Colocynthidis Compositum, — (see ante, page 285) contains 14 per 
cent, of Resin of Scammony, and is an ingredient of the Compound Cathartic Pill. 

Scammony is an active cathartic, stimulating the liver and the intes- 
tinal glands, and causing free purgation in a few hours with considerable 
griping. Its solution in the bile is necessary to its action, and it com- 
bines with the soda in that secretion. Though quite drastic in action it 
is somewhat uncertain as a purgative and is generally employed in com- 
bination with similarly acting agents. It is anthelmintic against the 
tapeworm, and in overdoses produces a high degree of irritation. It is 
used as a drastic purgative for children with calomel or potassium sulphate, 



scilla. 475 

when an active cathartic is indicated. In the same way it is the appro- 
priate agent on the principle of derivation in dropsies and cerebral affec- 
tions, also in torpid states of the intestines with much slimy intestinal 
mucus ; but it is contraindicated in cases attended by irritability of the 
stomach and bowels. 



SCILLA, Squill, — is the sliced bulb of Urginea maritima, a peren- 
nial plant of the nat. ord. Liliacese, growing on the shores of the Medi- 
terranean. Its active principle has not yet been definitely isolated, but 
it is probably the acrid, bitter glucoside Scillitoxin. Other principles 
have been obtained and are named Scillipicrin, Scillitin and Scillin, also 
a peculiar carbo-hydrate or mucilage named Sinistrin and the usual con- 
stituents of plants. Dose, in powder, gr. j-iij. 

Preparations. 

Extractum Scillse Fluidum, Fluid Extract of Squill. — Dose, TT\j-v. 

Tinctura Scillse, Tincture of Squill, — 15 per cent. Dose, TT\,v-xxx. 

Acetum Scillae, Vinegar of Squill, — 10 per cent. Dose, TtLx-^j. 

Syrupus Scillae, Syrup of Squill, — has of the Acetum 45 parts, with Sugar 80 and 
Water to 100. Dose, 3 ss-ij. 

Syrupus Scillae Compositus, Compound Syrup of Squill, — has of the fluid ex- 
tracts of Squill and Senega, each 8, Tartar Emetic 0.2, Calcium Phosphate I, Sugar 75, 
Water to 100. Is known popularly as Coxe's Hive Mixture, and contains less than one 
grain of Tartar Emetic to the fluid ounce (15 grains in 17 fl. ozs.). Dose, for children, 
!r L v-£j, the latter being an emetic dose ; for adults, as an expectorant, rtycx-xxx. 



Physiological Action and Therapeutics. 

In small doses Squill is expectorant, in larger doses emetic and diuretic, 
and in overdoses it is a violent irritant poison, producing nausea, vomit- 
ing, purging, gastro-enteritis, strangury, bloody urine, perhaps suppression 
of urine, paralysis and convulsions, with death by paralysis of the heart 
in systole. Medicinal doses slow the heart, making the pulse stronger 
and slower, raising the arterial tension, and increasing the flow of urine 
(like Digitalis). Its active constituents diffuse into the blood, and its 
systemic effects follow on its application to the skin and seem to be ex- 
erted upon the mucous membrane of the secretory organs, especially affect- 
ing the bronchial, gastro-intestinal and genito-urinary. 

Squill is employed in medicine for its expectorant and diuretic effects. 
It is especially applicable in cardiac dropsy, combined with digitalis or 
the saline diuretics, and in chronic bronchitis, in which it may be asso- 
ciated with ipecac or ammonia, asafetida, benzoin, etc. It is also used 
in croup, but is usually combined in this affection with some other 
emetic, as tartar emetic in the compound syrup, a mixture which may 
produce very depressing effects and should be used with caution. In 



476 SCOPARIUS. 

whooping-cough and other irritant coughs with tickling sensations in the 
throat the Syrup or Vinegar of Squill is often of great service. 

The action and uses of Squill should be studied in connection with 
those of Digitalis and Ipecacuanha. 



SCOPARIUS, Broom,— the tops of Cytisus Scoparius, the Broom- 
plant, a common garden shrub of the nat. ord. Leguminosse, having 
small, downy leaves and numerous large golden-yellow flowers. It con- 
tains Scoparin, C 2 iH 22 O 10 , a neutral, crystallizable principle ; also Spar- 
teine, C 15 H 26 N 2 , a volatile, liquid alkaloid, which contains no oxygen, 
but possesses very decided basic qualities and is highly poisonous. 

Prepa rations. 

Extractum Scoparii Fluidum, Fluid Extract of Scoparius, — made with diluted 
alcohol. Dose, gss-ij.. 

Decoctum Scoparii, Decoction of Broom-tops (Unofficial), — ^j to the pint. Dose, 
^j every three hours until a diuretic effect is produced. 

Sparteinae Sulphas, Sparteine Sulphate, — white, prismatic crystals, or a granular 
powder, of slightly saline and bitter taste, very soluble in water and in alcohol. Dose, 
gr. -y^-\, hypodermically, gr. J^-ij by the mouth. Small doses, gr. -^-\, every five 
hours, for cardiac action; larger, gr. j-ij, for diuresis (Clarke). Larger doses are nec- 
essary, say gr. iss-iij, ter die (Prior). 



Physiological Action. 

Broom-tops are diuretic and laxative, also emetic and cathartic in large 
doses. In the form of decoction they have long been a favorite diuretic 
and vehicle for other diuretics in the treatment of dropsies, both cardiac 
and renal, but are considered most reliable in dropsy of renal origin. 

Sparteine has been thought to resemble Coniine in its action, paralyz- 
ing the end-organs of the motor nerves and vagi, lowering the reflex 
excitability of the cord, and causing death by paralyzing the respiratory 
centre in the medulla. Later observations, however, place it in the 
Digitalis group, and in the front rank thereof. In small doses it slows 
and strengthens the heart-beats and raises the arterial tension, at the same 
time increasing the cutaneous and renal circulation, so that the surface 
becomes flushed and moist, and in some cases marked diuresis and dia- 
phoresis occur. The respiration, at first quickened, is soon slowed and 
deepened, the patient experiencing a sense of increased warmth and well- 
being, and if suffering from irregular cardiac action, precordial distress 
and dyspnea, these symptoms are promptly relieved. If the pulse has 
been abnormally slow Sparteine will quicken it, though its general action 
is to slow the cardiac rate. An overdose brings on marked palpitation, a 
small and rapid pulse of high tension, precordial pain and a sense of 
" tightness " about the chest, with anxiety, and a feeling of great debility, 



scoparius. 477 

perhaps even muscular tremor. Death occurs by asphyxia from depres- 
sion of both the centre and the muscles of respiration. 

Sparteine acts directly on the cardiac muscle as well as upon the inhib- 
itory apparatus, giving greater force to the cardiac contractions and 
regulating (generally slowing) the pulse-rate. It also stimulates the vaso- 
motor centre to contract the vessels throughout the splanchnic area, thus 
increasing the circulation in the skin and kidneys and raising arterial 
tension generally. Its diuretic power on healthy persons is denied by 
some observers and affirmed by others, though all acknowledge it in dis- 
ease. It is accompanied by increased excretion of urea, is due to the 
increase of blood-pressure both behind and in front of the renal circula- 
tion, and is produced only by large doses, gr. ^-gr. ij. 

The action of Sparteine upon the circulation is manifested quickly as 
compared with that of other similarly acting drugs. In ^ hour after its 
ingestion the pulse is markedly slower, in another ^ hour the arterial 
tension rises, and both effects last from 5 to 6 hours. When taken regu- 
larly for several days or weeks its influence remains for nearly a week after 
its discontinuance. There is no danger, of cumulative action. Though 
the dosage employed has varied from gr. -J-g- every 4 hours to gr. xij in 
24 hours, no toxic action was observed, nor was there any evidence of 
accumulation, even when given continuously for 3 to 4 months. (Clarke.) 
Only from a dose of gr. xxxj were evil effects observed. (Prior.) 

Therapeutics. 

Broom-tops are a favorite remedy for dropsy of cardiac origin and for 
the anasarca of chronic kidney disease, but are inadmissible in acute 
renal affections or where pulmonary congestion or inflammation exists. 

Sparteine has been employed with very great benefit in cardiac affec- 
tions requiring stimulation of the heart's action with the smallest possible 
increase of arterial tension, also the relief of dyspnea, precordial pain, 
palpitation and edema. In such cases small doses, gr. y 1 -^ to \, are best, 
and as the influence of the drug is remarkably sustained they need not be 
repeated oftener than once in 5 or 6 hours. It has given the most 
marked satisfaction in mitral regurgitation, in which it relieves all the 
symptoms; also in mitral stenosis, when the pulse is small, weak and 
irregular. In aortic regurgitation, it quiets the excited taction of the heart 
without unduly prolonging the systole, and is of great value. Used in 
chronic Bright's disease, with hypertrophy and high arterial tension, it 
stimulates the heart without increasing the tension. In exophthalmos it 
gives remarkable relief to all the symptoms. For cardiac palpitation and 
arrhythmia, small doses are of great service. In asthma it is of signal 
benefit, cutting short the paroxysms and rendering their recurrence much 
less frequent. In the opium-habit it is used at periods of depression 



47$ SCUTELLARIA SENEGA. 

during the treatment, to overcome the plateau shown in the sphygmo- 
graphic trace by stimulating the cardiac action. (Jennings.) For this pur- 
pose, doses of gr. iss-iij three or four times daily are necessary. (Prior.) 

SCUTELLARIA, Skull-cap, — is the plant Scutellaria lateriflora, an indigenous, 
perennial herb of the nat. ord. Labiatse, growing in moist places and along ditches. It 
contains a little volatile oil, traces of a bitter principle, besides fat, tannin and sugar. 

Extractum Scutellariae Fluidum, Fluid Extract of Scutellaria. — Dose, gss-ij. 

Scutellaria produces no very obvious effects when taken internally. By some practi- 
tioners it is said to have tonic, nervine and antispasmodic powers, and it has been used 
in domestic practice to calm the nervous system in diseases characterized by restlessness, 
tremors, spasms, twitching of the muscles, hyperesthesia, etc., as chorea, delirium tremens, 
nervous exhaustion from fatigue or over-excitement, hydrophobia, hysteria and epilepsy. 
The Scutellarin of the eclectics is not a proximate principle, but an extract precipitated 
by alum from a concentrated aqueous tincture. It is given in dose of gr. j-iv. 

SENEGA, — is the root oi Poly gala Senega, an indigenous, perennial 
plant of the nat. ord. Polygaleae, having small, white flowers in a close 
spike at the summit of the stem. Its principal constituent is the glucoside 
Senegin, C 32 H 54 18 , which is identical with Saponin, and closely allied to 
Digitonin. It is a white, amorphous powder, readily soluble in alcohol 
and hot water, forming a soapy emulsion when mixed with boiling water, 
and decomposed by HC1 into sugar and Sapogenin, C 14 H 22 2 . 

Preparations. 

Extractum Senegae Fluidum, Fluid Extract of Senega. — Dose, TTVx-xx. 

Syrupus Senegas, Syrup of Senega, — has of the fluid extract 20, Aqua Ammonise ^, 
Sugar 70, Water to 100. Dose, gj-ij. 

Syrupus Scillae Compositus, Compound Syrup of Squill, — contains 8 per cent, of 
Senega. (See under Scilla, page 475.) 

Physiological Action and Therapeutics. 

Senega is a stimulating expectorant, a diuretic and a diaphoretic. It 
causes irritation of the throat, with some salivation and gastro-intestinal 
irritation, an inclination to cough, increased bronchial secretion, and 
perhaps some diuresis and diaphoresis. Inhaled as a snuff it is very irri- 
tant to the mucous membrane of the nose, causing cough, sneezing and 
nasal catarrh. Senegin is violently irritant and a powerful depressant of 
the heart, and of the vascular, nervous and muscular systems. It is ex- 
creted by the bronchial mucous membrane, the kidneys and the skin, 
all of which it stimulates and in large quantity irritates. 

The use of Senega is chiefly that of a stimulating expectorant in chronic 
bronchitis, the second stage of acute bronchitis, typhoid pneumonia, 
asthma and croup, also as a diuretic in dropsy due to renal disease. It 
removes the tightness and oppression experienced in the subacute chest 
affections, relieves cough and rapidly promotes expectoration. When the 
mucus is tough and scanty this remedy is of no value. It has been used 



SENNA. 479 

with benefit in amenorrhea, given in saturated decoction for two weeks 
before the expected period. In chronic rheumatism and in rheumatic' 
paralysis its stimulating and diaphoretic powers have been of great value. 
Senegin has been successfully used in 2-grain doses as a remedy for uterine 
hemorrhage. 

SENNA, — the leaflets of Cassia acutifolia (Alexandria Senna), and of 
Cassia angustifolia (India Senna), shrubs of the nat. ord. Leguminosae, 
growing in Egypt and India. They contain an amorphous glucoside, 
Cathartic Acid, C 180 H 192 N 2 SO 82 , which forms salts with bases and may be 
decomposed into glucose and Cathartogenic Acid. Other constituents 
are Sennapicrin and Sennacrol, both glucosides ; Catharto-mannite, a 
peculiar, unfermentable sugar ; also a coloring matter allied to Chrysa- 
robin, and various vegetable salts. 

Preparations. 

Extractum Sennae Fluidum, Fhiid Extract of Senna, — an excellent preparation. 
Dose, 3 ss- ^ ss. 

Syrupus Sennae, Syrup of Senna, — has of Alexandria Senna 25, Oil of Coriander 
y 2 , Alcohol 15, Sugar 70, Water to 100. Dose, 3J-^j. 

Confectio Sennae, Confection of Senna, — has of Senna 10, Cassia Fistula 16, Tama- 
rind 10, Prune 7, Fig 12, Sugar 55^2, Oil of Coriander ]/ 2 , Water to 100. Is sold under 
the trade names Tamar-Indien, Tropical Fruit Laxative, etc. Dose, £J-ij. 

Infusum Sennae Compositum, Compound Infusion of Senna (Black Draught), — 
has of Senna 6, Manna 12, Magnesium Sulphate 12, Fennel 2, Boiling Water 80, Cold 
Water to 100. Dose, ^j-iij. 

Pulvis Glycyrrhizae Compositus, — Co ?npound Liquorice Powder (See under Gly- 
CYRRHIZA), — contains 18 per cent, of Senna. Dose, ^ss-^jss. 

Syrupus Sarsaparillae Compositus, Compound Syrup of Sarsaparilla (See under 
Sarsaparilla), — contains iy£ per cent, of the fluid extract of Senna. Dose, 3J-5J. 

Physiological Action and Therapeutics. 

Senna is a very efficient and safe cathartic, producing copious yellow 
stools in about 4 hours, with considerable griping and flatulence, which 
may, however, be lessened by combining it with carminatives. Its action 
is chiefly expended on the small intestine, and it increases both peristalsis 
and secretion. It has no irritant quality in ordinary doses, and does not 
produce hypercatharsis, or leave constipation as an after-result. Its in- 
fusion injected into the veins causes both vomiting and purging ; and in 
large doses by the mouth it produces nausea, vomiting, flatulence, excited 
pulse and drastic purgation with severe tenesmus, but its effects are never 
poisonous. It may cause hemorrhoids and increase the menstrual flow in 
women. Given to a nursing mother her milk will acquire purgative 
powers. In some very susceptible persons the odor of the leaves or of 
the infusion will cause an evacuation of the bowels. Its odor and taste, 
are particularly disagreeable, especially when administered in infusion. 



4§0 SERPENTARIA. 

Senna would probably take rank as our best and safest cathartic but for 
the nauseousness of its smell and taste. It is a favorite laxative in England 
for children, and is used with great benefit in habitual constipation or 
where prompt evacuation of the bowels is required. In hemorrhoids and 
anal fissure it is employed to produce soft and easy motions ; but if a 
tendency to hemorrhoids exists, the use of this drug in cathartic doses 
will cause irritation of the part and induce an acute attack. For the same 
reason it is contraindicated in hemorrhage or inflammation of the intes- 
tinal mucous membrane, menorrhagia, and abortion. The least disa- 
greeable of its preparations are the Confection of Senna and the Com- 
pound Liquorice Powder. 

SERPENTARIA, Virginia Snake-Root,— is the rhizome and 
roots of Aristolochia Serpentaria and of Aristolochia reticulata, indigen- 
ous herbaceous plants of the nat. ord. Aristolochiaceae, growing in rich, 
shady woods, with purple flowers arising from joints near the root. It 
contains a volatile oil, a camphor-resin and a bitter principle named 
Aristolochine, which is soluble in both alcohol and water. All its prepa- 
rations should be made from the fresh root, as it deteriorates by keeping. 

Preparations. 
Extractum Serpentarias Fluidum, Fluid Extract of Serpentaria. — Dose, rt^x-ocxx. 
Tinctura Serpentariae, Tincture of Serpentaria, — 10 per cent. Dose, ^ss-ij. 
Tinctura Cinchonae Composita, Compound Tincture of Cinchona, — has two parts 
of Serpentaria in 100. (See ante, under Cinchona.) Dose, ^j-ij. 

Physiological Action and Therapeutics. 

Serpentaria is a stimulant expectorant and tonic, a cardiac stimulant, 
a diaphoretic, diuretic, emmenagogue, aphrodisiac, and somewhat of an 
antiperiodic. Its taste is warm and pungent, its odor is characteristic. 
Small doses promote appetite and digestion, increase the bronchial and 
intestinal secretions, the action of the heart, the cutaneous circulation 
and the surface temperature, and produce mental exhilaration. Large 
doses are irritant, causing nausea and vomiting, vertigo and headache, 
colic, borborygmi, rectal tenesmus, flatulent distention and frequent but 
not watery stools. The irritant action seems to produce gas rather than 
fluid. Pruritus ani and hemorrhoids are occasionally caused by its use. 

Serpentaria is chiefly employed as a vehicle for other stimulant drugs, 
but has many uses of its own. In bronchial affections it is extremely 
valuable as a stimulating expectorant. In typhoid pneumonia it is a 
good vehicle for ammonium carbonate, and in the exanthemata it is use- 
ful when much depression exists. It is indicated in typhoid conditions 
generally, and in the amenorrhea of anemia and chlorosis it is an efficient 



SESAMI OLEUM SILICATES SINAPIS. 48 I 

emmenagogue in many cases. It will often restore the waning sexual 
power in functional impotence, while in bilious vomiting it frequently 
checks the nausea and settles the stomach. It is used as a vehicle for cin- 
chona in remittent fever. In diphtheria, scarlatina, etc., an infusion 
forms an excellent gargle. Its diaphoretic and diuretic properties, though 
slight, are sometimes of avail in chronic rheumatism. 

SESAMI OLEUM, Oil of Sesamum, Teel Oil, Benne Oil,— is a fixed oil ex- 
pressed from the seeds of Sesamttm indicum, or Benne plant (nat. ord. Pedaliaceae), 
which is a native of India, but is cultivated in the southern portion of the U. S. It is a 
yellowish or yellow, oily liquid, inodorous or nearly so, having a bland, nut-like taste 
and a neutral reaction. It is a bland fixed oil, very similar in its properties to olive oil, 
and may be used for the same purposes. It is rich in Olein (76 per cent.) and keeps 
better than olive oil. It is chiefly employed as a hair-oil. 

SILICATES of Sodium (Na 2 Si0 3 ), of Potassium (K 2 Si0 3 ), and of 
Magnesium (2Mg03Si0 2 ) are used in medicine and surgery, a solution 
of the Sodium Silicate being official. 

Liquor Sodii Silicatis, Solution of Sodium Silicate, Soluble Glass 
Solution, — is a semi-transparent, colorless or yellowish, viscid liquid, 
odorless, of sharp saline and alkaline taste and alkaline reaction. A 
small quantity should not produce any caustic effect when applied to the 
skin. It usually contains about 20 per cent, of Silica and 10 per cent, of 
Soda, and is used on bandages to make immovable dressings, being lighter 
than plaster-of- Paris and stronger than starch. 

Liquor Potassii Silicatis, Solution of Potassium Silicate (Unofficial), — also known 
as Soluble Glass Solution, — is used for immovable dressings in the same manner as the 
preceding. A mixture of 2 parts of this solution with one of the soda salt solution is said 
to set more quickly and firmly than either solution separately. Diluted (1 to 4) the 
solution of Potassium Silicate has been applied locally in erysipelas, gonorrhea, cystitis, 
vaginitis, etc., as an antiseptic with good results. 

Magnesii Silicas Hydratus, Hydrated Magnesium Silicate, Meerschaum, 2MgO,- 
3Si0 2 -j-2H 2 (Unofficial), — a mineral used for the manufacture of smoking-pipes, and 
employed in France as a substitute for Bismuth Subnitrate in obstinate choleraic diarrhea, 
to protect the intestinal mucous membrane or as an absorbent. It is given in fine powder 
and in doses of 3 j-iv per diem. 

SINAPIS, Mustard, — is official under the two following titles, but 
the pharmacopceial preparations are directed to be made from Black Mus- 
tard only. 

Sinapis Alba, White Mustard, — the seed of Brassica alba, an annual 
plant of the nat. ord. Cruciferae, cultivated in our gardens. It has yellow 
flowers in racemes, and ribbed pods with a long, ensiform beak. 

White Mustard contains Myrosin, a ferment, and Sinalbin, a crystalline substance, 
which reacting on each other in the presence of water produce Sulpho-cyanate of Acrinyl, 
a rubefacient principle allied to the volatile oil of black mustard. It also contains Sin- 
apine, an alkaloid, Erucic or Brassic Acid, and a bland, fixed oil, all three of which are 
contained also in black mustard. 



4§2 SINAPIS. 

Sinapis Nigra, Black Mustard, — is the seed of Brassica nigra, an 
annual plant of the nat. ord. Cruciferse, native of Europe, but natural- 
ized in the U. S. It has small, yellow flowers on peduncles at the end 
of the branches, also smooth, erect pods with a short beak. 

Black Mustard contains Myrosin, a ferment, and Sinigrin (Potassium Myronate), 
which reacting on each other in the presence of water produce the Sulpho-cyanide of 
Allyl, or Volatile Oil of Mustard. It also contains Sinapine, an alkaloid, Erticic or 
Brassic Acid, and a bland, fixed oil ; all three of which are contained also in white 
mustard. 

Commercial Flour of Mustard (Unofficial), — is a mixture of white and 
black mustard seeds ground to a fine powder. It may be employed in 
lieu of either variety. Dose, as an emetic, ^ij-iv. 

Preparations. 

Oleum Sinapis Volatile, Volatile Oil of Mustard, Stdpho-cyanide of Allyl, C 4 H 5 - 
NS, — a colorless or pale yellow liquid, of pungent, acrid odor and taste and neutral re- 
action, almost insoluble in water but freely soluble in alcohol and ether. Dose, '^\J L /%-]/\- 

Charta Sinapis, Mustard Paper, — ^Consists of Black Mustard, the fixed oil removed 
by percolation with Benzin, mixed with Solution of Gutta-Percha and spread on paper. 
Each square inch should contain about gr. vj of Mustard. For local use. 

Linimentum Sinapis Compositum, Compound Liniment of Mustard, — has of the 
Volatile Oil 3, Fl. Ext. of Mezereum 20, Camphor 6, Castor Oil 15, Alcohol to 100. 



Physiological Action and Therapeutics. 

Locally used, Mustard is rubefacient, counter-irritant, and a nervous 
stimulant, causing heat, redness and severe burning pain. Its prolonged 
application produces vesication by inducing local inflammation. Inter- 
nally it is a local emetic in full doses, in smaller doses a condiment and 
carminative. Its irritant effect on the gastric mucous membrane is much 
less powerful than on the skin. 

Mustard is commonly used as a local application to relieve local pain, 
to stimulate the viscera, and to produce counter-irritation. These ob- 
jects find their application in muscular rheumatism, neuralgia, colic, 
gastralgia, inflammation of the throat, larynx, bronchi, lungs, pleurseand 
pericardium ; also as a derivative in headache, cerebral congestion, and 
suppressed menstruation. It may be used as a stimulant to the heart, 
vascular system and respiratory apparatus. When action of a mild char- 
acter is desired it may be diluted with flaxseed or flour. Internally it 
may be employed as an emetic in indigestion or narcotic poisoning. Its 
use as a condiment is familiar, acting by stimulation of the gastric mu- 
cous membrane. In overdoses it may excite severe gastritis. White 
Mustard seed, unground, has been used as a laxative, as it produces no 
irritation. The Oil is one of the most irritant of the volatile oils, pro- 
ducing severe gastro-enteritis. It is used chiefly as an ingredient of 
stimulating liniments, but may be employed internally in small doses. 



SODIUM. 483 

SODIUM, Natrium, Na. — This metal is represented by a number 
of official salts, which are generally colorless or white, and with very few 
exceptions are readily soluble in water. Some of them are found native, 
as the Chloride (in sea-water, salt lakes, salt mines), the Nitrate (in 
Peruvian deserts), and the Borate (in lakes of Persia, California, etc.). 
The Carbonate is found in the ashes of marine plants. From the Chlo- 
ride is prepared the Sulphate, from this the Carbonate, and from the latter 
most of the other salts are prepared. All sodium salts impart a yellow 
color to flame, which should not appear more than transiently red when 
observed through a blue glass. The latter cuts off the yellow rays 
but allows the violet ones of potassium to be seen. 

Sodium Compounds and their Preparations. 

Soda, Sodium Hydrate, Caustic Soda, NaOH, — a white, hard, opaque solid, deliques- 
cent in moist air, efflorescent in dry air, odorless, of intensely acrid and caustic taste and 
strongly alkaline reaction, soluble in 1.7 of water at 59 F., and in 0,8 of boiling water, 
very soluble in alcohol. Is a powerful caustic, but milder than Potassa, and should be 
kept in well-stoppered bottles made of hard glass. 

Liquor Sodae, Solution of Soda, — contains about 5 per cent, of the hydrate, and may 
be prepared by dissolving 56 of Soda in 944 of Distilled Water. It is a clear, colorless 
liquid, odorless, of acrid and caustic taste and strongly alkaline. Dose, TTLv-^ss, well 
diluted with water. 

Sodii Acetas, Sodium Acetate, NaC 2 H 3 2 -f- 3H 2 0, — large, transparent prisms, efflo- 
rescent in dry air, odorless, of saline, bitter taste and a neutral or faintly alkaline reaction, 
soluble in 1. 4 of water and in 30 of alcohol at 59 F. , in ]/ z of boiling water and in 2 of 
boiling alcohol. Dose, gr. xx-^j. 

Sodii Carbonas, Sodium Carbonate, Na 2 C0 3 -f- ioH 2 0, — large, colorless crystals, 
rapidly efflorescent, with a harsh alkaline taste and strongly alkaline reaction ; very solu- 
ble in water, insoluble in alcohol. Of it 20 grains will neutralize 9.7 grains of Citric 
Acid, or \o l / 2 grains of Tartaric Acid. Dose, gr. v-xxx. 

Sodii Carbonas Exsiccatus, Dried Sodium Carbonate, — is the Carbonate 200 parts 
dried at a heat of 113 F. , until it is converted into a white powder weighing 100 parts. 
Is chiefly used for pharmaceutical purposes. 

Sodii Bicarbonas, Sodium Bicarbonate, NaHC0 3 , — an opaque, white powder, per- 
manent in the air, odorless, of cooling, saline taste, and a slightly alkaline reaction ; solu- 
ble in 1 1. 3 of water, insoluble in alcohol, decomposed by hot water and converted into 
normal Carbonate. Of it 20 grains neutralize 16.7 grains of Citric Acid, or 17.8 grains 
of Tartaric Acid. It is a constituent of Mistura Rhei et Sodae and of Pulvis Effervescens 
Compositus. Dose, gr. x-gj. 

Trochisci Sodii Bicarbonatis, Troches of Sodium Bicarbonate, — each troche con- 
tains of the Bicarbonate about 3 grains, with Sugar, Nutmeg and Mucilage of Tragacanth. 

Sodii Chloras, Sodium Chlorate, NaC10 3 , — colorless, transparent tetrahedrons, per- 
manent in dry air, odorless, of cooling, saline taste and neutral reaction ; soluble in I.I 
of water and in about 100 of alcohol, also in 0.5 of boiling water and in about 40 of boil- 
ing alcohol. Should be kept in well-stoppered bottles, and should not be mixed or 
heated or triturated with readily oxidizable or combustible substances. Dose, gr. v-xx. 

Sodii Chloridum, Sodium Chloride, Common Salt, NaCl, — white, hard, cubical 
crystals or a crystalline powder, permanent in the air, odorless, of a purely saline taste 
and neutral reaction ; soluble in 2.8 of water at 59 F. , and in 2.5 of boiling water. 
Almost insoluble in alcohol. Dose, gr. x-^j. 

Sodii Nitras, Sodium Nitrate {Chili Nitre, Chili Saltpetre), NaN0 3 , — colorless, 
transparent crystals, slightly deliquescent, odorless, of cooling, saline and bitter taste,, 
and neutral reaction ; soluble in 1.3 of water at 59 F. , in 0.6 of boiling water, scarcely 
soluble in cold alcohol. Dose,^j-ij. 



484 SODIUM. 

Sodii Sulphas, Sodium Sulphate, Glauber' 's Salt, '^Sa 2 SO i -f- loH 2 0, — large, color- 
less, transparent, monoclinic prisms, rapidly efflorescent in air ; of cooling, saline taste 
and neutral reaction ; soluble in 2.8 of water at 59 F., in 0.25 of water at 93. 2° F., 
and in 0.47 of boiling water, insoluble in alcohol. Dose, gr. v-xx ; as a purgative ^ ss-j. 

Sodii Ethylas, Sodium Ethylate, Caustic Alcohol, C 2 H 5 NaO (Unofficial), — is a 
white powder, often having a brownish tinge, dissolving in water with a hissing sound. 
Upon contact with the smallest quantity of water or moist living tissue it splits into alco- 
hol and caustic soda. An alcoholic solution is made by dissolving sodium in absolute 
alcohol, and is used as a caustic. Chloroform decomposes it at once into ether and 
sodium chloride. It should be kept in a cool place as it is liable to explode. 

The Arsenate is described under Arsexum ;— the Benzoate under Benzoinum ; — 
the Borate under AciDUM Boricum ; — the Bromide under Bromum ; — the Solution 
of Chlorinated Soda under Chlorum ; — the Iodide under Iodum ; the Hypophos- 
phite, Phosphate and Pyrophosphate under Phosphorus ; — the Nitrite under 
Amyl Xitris ; — the Salicylate under Salicix ; — the Sulphite, Bisulphite and 
Hyposulphite under AciDUM Sulphurosum ; — and the Sulpho-carbolate under 
Acidum Carbolicum. 

Physiological Action. 

The action of the Sodium salts is similar to that of the Potassium salts, 
except that the former are feebler as alkalies, are not so depressant, and 
are not so poisonous to the cardiac muscle or the nerves. They are dif- 
fused more slowly, are neither absorbed nor excreted so readily, and have 
not so marked a diuretic action. Locally applied in large doses to mus- 
cular and nervous tissue they are paralyzant, but not so powerfully as 
potassium salts. Sodium Urate is not soluble like the urates of lithium 
and potassium, and is therefore much less readily excreted, forming the 
masses called chalk-stones in gouty subjects. Soda is a less active eschar- 
otic than potash, having less affinity for water. Liquor Sodas renders 
the blood and secretions more alkaline, but does not alter nutrition to 
the extent that liquor potassse does. The Acetate is converted into the 
Carbonate in the blood, and is a less active diuretic than the correspond- 
ing potassium salts. The Carbonate is chiefly used in the preparation of 
the other salts. The Bicarbonate is slightly irritant, stimulates the secre- 
tion of gastric juice, acts as an antacid and will increase the alkalinity of 
the blood. The Nitrate is a mild cathartic and in solution is a solvent 
of false membranes. The Ethylate is an antiseptic and a powerful but 
almost painless caustic. 

Sodium Chloride (common salt) is one of the most important and 
abundant of the saline constituents of the animal organism, existing nor- 
mally in the blood, where it keeps the fibrin and albumin in solution ; 
hence in inflammation, being thus needed, it accumulates at the seat of 
the morbid action disappearing temporarily from the urine ; its reap- 
pearance therein being considered one of the surest signs of the patient's 
improvement. In very dilute solution it enables water to dissolve both 
albumins and globulins, and renders water non-irritant to the animal 
tissues and harmless to the red blood-corpuscles. For these purposes the 
solution employed is one of 0.65 per cent., known in experimental physi- 



SODIUM. 485 

ology as the normal salt solution. In substance however or in concen- 
trated solution, the salt is very irritant to cut surfaces, mucous mem- 
branes, muscle and nerve tissues. Taken into the stomach in quantity it 
irritates that organ and induces vomiting. When absorbed in excess of 
the normal requirements of the body it causes the peculiar nervous irri- 
tation expressed by the sense of thirst; which is relieved only by the 
ingestion of water in sufficient quantity to enable the excess to be dis- 
solved and excreted by the kidneys. It is rapidly absorbed, and rapidly 
excreted ; and when consumed in excess it increases tissue-change and 
consequently the excretion of urea and potassium salts. On the other 
hand, the excessive ingestion of potassium salts (as in the cases of herbi- 
vorous animals and vegetarian cranks) increases the excretion of sodium 
chloride by a double decomposition between these salts in the blood, 
forming potassium chloride and sodium phosphate, which being foreign 
to the blood are constantly excreted. In this way, by a continuous vege- 
table diet the normal amount of sodium chloride in the organism may be 
greatly reduced, and the animal will feel the want of it and will travel 
hundreds of miles to visit a salt-lick. Besides being emetic when given 
internally, Sodium Chloride also acts as a hemostatic, decreases the 
secretion of mucus, is a vermifuge against thread-worms, promotes the 
absorption of pleuritic serous exudations and of dropsies, and has consider- 
able power as an antiperiodic and an antiseptic. 

Sodium Sulphate, administered by the mouth in dilute solution, excites 
active secretion in the intestines, especially in the small intestine, partly 
by its bitterness but also by its irritant quality and its specific property 
of stimulating the activity of the intestinal glands. The action is not an 
osmotic one, as was formerly taught. The stimulation caused by this 
salt extends to the liver and the pancreas, especially the former. The 
absorption of the secretions is impeded by the low diffusibility of the 
salt, so that the result is a large accumulation of fluid in the intestinal 
canal, which finds its way to the rectum and produces purgation. The 
more dilute the solution employed the more prompt will be the effect, 
but this salt will not produce catharsis if administered in concentrated 
form. When injected into the blood it excites no intestinal secretion, 
does not act as a purgative, and produces no toxic effect. [Magnesium 
Sulphate is toxic when so administered.] The quantity of Sodium Sul- 
phate to the pint of Carlsbad water (Sprudel) is 20 grains, in Friedrichs- 
thal 463^ grains, and in Hunyadi Janos from 122 to 173 grains ; the latter 
being the most active hepatic stimulant of the three. A mixture of the 
Sulphate and the Bicarbonate is sold as the natural salt obtained by 
evaporation of Carlsbad water. 

The action of the other Sodium salts is described under the titles of 
the respective constituents to which their effects are mainly referable. 



486 SOLANUM CAROLINENSE. 

Antidotes and Inconipatibles. 
Poisoning by caustic alkalies is treated by the dilute Vegetable Acids, as vinegar, cider r 
lemon-juice ; then demulcent drinks and oils to protect the mucous membrane, and the 
usual vital supporters. The alkalies and their carbonates are incompatible with the acids 
and also with metallic salts, and the caustic alkalies decompose most alkaloids. 

Therapeutics. 

The Sodium salts mentioned in the first paragraph treating of their 
action are not much used internally, the corresponding Potassium salts 
being preferred, especially when it is desired to alkalinize the urine or to 
promote oxidation. In the alkaline treatment of stomach affections the 
Sodium salts are the most efficient, especially the Bicarbonate, in small 
doses before meals or on an empty stomach to increase the gastric juice. 
The same salt is used in diabetes to lessen the amount of sugar, in frontal 
headache with constipation, the pain being seated at the junction of the 
forehead with the hairy scalp, also as a wash (gr. ij ad Sj) in itching skin 
affections and as a lotion in burns and eczema. The Chloride is used 
internally as an antidote in poisoning by silver nitrate and as an emetic, 
and will often relieve hemoptysis and migraine. In bilious diarrhea it 
is employed in doses of gr. x-^j, thrice daily. Locally in baths it is a 
good stimulant to the skin, and in solution (*4 to 1 P er cent.) to wash 
wounds, to cleanse the nasal cavities, or to destroy thread-worms, in 
which case it is given by enema of the strength of two tablespoon fuls to 
the pint. The Carbonate may be used in dilute solution locally to pre- 
vent itching, but is chiefly employed in the preparation of the other salts. 
The Sulphate is a good purgative and hepatic stimulant, and is given 
either alone or with the Bicarbonate in imitation of Carlsbad salts, for 
bilious disorders, gouty affections, chronic constipation, obesity and dia- 
betes mellitus. The Chlorate has uses similar to those of Potassium 
Chlorate, and being more soluble can be used in stronger solutions, but 
this is of doubtful benefit for internal use, as it has all the irritating 
power on the kidneys and destructive action on the blood possessed by 
the other salt. The Nitrate is employed as a mild cathartic, and in solu- 
tion by atomization to destroy the false membrane in diphtheria. The 
Ethylate has been of service as a caustic in cancer, lupus and nevus, for 
the latter affection being painted over the growth with a glass rod. 
Caustic Soda is a better escharotic than caustic potassa, as it has less 
affinity for water, and hence does not destroy the tissues so deeply, nor 
has it the same tendency to run over adjacent parts. 

The therapeutics of the other sodium salts are described under the titles 
of the constituents to which their uses are chiefly referable. 

SOLANUM CAROLINENSE, Horse-nettle, Sand-brier (Unofficial),— is a 
weed belonging to the nat. ord. Solanaceae, a native of Florida and Carolina. In epilepsy 



SPIGELIA STAPHISAGRIA STILLINGIA. 487 

a 20 per cent, tincture of the berries is highly recommended, in doses of 3 ss-j thrice 
daily. It has also been used with benefit in convulsions due to the albuminuria of 
pregnancy and in other convulsive affections. 

SPIGELIA, Pink-root, — is the rhizome and roots of Spigelia ma- 

rilandica, the Carolina Pink, an herbaceous perennial of the nat. ord. 
Loganiaceae, native of the Southern States; having large, showy flowers, 
scarlet or crimson externally, yellow within. It contains a bitter prin- 
ciple and a volatile oil, also tannin, wax, resin, lignin and salts. Dose, 
3j-ij for an adult, gr. x-xx for a child of 3 years. 

Extractum Spigeliae Fluidum, Fluid Extract of Spigelia. — Dose for an adult, 3 j-ij ; 
for a child of 3 years, TT^x-xx. 

Infusum Spigeliae Compositum, Compound Infusion of Spigelia, Worm Tea (Un- 
official), — has Spigelia 15, Senna 10, Fennel 10, Manna 30, Water 500. Dose, ^iss-v. 

Spigelia is anthelmintic against the round-worm (ascaris lumbricoides), 
and is in popular use as a vermifuge, administered with senna. In large 
doses it is an uncertain cathartic, and may produce serious symptoms, as 
vertigo, dimness of vision, dilated pupils, spasms and convulsions. These 
effects are most apt to occur when the drug fails to produce purgation, 
hence it is usually administered with an active cathartic. 

Spigelia Anthelmia, Demarara Pink-root, Worm-grass (Unofficial), — produces 
vomiting, dilated pupils, dyspnea, convulsions and death. If eaten by cattle they perish 
in great agony. It has been used with real benefit in cardiac affections of rheumatic 
origin, also in rheumatic fever and in cardiac palpitation with dyspnea, due to mitral and 
aortic disease. A tincture (i to 8) may be used in doses of TT\v-xx. 

STAPHISAGRIA, Stavesacre, — is the seed of Delphinium Staphisagria, an an- 
nual or biennial plant of the nat. ord. Ranunculacese, a native of Europe, having bluish 
or purple flowers in terminal racemes, and seeds in straight, oblong capsules. The seeds 
contain an alkaloid Delphinine, probably three other alkaloids, a bitter principle, a 
volatile oil and a fixed oil, etc. There are no official preparations. 

Unguentum Staphisagriae, Ointment of Staphisagria (Unofficial), — contains of the 
powdered seeds I part with 2 each of olive oil and lard. 

Delphinina, Delphinine, C 22 H 35 N0 6 (Unofficial), — is the active alkaloid, and exists in 
the fatty oil which is extracted by ether. Dose, gr. jz~h 

Stavesacre is a violent emetic and cathartic, also parasiticide. The alkaloid is irritant 
to the skin if locally used, producing tingling, burning and inflammation. Internally, it 
lowers the activity of the heart and respiration and produces a most profound adynamia, 
and may prove fatal from paralysis of the spinal cord and asphyxia. In many respects 
its alkaloid resembles Aconitine and Veratrine. The ointment is often employed as a 
parasiticide against pediculi and the acarus scabiei. The fixed oil is probably equally 
effective. Delphinine has been used internally in asthma, rheumatism and neuralgia, and 
in the latter affection is well employed as an ointment (gr. xx to ^j), applied over the 
course of painful superficial nerves. It has been suggested as an antipyretic and for 
dropsy. A tincture or fluid extract is a very efficient application against pediculi. 

STILLINGIA, Queen's Root, — is the root of Stillingia sylvatica, 
or Queen's Delight, an indigenous, perennial plant of the nat. ord. 
Euphorbiaceae. It contains a resin and a volatile oil, but its active prin- 
ciple has not yet been isolated. The fresh root should be used in making 



488 STRAMONIUM. 

the preparations, as those from the dried root are almost inactive. Dose 
of the powdered root, gr. x-^j. 

Preparations. 

Extractum Stillingise Fluidum, Fluid Extract of Stillingia. — Dose, Tt^x-gj. 

Tinctura Stillingiae, Tincture of Stillingia (Unofficial). — Dose, gss-ij. 

Decoctum Stillingise, Decoction of Stillingia (Unofficial). — g] ad Oj. Dose, ^j-ij. 

Syrupus Stillingiae Compositus, Compmmd Syrup of Stillingia (Unofficial), — is 
composed of Stillingia, Corydalis, Iris, Chimaphila, Coriander, Xanthoxylum, Sam- 
bucus, Sugar, Water and Alcohol. For the formula, see U. S. Dispensatory, 17th 



editi 



ion. 



Physiological Action and Therapeutics. 

Stillingia in large doses is emetic and cathartic, in smaller doses it is 
expectorant, diaphoretic, diuretic, sialogogue and cholagogue, possessing 
the various properties which are considered "alterative." Its taste is 
acrid and pungent and it increases the action of the heart, skin, kidneys, 
and bronchial mucous membrane, also the gastric, hepatic, intestinal and 
salivary excretions. Full doses often excite epigastric pain, nausea and 
vomiting. 

Stillingia is much employed with Sarsaparilla and similarly acting drugs 
as an alterative in syphilitic affections, particularly in chronic cases of 
the tertiary form, in which the system is greatly reduced by the abuse of 
mercurials and iodides. In these cases it possesses considerable power 
and frequently cures. It is highly esteemed in strumous affections, in 
ascites due to hepatic changes, in portal changes with jaundice following 
malaria, also in habitual constipation, hemorrhoids from hepatic obstruc- 
tion, and intermittents. In the latter affection the fluid extract with 
quinine or arsenic is a very useful combination. A strong decoction is 
used to ward off an impending paroxysm of ague. The compound syrup, 
notwithstanding its reputation as a model of polypharmaceutical skill, is 
still largely used in the West and South. 

STRAMONIUM, Thornapple. — The plant Datura Stramonium, 
the Jamestown Weed or Thornapple (nat. ord. Solanacese), is official in 
two forms, the leaves and the seed. It is an annual, of rank and vigor- 
ous growth, having a green stem with large white flowers. It grows wild 
in Southern Russia and the middle United States, and contains an alka- 
loid, Daturine (see next page), which is generally considered identical 
with Atropine both physiologically and chemically, — also malic acid, 
albumin, gum, resin, etc. 

Stramonii Folia, Stramonium Leaves, — the leaves of Datura Stra- 
monium, of bitter and nauseous taste. Dose, gr. ij-xx. 

Stramonii Semen, Stramonium Seed, — the seed of Datura Stra- 



STRAMONIUM. 489 

monium, of unpleasant odor when bruised and an oily, bitter taste. 
Dose, gr. j. The official preparations are all made from the seed. 

Preparations. 

Extractum Stramonii Seminis, Extract of Stramonium Seed. — Dose, gr. Y°~Yz- 

Extractum Stramonii Seminis Fluidum, Ft. Ext. of St. Seed. — Dose, TuJ-v. 

Tinctura Stramonii Seminis, Tinct. of St. Seed, — 15 percent. Dose, TTLv-xxx. 

Unguentum Stramonii, Stramonium Ointment, — has of the Extract 10, Diluted 
Alcohol 5, Benzoinated Lard 85. 

Daturina, Daturine, C 17 H 23 N0 3 (Unofficial), — is the alkaloid found in all parts of 
the plant, also in Datura Tatula. It is a Tropate of Tropin, isomeric and identical with 
Atropine. Dose, gr. T ^-^. 



Physiological Action. 

The action of Stramonium is similar to that of Belladonna in almost 
every particular, except that Stramonium is more powerful and chiefly 
influences the sympathetic nervous system, not affecting the motor or sen- 
sory nerves. It excites a greater degree of cardiac irregularity and a more 
furious delirium, and seems to have a special affinity for the generative 
apparatus, being decidedly aphrodisiac in full doses. 

As previously stated the alkaloids Atropine, Daturine, Hyoscyamine 
and Duboisine are chemically alike and almost identical physiologically. 
They all produce dilatation of the pupil, increase the cardiac action, the 
pulse and respiration rate and cause delirium. Poisoning by one of them 
is indistinguishable from that by another. 

Antidotes, Antagonists and Incompatibles. 

These are the same as for Belladonna. Poisoning by Stramonium is not uncommon, 
as children may eat the seeds, which should be evacuated by an emetic. If physiolog- 
ical symptoms follow Opium must be exhibited as the antagonist, but cautiously lest 
opium-narcosis be substituted. 

Therapeutics. 
Stramonium is chiefly used as an antispasmodic and to relieve pain. In 
asthma the leaves are smoked with advantage at the commencement of a 
paroxysm, the smoke being drawn into the lungs. In other spasmodic 
affections, as hepatic colic, laryngeal cough, chorea and stammering, it is 
very beneficial. In dysmenorrhea and neuralgia it is used in combina- 
tion with opium and hyoscyamus, and in tic douloureux and sciatica it 
is often very efficient. In nymphomania with great mental depression it 
is frequently effective, and in mania of furious character, particularly the 
puerperal form with suicidal tendency, it is highly serviceable in 10 to 20 
minim doses of the tincture every 3 or 4 hours. The ointment is much 
used in irritable ulcers, and as an anodyne application in painful hemor- 
rhoids and certain cutaneous diseases. 



49° STRONTIUM. 

STRONTIUM, Sr— The metal Strontium is represented in the 
pharmacopoeia by three of its salts, viz. — 

Strontii Bromidum, Strontium Bromide, SrBr 2 -(- 6H 2 0, — colorless, transparent, 
hexagonal crystals, very deliquescent, of bitter, saline taste ; very soluble in water and 
in alcohol, insoluble in ether. Dose, gr. v-xxx. 

Strontii Iodidum, Strontium Iodide, Srl 2 -(- 6H 2 0, — hexagonal plates, colorless, 
transparent, of bitter, saline taste ; very soluble in water also in alcohol and slightly so 
in ether. Dose, gr. v-xxx. 

Strontii Lactas, Strontium Lactate, Sr(C 3 H 5 3 ) 2 -)-3H 2 0, — a white, granular pow- 
der, or crystalline nodules, of slightly bitter and saline taste ; soluble in 4 of water, in 
less than ]/ z of boiling water, also in alcohol. Dose, gr. v-xxx. 

Strontii Salicylas, Strontium Salicylate (Unofficial), — is highly recommended by 
Dr. H. C. Wood. Dose, gr. v-xxx. 

Physiological Action and Therapeutics. 

The Strontium salts are among the recent additions to the materia 
medica. Their marked anti-putrescent and antiseptic properties were 
first noticed in 1891 by Germain See, on patients suffering from gastric 
dilatation. He found that in such cases the Bromide prevented the acetic 
and lactic fermentations and the formation of the gases of decomposi- 
tion. The toxic action, hitherto attributed to the salts of strontium, has 
been ascertained to be due to barium, which was present in the commer- 
cial products used. When pure, they may be safely employed in the 
same doses, and in the same cases, as the corresponding preparations of 
potassium and sodium ; while they are much less liable to cause erup- 
tions and are more rapidly and completely eliminated by the kidneys. 

The Iodide is analogous in action to potassium iodide, its intravenous 
injection producing at first a rapid elevation of arterial pressure with 
acceleration of the cardiac rate, followed by slowing of the heart, and 
later on by lowered blood-pressure with increased heart-rate. It has been 
used, with good results, in the treatment of scrofulous, rheumatoid and 
cardiac disorders, especially scrofuloderma, scrofulous otorrhea, and 
enlarged lymphatic glands ; also in lupus vulgaris and ozena. 

The Lactate has been successfully employed in diabetes and in albu- 
minuria. It diminishes the amount of albumin in Bright's disease, in 
the parenchymatous nephritis of rheumatic and scrofulous subjects, and 
in the albuminuria of pregnancy ; for which purpose it should be given in 
full doses (gr. xxx) thrice daily. It is contraindicated when there is 
scanty urine or symptoms of uremia. Da Costa holds that while the 
strontium salts are admirable as diuretics in renal affections, they accom- 
plish more in the acute than in the chronic forms of nephritis. 

The Salicylate, in doses of gr. v, is one of the best intestinal antiseptics, 
yielding better results than salol, naphtalin and similar agents. In doses 
of gr. x-xv it acts very decidedly as a salicylate in gouty and chronic 
rheumatic conditions, without producing gastric disturbance. In chronic 



STROPHANTHUS. 49 1 

gouty conditions and in lithemia with intestinal indigestion, it is one of 
the most valuable drugs we have. (H. C. Wood.) 

The uses of Strontium Bromide are mentioned with those of the other 
Bromides under the title Bromum. 

STROPHANTHUS,— is the seed, deprived of its long awn, of 
Strophanthus hispidus, an African climbing plant (nat. ord. Apocynacese), 
from which the natives extract a toxic preparation known as the Kombe 
arrow-poison. It contains a crystalline glucoside, named Strophanthin, 
the active principle, which is bitter, slightly acid, soluble in water and 
in alcohol, but almost insoluble in ether, chloroform, benzin, etc. It is 
very plentiful in the seeds (8 to 10 per cent.), and is an agent of great 
energy, the frog being killed by a solution of i in 10,000,000. 

Preparations. 

Tinctura Strophanthi, Tincture of Strophanthus, (i in 20). — Dose TT\v-x, or 
VO^yi-i] frequently repeated. A stronger tincture (i in 8) is on the market. 

Strophanthinum, Strophanthin (Unofficial). — Dose,gr. T | 7 — J-^ hypodermically : gr. 
5^ has been used, the influence of one such injection upon the circulation having lasted 
at least eight days. 

Physiological Action. 

Strophanthus acts primarily upon muscular tissue by direct contact 
through the blood and with great energy. It increases the contractile 
power of all striped muscle, and in poisonous quantity it fixes the muscu- 
lar contraction into a condition of tetanic permanence, the muscle being 
unable to resume its normal condition of partial flexibility. As the heart 
receives much more blood in a given time than any other muscle in the 
body, it is quickly and markedly affected by the strophanthus-charged 
fluid, and by regulating the dosage the cardiac muscle may be affected by 
a quantity which will not influence the other muscles. 

Small doses stimulate the cardiac contractions, increasing the force of 
the ventricular systole and lowering the rate of the heart-beats. At the 
same time the general blood-pressure is raised and diuresis is produced, 
both being due to the vis a tergo — the direct stimulation of the circulation 
from behind. Large doses paralyze the heart in systole and leave the 
cardiac muscle in a state of contraction resembling cadaveric rigidity. It 
does not act through the nervous system, but paralyzes the muscular tis- 
sue, striated and non-striated, by direct contact ; and when contractility 
has been once destroyed thereby no stimulus will re-excite it. It does 
not affect the vascular system directly. 

Compared with Digitalis, Strophanthus is a powerful cardiac stimulant, 
differing from digitalis in not producing vaso-motor constriction of the 
arterioles. It reduces the pulse, lowers body- temperature somewhat, is 
not cumulative in action, and does not cause any gastro-intestinal dis- 



492 STYRAX. 

turbance. It is diuretic by direct stimulation of the renal circulation ; 
and has power over rigors by its rapid cardiac action, stopping them 
and preventing their recurrence. 

Therapeutics. 
Strophanthus is undoubtedly a valuable cardiac stimulant, from the 
rapidity and permanence of its action, as well as its non-interference 
with the calibre of the peripheral vessels. It promptly relieves cardiac 
dyspnea, often modifies the pulse-rate in less than an hour, while the in- 
fluence of a single dose upon the circulation persists for a long time. It 
may well replace digitalis in the treatment of chronic Bright's disease 
and valvular lesions of the heart, when it is important that the work of 
the heart should not be increased by any additional resistance in the 
arterial system. It has been reported as exceedingly useful in the treat- 
ment of Bright's disease for the dyspnea, orthopnea, dropsy and uremia ; 
also in mitral insufficiency with great anasarca and dyspnea, in palpita- 
tion, exaggerated cardiac action, in weak heart, and for exophthalmos 
with tumultuous action of the heart ; also in pulmonary edema due to 
valvular lesions or to pneumonia. It is useful in endocarditis, also in 
atheroma of the arteries, in reflex palpitation of neurasthenia, hysteria 
and chlorosis, and for rigors due to catheterization or operations on the 
urethra. These high claims, made by enthusiastic therapeutists, have not 
been maintained by the experience of the general profession, so that this 
drug is gradually falling into disuse though but recently added to the 
official pharmacopoeia. 

Ouabain, C 30 H 46 O 12 (Unofficial), — is a glucoside obtained from the root and wood of 
Acocanthera Ouabaio, an apocynaceous tree of the Somali coast ; also from the seeds of 
Strophanthus glabr us, a climbing plant from Gaboon. The former furnishes an arrow 
poison used by the African natives. Ouabain occurs in white, odorless crystals, of 
feebly bitter taste ; soluble in hot water and in spirit, slightly in cold water, insoluble in 
absolute alcohol, chloroform and ether. Dose, gr. jqV o ever 7 three hours, in children. 

Ouabain is an extremely active poison, paralyzing the cardiac muscle by direct action. 
It is a powerful emetic, especially when given hypodermically ; also a potent local anes- 
thetic, being considered by many observers as superior to Cocaine in this respect. In 
therapeutic doses it does not seem to affect the body-temperature, but increases urination, 
either by stimulating the blood-pressure or by paralyzing the sphincter vesicae. It also 
promotes defecation, probably by stimulating peristalsis. Very small doses give some 
evidence of action similar to that of Digitalis. It has been used with striking benefit in 
all stages of pertussis ; and to some extent as a local anesthetic for the eye. 

STYRAX, Storax, — is a balsam prepared from the inner bark of Liqnidambar 
orientalis, the Oriental Sweet-gum, a tree of the nat. ord. Hamamelaceae, growing in Asia 
Minor. It is semi-liquid, sticky, opaque and gray-colored, of agreeable odor and bal- 
samic taste, completely soluble ( except accidental impurities) in an equal weight of warm 
alcohol. It consists of a volatile oil named Stryol, C 8 H 8 ; a crystalline solid Stj/racin, 
which is a cinnamate of cinnamic ether; two peculiar resins, one hard, the other soft; 
and Cinnamic Acid, C 9 H 9 2 , a colorless, odorless, crystalline body, closely allied to 
Benzoic Acid, excreted in the urine partly as Hippuric Acid, and occurring also in the 
Balsams of Peru and Tolu. Dose of Storax, gr. v-xx. 



SUCCINUM SULPHONAL. 493 

Tinctura Benzoini Composita, Compound Tincture of Benzoin, Fi'iar's Balsam, 
contains 8 per cent, of Storax. Dose, gss-ij. 

Storax is a stimulant expectorant, an antiseptic and a disinfectant, acting both locally 
and remotely, like benzoin and the balsams. It is used with benefit in chronic bronchitis 
and other affections of the respiratory organs, also in chronic catarrhs of the genito- 
urinary passages, in gonorrhea and in amenorrhea. Externally it is employed in oint- 
ment as a detergent for foul ulcers, and as a parasiticide for scabies and phthiriasis. 

SUCCINUM, Amber (Unofficial), — the source of Oil of Amber, is a fossil resin, 
occurring in alluvial deposits, chiefly in Prussia, Bohemia, and Courland. It is usually 
associated with lignite, sometimes encloses insects and parts of vegetables, and consists 
of a volatile oil, a yellow resin, another resin, succinic acid and a bituminous principle. 
Its source is thought to be an extinct coniferous tree, the Pinites succinifer, of which 
amber represents the exudation. The Kauri Gum from New Zealand is a similar sub- 
stance. 

Oleum Succini, Oil of Amber (Unofficial), — is a volatile oil obtained by the destruc- 
tive distillation of Amber, and purified by subsequent rectification ; a pale yellow, thin 
liquid, of sp. gr. about 0.920, of empyreumatic and balsamic odor, warm, acrid taste, 
and neutral or faintly acid reaction, readily soluble in alcohol. Dose, gtt. v-x. 

Oil of Amber is stimulant, antispasmodic and diuretic, when used internally. Exter- 
nally it is irritant and rubefacient. It has been employed with benefit in epilepsy, hys- 
teria, convulsions, amenorrhea, whooping-cough, etc. As a liniment it is often used in 
chronic rheumatism, and has been applied along the spine in infantile convulsions, mixed 
with an equal part of laudanum and diluted with olive oil or brandy. 

SULPHONAL, Sulphonal, Diethyhulphon - dimethyl - methane, 
C 7 H 16 S 2 4 (Unofficial), — is a synthetical hypnotic which has recently been 
admitted to an official place in the pharmacopoeias of several countries, 
though unofficial as yet in the United States. It is produced by the in- 
teraction of anhydrous Mercaptan (ethyl hydrosulphide) and anhydrous 
Acetone, in the presence of a stream of dry HC1. The resulting Mercap- 
tol is separated, washed and oxidized by potassium permanganate ; yield- 
ing Sulphonal in colorless, prismatic crystals, soluble in 15 of boiling 
water, in about 450 of cold water, and in about 50 of cold alcohol; very 
soluble in boiling alcohol and in ether. Sulphonal is a very stable body, 
being unaffected by concentrated acids, alkalies or oxidizing agents, cold 
or warm. Dose, gr. xv-xxx. 

Physiological Action and Therapeutics. 
Sulphonal was introduced several years ago as a harmless hypnotic, 
producing sound and quiet sleep without unpleasant after-effects, without 
intoxicant or narcotic action, and having no unfavorable effects on the 
heart or circulation even in full doses. It rapidly came into general use 
as a hypnotic in mental diseases, in nervous insomnia and in sleeplessness 
from various causes. Recently a number of competent observers have 
recorded instances of toxic action following its use, and opinions are now 
greatly divided as to its therapeutical value. If it were not for the very 
evident advantage of the drug when used with care and under medical 
supervision, it would stand a very fair chance of being either excluded 



494 SULPHONAL. 

from practice or restricted by legislative authority (Squibb). In many 
cases of serious poisoning thereby death has followed; and its prolonged 
use may give rise to such minor toxic effects as noises in the ears, headache, 
vertigo, weakness and incapacity for mental or physical exertion. The 
patient may next pass into a condition of drowsiness or stupor, or may 
suffer from difficulty of speech ; and ptosis, edema of the eyelids and 
cyanosis may be experienced. The stopping of the drug in subjects of 
sulphonism is followed by vertigo, motor disturbances, general weakness, 
digestive troubles, etc., a condition resembling that in morphinism when 
the morphine is suddenly cut off (Lepine). In one reported case, a dose 
of 20 grains nightly for 15 months was accompanied by complete cessa- 
tion of menstruation. It has produced persistent skin eruptions in some 
cases and severe functional disturbances in others. The chief character- 
istics of chronic poisoning by this drug are as follows: — disturbances of 
digestion, shown by vomiting and diarrhea or constipation ; disturbances 
of the nervous system, as ataxy and feebleness of the limbs, ptosis and 
ascending paralysis ; also ischuria and oliguria, sometimes albuminuria 
or the presence of hematoporphyrin (Kast). Recovery rapidly follows 
if the entire alimentary tract be thoroughly purged ; and as long as this 
is kept free and the kidneys act efficiently and normally, the drug may 
be considered harmless (Fuerst). In order to secure elimination and to 
guard against cumulative action and consequent toxicity, its administra- 
tion should be interrupted from time to time. Anorexia, vomiting, or 
pains in the stomach may be regarded as indications for immediate dis- 
continuance (Kast). In acute poisoning by Sulphonal the treatment is 
by alkalies freely administered. 

As a hypnotic Sulphonal acts admirably in many instances, if admin- 
istered in hot fluids and about two hours before its action is required ; but 
its efficacy decreases with use, and it is of no value whatever against 
insomnia due to pain. The average hypnotic dose is about 20 grains for 
a woman and 30 grains for a man. The dose is to be administered only 
once daily, and should be discontinued at the first sign of toxic action. 
In no case should its administration be continued over any great length 
of time. In cases of insomnia due to neuralgia and nervous excitement, 
the dose of sulphonal may be advantageously combined with a small 
dose of morphine, in proportion to suit individual cases, the mixture 
forming a safe and efficient hypnotic (Gonzales). An excellent hypnotic 
combination is made by mixing together 10 or 15 grains each of sul- 
phonal and trional, to be taken in some hot liquid at bed-time. The 
trional producing early sleep and the sulphonal effects being manifested 
later, the patient will usually obtain a more prolonged result from the 
small dose of each agent administered together than from a larger dose of 
either alone. 



sulphur. 495 

Trional, Diethylsulphon-methyl-ethyl-methane, — differs from Sulphonal only in the 
substitution of an ethyl for a methyl group. It occurs in lustrous, bitter, tabular crystals, 
soluble in 320 of cold water, readily soluble in hot water, in alcohol and in ether. It is 
an efficient hypnotic, prompter in action and less liable to produce ill effects than Sul- 
phonal, but must be given in doses fully as large, gr. xv-xxx. It is said to be peculiarly 
valuable in cases of slight psychical excitement accompanied by obstinate insomnia, and 
to act promptly and usefully in many forms of delirium. When pain is present it may be 
administered in conjunction with phenacetin or acetanilid. A potent objection to its use 
is the fact that it is patented in this country, which is also true of the following agent. 

Tetronal, Diethylsulphon-diethyl-methane, — contains 4 ethyl groups to 3 in Trional 
and but 2 in Sulphonal. Dr. Lauder Brunton holds of the physiological action of the 
disulphones, to which group these three substances belong, that only those conlaining 
ethyl groups are active and that the hypnotic activity is increased with the number of 
such groups. This, if substantiated in practice, would make Tetronal the most powerful 
hypnotic of the three. Trional is found to be generally more active however in this 
respect, and to be freer from unpleasant by-effects, Tetronal producing vomiting and other 
digestive disturbances in many cases. Neither of them has any value against insomnia 
due to pain. Dose, gr. xv-xxx, twice or thrice daily. 



SULPHUR, and SULPHIDES.— The non-metallic element Sul- 
phur, S, is a brittle solid of a pale yellow color, permanent in the air, of 
crystalline texture and susceptible of several allotropic states, which are 
for the most part induced by heat. It is obtained native in several vol- 
canic districts, or from the native Sulphides of Iron and Copper (iron and 
copper pyrites) by roasting, as it sublimes at about 238 F. It is official 
in three forms, viz. — 

Sulphur Sublimatum, Sublimed Sulphur, S, — is prepared from crude 
Sulphur by sublimation and condensation. It is a fine citron-yellow 
powder, of faintly acid taste and acid reaction, insoluble in water or 
alcohol. Ignited it burns with a blue flame, forming sulphurous acid gas, 
and leaving no residue or only a trace. Dose, gr. x-xx-lx. 

Sulphur Lotum, Washed Sulphur, S, — prepared by digesting sub- 
limed Sulphur with dilute Water of Ammonia, thoroughly washing with 
water and passing through a sieve. In this process the Ammonia dis- 
solves out any sulphide of arsenic which may be present and neutralizes 
any sulphurous or sulphuric acid. [For its solubility and dose see Sul- 
phur Pr^ecipitatum below.] 

Sulphur Prsecipitatum, Precipitated Sulphur, Lac Sulphuris, Milk 
of Sulphur, S, — is prepared by boiling sublimed Sulphur with slaked lime 
and water, forming the sulphide and hyposulphite of calcium, which are 
then decomposed by HC1, and Sulphur is precipitated as a very fine 
powder which is next washed until the washings are tasteless and dried 
with a gentle heat. The result is a very fine, yellowish-white, amorphous 
powder, odorless and almost tasteless, insoluble in water or alcohol, but 
completely soluble in carbon disulphide or in a boiling solution of soda. 
By heat it is completely volatilized. Dose, gr. x-gj. 



49^ SULPHUR. 

Preparations of Sulphur. 

Unguentum Sulphuris, Sulphur Ointment, — has of Sublimed Sulphur 30, Benzoin- 
ated Lard 70, rubbed together until thoroughly mixed. 

Pulvis Glycyrrhizae Compositus, Compound Liquorice Powder (see under Gly- 
CYRRHIZA), — contains 8 per cent, of Washed Sulphur. 

Sulphurous Acid and the Sulphites are described under Acidum Sulphurosum ; 
the Sulphates under the titles of their respective bases. For Sulphuric Acid see 
Acidum Sulphuricum. 

Sulphides. 

Calx Sulphurata, Sulphurated Lime, Critde Calcium Sulphide, — is a mixture of CaS, 
CaSC\ and Carbon, in varying proportions, containing at least 60 per cent, of the first. 
A pale, gray powder, of offensive taste and smell, and alkaline reaction, insoluble in 
alcohol, very slightly soluble in water. Dose, gr. y^— |. 

Calcii Sulphidum, Calcium Sulphide, CaS (Unofficial), — a constituent of the preced- 
ing, is named Hepar Sulphuris, Liver of Sulphur, by the homeopathists, who prepare it 
by mixing equal parts of powdered oyster-shell and sublimed sulphur, and heating at a 
white heat in a crucible hermetically sealed. Dose, gr. j^-\. 

Potassa Sulphurata, Sulphurated Potassa, Liver of Sulphur, — is a mixture of 
Potassium Trisu'phide with small quantities of Potassium Hyposulphite and Potassium 
Sulphate ; prepared by heating together Sublimed Sulphur I , Potassium Carbonate 2, in 
a covered crucible until melted. Occurs in irregular pieces of liver-brown color, of dis- 
agreeable odor, alkaline reaction and repulsive taste. Soluble in 2 of water, except a 
small residue. Alcohol dissolves only the potassium sulphide, leaving the other con- 
stituents undissolved. Dose, gr. ij-x, in pill or solution. 

Sulphuris Iodidum, Sulphur Iodide, Iodine Bisulphide, I 2 S 2 , — is prepared by fusing 
together Washed Sulphur I part and Iodine 4. It is a grayish-black crystalline solid, 
having the odor of iodine, an acrid taste and a faintly acid reaction, insoluble in water, 
but very soluble in disulphide of carbon and in about 60 of glycerin. Alcohol and ether 
dissolve out the iodine, leaving the sulphur. Used only as ointment, gr. xxx to the ^ . 

Hydrogenii Sulphidum, Hydrogen Sulphide, Sulphuretted Hydrogen, H 2 S, — is used 
only for test purposes ; a saturated, aqueous solution being one of the official reagents. 
It is a colorless gas, having the odor of rotten eggs, prepared by the action of dilute 
sulphuric acid on iron sulphide ; the gas being passed into water a solution is obtained. 
It precipitates most of the metals from acid solutions as sulphides ; that with Arsenic 
being yellow ; with Antimony, orange ; with Cadmium, yellow ; with Copper, Lead, 
Mercury and Silver, black ; with Bismuth, brown ; with Gold and Platinum, brownish- 
black. 

Carbon Disulphide is described under Carbo ; Antimony Sulphide and Sulphu- 
rated Antimony under Antimonium. 

Unofficial Allied Compounds. 

Ichthyolum, Ichthyol [Ammonium Sulpho-ichthyolate'), C 28 H 3fi S 3 6 (NHJ 2 , — is pre- 
pared from the product of the distillation of bituminous rocks from the Tyrol which 
contain fossil fishes. It occurs as a viscous, reddish-brown mass, of tarry odor and ap- 
pearance and feebly alkaline reaction ; soluble in water and in a mixture of alcohol and 
ether ; mixes in all proportions with glycerin, fats and oils. It contains a large propor- 
tion of Sulphur, about 10 per cent. Dose, internally, gr. v-xxx. 

Sulpho-ichthyolates of Lithium, Sodium and Zinc are also prepared, and are on the 
market. 

Thiolum, Thiol, — is prepared by the sulphuration of certain non-saturated hydro- 
carbons, and is a product very similar to Ichthyol. It occurs in both dry and liquid 
form, the former, Thiolutn siccum, as dark-brown lamellae or powder, of bituminous 
odor and bitter, astringent taste ; soluble in water and in chloroform, sparingly in alco- 
hol, insoluble in ether and in benzin. The liquid form, Thiolum liquidum, is a dark- 
colored, syrupy fluid, miscible in all proportions with water. Dose, internally, gr. v-xxx. 

Tumenolum, Tumenol, — is obtained by treating the unsaturated hydrocarbons of 
mineral oils with concentrated sulphuric acid. It occurs in several forms, solid and 



sulphur. 497 

fluid, that known as Commercial Tumenol being considered the most generally useful. 
It is a dark-brown fluid, which can be employed in ointment and in tincture, externally. 

Physiological Action. 

Sulphur is a mild laxative and a diaphoretic. In contact with living 
protoplasm it enters into combination and produces either sulphuretted 
hydrogen or sulphurous acid ; taken into the intestinal canal a large por- 
tion passes out unchanged, some of it being converted by the alkaline 
bile into sulphuretted hydrogen and sulphides. The former is excreted 
by the lungs, giving to the breath the smell of rotten eggs, also by the 
skin, discoloring silver articles carried about the person by forming a 
sulphide of silver. The Sulphides are partly absorbed into the blood and 
are excreted in the urine, chiefly as sulphates, and in the feces, which 
they blacken and render soft. Given in full doses they are irritant to the 
stomach and intestines, extremely nauseous to the taste and smell, increase 
the secretions of the intestinal glands, promote peristaltic action, and if 
used for any length of time they impair the blood, causing anemia, 
emaciation, tremor and great debility. 

Sulphuretted Hydrogen is very destructive to plant life. In animals it 
destroys the tissue functions, decomposing the blood and paralyzing the 
nervous and muscular systems. The symptoms of poisoning are those of 
asphyxia ; muscular tremors occur and are followed by convulsions and 
death. This gas is often found in cesspools in large quantities, but in 
one case poisoning occurred from its excessive formation in the intestines 
and subsequent absorption into the blood. 

Calx Sulphurata and Potassa Sulphurata act like the sulphides as local 
irritants and in large doses as irritant poisons, producing narcotic symp- 
toms and convulsions. In small doses they act like sulphur, and are 
supposed by many observers to have a special influence on suppuration, 
limiting or preventing it if given in small doses frequently repeated. 

The Iodide is believed to possess some of the properties of both its 
elements. It is doubtful whether it is a distinct chemical compound or 
merely a physical mixture. As a parasiticide it is very efficient, and has 
been found remarkably alterative in many local affections of chronic 
character, but may prove very irritant to the skin if improperly prepared. 

The actions of Sulphuric Acid, of Sulphurous Acid and of the Sulphites 
are respectively described under the titles Acidum Sulphuricum and 
Acidum Sulphurosum. 

Incompatibles and Antidotes. 

Solutions of the Sulphides are decomposed by the mineral acids and by solutions of 
metallic salts. Antidotes are Chlorine-water, Chlorides of Sodium and Potassium, Sul- 
phate of Iron, etc. Poisoning by Sulphuretted Hydrogen is best treated by artificial 
respiration. 

32 



( 



49$ SULPHUR. 

Therapeutics. 

Sulphur is chiefly used as a laxative when pultaceous rather than liquid 
stools are required, as in hemorrhoids and anal fissure, also in constipa- 
tion. Scabies has long been treated by its local and internal use, but 
sulphur alone does not kill the itch insect. The older sulphur ointments 
were made with sublimed sulphur, and probably contained a consider- 
able amount of sulphurous acid on which their parasiticide property de- 
pended. The later ointments, made with purified sulphur, all contain 
an alkaline ingredient and develop sulphides, which are powerful insect 
poisons. Sulphur fumigations are practically applications of volatile 
sulphurous acid, while most of the sulphur baths and sulphurous mineral 
waters are solutions of sulphuretted hydrogen or of the alkaline sulphides. 
They are of value in lead poisoning to favor the elimination of that metal, 
in chronic constipation, chronic rheumatism and sciatica and many skin 
diseases, especially chronic psoriasis, eczema, pityriasis and prurigo. 
The Ointment and the Alkaline Ointment are both used in scabies. 

The Iodide has been used internally in scrofula, glanders and cutaneous 
disorders, but it is chiefly employed as an ointment in lupus and parasitic 
skin diseases, especially herpes circinatus. Calx Sulphurata is extremely 
efficient as an internal remedy in crops of boils, scrofulous sores, glan- 
dular enlargements, acne, etc., and will prevent or limit suppuration. 
For these purposes it must be used in small doses (gr. -^) frequently re- 
peated. Potassa Sulphurata is only used externally as baths or ointment 
in skin diseases and mucous discharges, also in chronic rheumatism. 

Ichthyol was introduced several years ago, by Dr. Unna, the cele- 
brated dermatologist, as a promptly efficient remedy in certain chronic 
skin diseases, particularly eczema and psoriasis. It mixes with vaselin, 
lard and oils, is soluble in a mixture of ether and alcohol, and is not 
irritant locally, even if covered with oiled silk. 

In one case of eczema infantile, an ointment was applied containing I part of Ichthyol 
to 5 of Vaselin, resulting in the child sinking into a stupor which lasted for 12 hours. A 
fatal case of poisoning thereby is reported by Bergerio, of Turin, in a woman whose 
uterus had been curetted the day previous. After the washing out of the uterine cavity 
with a solution of Ichthyol 33 to Glycerin 66, she complained of a putrid fish taste in her 
mouth, her pulse became like that in tachycardia and symptoms of general depression 
rapidly supervened, ending in death after about 12 hours. These instances show that 
this agent is not devoid of danger, and that care must be exercised in its employment. 

The particular value of Ichthyol, as a local remedy, is due to its non- 
irritant quality and to the large proportion of sulphur contained therein ; 
which in any pharmaceutical combination would excite a dermatitis. 
Its application in medicine depends chiefly upon its reducing property, 
its antiseptic power and its contractile action upon the vascular system. 
Most of the affections for which it has been recommended are caused by 



SUMBUL TABACUM. 499 

anomalous circulation and especially capillary dilatation. Used inter- 
nally, it retards the disintegration of albumins and favors their formation 
and accumulation. Upon exudations it has a remarkable effect, given in- 
ternally at the same time as applied externally, promoting their reabsorp- 
tion and promptly alleviating pain. For these purposes it has been 
highly praised in gynecology and even in pleurisy. For chronic rheu- 
matism a 50 per cent, ointment is used locally and the remedy is also 
given internally. It has done excellent service in erysipelas and in ulcers 
of the leg, locally applied in ointment form with Lanolin or pure ; and 
internally in various affections of the digestive and intestinal tract, also 
in phthisis, syphilis and leprosy. In gynecology it is combined with 
glycerin (1 in 10); it is used with turpentine as a liniment for rheumatism, 
or with an equal weight of a mixture of lanolin and olive oil and 30 per 
cent, of chloroform; and against erysipelas as a 10 to 20 per cent, collo- 
dion, with or without castor oil. 

Thiol, the German artificial Ichthyol, is largely used in place of Ichthyol by gyne- 
cologists and dermatologists. It causes no pain, burning, or other irritation, and no 
bleeding from eroded surfaces ; promotes rapid absorption of effusions, and has many 
advantages over the natural Ichthyol, among which is the ease with which the stains it 
produces on linen may be removed. The dry form, used as a dusting powder, is of 
especial service in erysipelas and is employed with benefit in eczema, erythema, inter- 
trigo, impetigo, pemphigus and other cutaneous affections ; especially in acute, moist in- 
flammations of the skin and subjacent tissues, in chilblains, periphlebitis, contusions, 
subcutaneous hemorrhages and syphilitic ulcers. It is also an efficient application in 
pelvic exudations and endometritis. It may be applied as a powder or collodion, also in 
aqueous or glycerin solutions, as ointment, soap, plaster, etc. Internally, it is given in 
wine or chocolate (i to 2 per cent.), also in pills containing a grain each. Mixed with 
Talc, in the proportion of 10 to 20 per cent., it makes an excellent dusting powder for 
use on babies' skin. 

Tumenol is said to owe its therapeutic action to its powerful reducing property rather 
than to the sulphur in its composition. The tincture has been almost universally success- 
ful in all forms of pruritus. Moist eczema is especially benefited by it, and it generally 
gives good results when employed in erosions, excoriations and superficial ulcerations. 
It is not anti-parasitic in action and is of no service in erysipelas. 

SUMBUL, — is the root of Ferula Sumbul, a very large plant of the nat. ord. Umbel- 
liferae, which grows to the height of 8 feet in Northern Asia. The root contains Angelic 
Acid, C 5 H 8 2 , Valerianic Acid, C 5 H 10 O 2 , also a volatile oil, two balsamic resins, a bitter 
substance, etc. Dose, gr. xxx-^j or more, in infusion or decoction. 

Tinctura Sumbul, Tincture of Sumbul, — 10 per cent. Dose, gj-iv. 

Sumbul is an efficient nerve tonic, having qualities closely resembling musk and vale- 
rian. It is used by the Russian physicians in very many morbid conditions and seems 
to be a favorite remedy in that country for almost any disease. It is probably of some 
value in hysteria and other nervous derangements of delicate females, and may be used 
as a substitute for musk in typhoid conditions and fevers, asthma, delirium tremens and 
perhaps in epilepsy. 

TABACUM, Tobacco, — is the commercial dried leaf of Nicotiana 
Tabacum, an annual plant of the nat. ord. Solanaceae, native of tropical 
America, but cultivated in several parts of the world, especially in Cuba 
and Virginia. The leaves contain a very poisonous, oily fluid alkaloid 



( 



500 TABACUM. 

named Nicotine, C 10 H U N 2 , which occurs as a malate and in quantity- 
varies greatly in different specimens. Tobacco contains also a volatilizable, 
camphoraceous principle named Nicotianin, the existence of which is de. 
nied by some analysts, besides potassium and calcium salts (nitrates and 
phosphates), silica, gum, resin, and other substances. There are no 
official preparations. 

Nicotina, Nicotine, C 10 H U N 2 (Unofficial), — the alkaloid and active 
principle ; a colorless, oily fluid, having the odor of tobacco and an 
acrid taste; readily soluble in water, and forming soluble salts with acids. 
Dose, ttl-2V~To' U P to ^iJ i n tw0 hours, in tetanus and in strychnine poi- 
soning. [Other Liquid Alkaloids besides Nicotine are — Coniine, Lobeline, 
Lupuline, Muscarine, Piperidine, Pyridine, Sparteine and the alkaloidal 
compound Trimethylamine.] 

The proportion of Nicotine in tobacco is stated at 6 in 10,000 parts (0.06 per cent.) 
by Posselt and Reimann, but other analysts have found 2 per cent, in Havana tobacco 
and more than 8 per cent, in French tobacco. Turkish tobacco is said to contain little 
or none. The effect of curing undoubtedly produces chemical changes but chemists 
differ as to whether the proportion of nicotine is greater or less after that process. 

According to Zeise (1843) and Vohl and Eulenberg (1872), tobacco-smoke contains 
no nicotine, but does contain a series of empyreumatic products, the result probably of its 
decomposition, viz. — pyridine, collidine, picoline, parvoline, etc. Of these, Pyridine 
C 5 H 5 N, predominates when tobacco is smoked in a pipe, but Collidine C 8 H n N, which 
is far less active, predominates when there is free access of air as in smoking cigars. 
Tobacco-smoke also contains Carbon Dioxide, C0 2 , of which Krause determines the 
average proportion to be 9.3 per cent., and to which he credits much of the injurious 
effects of smoking in young subjects. It also contains creosote, hydrogen cyanide and 
sulphide gases, also several acids, including acetic, carbolic and valerianic. 

Unofficial Preparations and Salts, etc. 

Enema Tabaci, Eneiiia of Tobacco (B. P. 1867), — gr. xx of the leaf infused in ^viij 
of boiling water for an hour, strained, and the whole administered as one enema. 

Oleum Tabaci, Oil of Tobacco, — is an empyreumatic product and a most virulent 
poison, obtained by distillation at a temperature above that of boiling water. 

Vinum Tabaci, Wine of Tobacco, — ^j to the pint. Dose, ir^v-^j. 

Pyridina, Pyridine, C 5 H 5 N, — a colorless, liquid alkaloid, of powerful odor, evapor- 
ating when exposed to air and mixing with water in all proportions. Dose, ^j— ^jss, 
allowed to evaporate in an open dish in a small room, in which the patient is exposed 
for 20 to 30 minutes thrice daily for the relief of asthma (See). 

Nicotinae Bitartras, Nicotine Bitartrate, — occurs in fine, white crystals, having a 
tendency to aggregate, readily soluble in water. This salt is stable and keeps well, even 
in solution. It is recommended as the most suitable form of administering nicotine in 
tetanus, strychnine poisoning, etc. Dose, gr. 2V~To> U P to a max i mum °fg r - ij i Q 2 hours. 



Physiological Action. 
Tobacco is a very depressant nauseant, an emetic by irritant as well as 
by systemic action and an antispasmodic ; also sternutatory, diuretic, dia- 
phoretic, cathartic, sedative and narcotic. It first stimulates and after- 
wards paralyzes the motor nerves of involuntary muscles and the secreting 
nerves of the glands, also the spinal cord and the vagus ; at first stimulating 



TABACUM. 501 

both the vagus-roots and its ends in the heart (slowing the pulse-rate), but 
afterwards paralyzing the latter (causing high pulse-rate). It increases 
the salivary and intestinal secretions and produces diuresis, tremor, clonic 
spasms and a tetanic stage followed by paresis. It contracts the pupils, 
slows and depresses the heart, lowers arterial tension at first and after- 
wards raises it, reduces the body-temperature and causes profuse sweating, 
cold and clammy skin, collapse and death usually by paralysis of respi- 
ration, sometimes by paralysis of the heart. It does not impair the 
muscular irritability, nor does it act upon the cerebrum directly. Its 
empyreumatic products act similarly but less powerfully. Fatal results 
have followed the inhalation of its vapor into the lungs. 

The continued use of Tobacco, by smoking or chewing it to excess, 
produces granular inflammation of the fauces and pharynx, atrophy of 
the retina, dyspepsia, lowered sexual power, sudden faints, nervous de- 
pression, cardiac irritability and occasionally angina pectoris. Used by 
the young it hinders the development of the higher nerve centres and 
impairs the nutrition of the body by interfering with the processes of 
digestion and assimilation. It has been credited with causing cancer of 
the lips and tongue, blunting of the moral sense, mental aberration and 
even insanity. The so-called "tobacco heart" includes many forms of 
nervous, painful or oppressed cardiac action, depending on the age of 
the subject, the quantity consumed and other circumstances. In mild 
cases an occasional palpitation or flutter is complained of; in more severe 
ones there is considerable cardiac irregularity and rapidity, and more or 
less distress experienced ; in some there is actual cardiac pain, decided 
irregularity and occasional intermittence of action, and the symptoms 
may simulate those of a case of angina pectoris. There are no physical 
signs as a rule, so that the diagnosis is made by exclusion. The pathology 
is unknown, but probably involves some lesion of the vagus. In the 
young, excessive indulgence in tobacco may lead to cardiac hypertrophy, 
dilatation and even valvular lesions (Osier). 

Nicotine, in even minute doses (gr. 1), causes symptoms of intense gas- 
tric irritation with an extreme degree of collapse. It abolishes the func- 
tion of the motor nerves and paralyzes respiration. Its general action is 
that of tobacco, but it is one of the most powerful and rapidly-acting 
poisons known, death having occurred within three minutes after its in- 
gestion, the patient dropping instantly to the floor insensible, with no 
symptoms except a wild stare and a deep sigh. The ^ of a grain has 
caused death in a human being, and -g 1 ^ is fatal to cats and dogs. 

Antidotes and Antagonists. 

Strychnine is the true physiological antagonist to Nicotine (or Tobacco) and vice versa. 
Alcohol, Ammonia, Ergot, Digitalis, Belladonna, etc., antagonize its action on the circu- 
lation. In poisoning by Tobacco the means resorted to are evacuation of the stomach, 



502 TAMARINDUS TANACETUM. 

Tannin, Iodides, and artificial respiration. A curious synergism has been observed by 
the author between Opium and Tobacco. If a person, habituated to the use of the latter, 
either by smoking or chewing, begins to use Morphine, the smallest quantity of Tobacco 
will make him sick, the symptoms being those experienced by a novice in its use. For 
the depression due to excessive smoking, the best agent is Spiritus iEtheris Compositus 
(Hoffman's Anodyne). 

Therapeutics. 
Tobacco is now but little used in medicine, the dangers attending its 
employment either internally or externally having caused it to be super- 
seded by less violently acting agents. The principal objects for which it 
is employed are to relax spasm of the intestines and to relieve local pain 
therein. Intestinal affections, like impaction of the cecum, intussuscep- 
tion and strangulated hernia, may be overcome by a tobacco-enema to 
relax spasm, but it is a dangerous expedient. In dropsy, especially the 
renal form, it makes a very efficient diuretic. In tetanus there is no 
more effective remedy than minim doses of the alkaloid every two hours 
by the stomach, or n^ij by the rectum, or better still the wine in 10 minim 
doses repeated for effect. Strychnine-poisoning is best met by minute 
doses of Nicotine, gr. fa hypodermically, as a physiological antagonist. 
It may be employed with advantage in habitual constipation, for the 
dyspnea of spasmodic asthma and emphysema, also in nymphomania and 
chordee. In all forms of asthma the inhalation of the fumes of Pyridine is 
beneficial, as it has a powerfully sedative action on the respiratory centre. 
The use of Tobacco in moderation, when under excessive exertion, aids 
in supporting the system and lessening the sense of fatigue. Smokers 
rarely surfer from constipation, but generally experience an immediate 
laxative result from their morning cigar. 

TAMARINDUS, Tamarind, — is the preserved pulp of the fruit of Tamarindus 
indica, a large tree of the nat. ord. Leguminosae, native in the East and West Indies. 
It contains citric, tartaric and malic acids, sugar, gum, potassium bitartrate, etc. 

Confectio Sennae, Confection of Senna, — contains Tamarind to the amount of io per 
cent. Dose, 5J-ij. (See under Senna.) 

Tamarind is a laxative and refrigerant fruit. In infusion it may be used by convales- 
cents as a pleasant acidulous drink, or the pulp may be boiled with milk as a whey for 
the same purpose. As a laxative it is usually prescribed in connection with other agents 
having the same action. 

TANACETUM, Tansy, — the leaves and tops of Tanacetum vulgare, a perennial, 
herbaceous plant of the nat. ord. Compositse, indigenous in Europe but cultivated in our 
gardens and growing wild in old fields. It contains a volatile oil, a bitter principle Tanac- 
etin, a tannic acid, etc. There are no official preparations, but a fluid extract may be 
prepared according to the general rule and administered in doses ofTTLx-^j. The dose 
of the volatile oil (Oleum Tanaceti) is I to 3 drops. An infusion (Tansy Tea) may be 
made in the proportion of ^j to the pint, and used in doses of ^j-ij. 

Tansy is emmenagogue, diuretic and anthelmintic, an aromatic bitter and an irritant 
narcotic poison. Fatal results have followed upon overdoses of the oil ( j§ss-j) or strong 
decoctions, preceded by clonic spasms, disturbed respiration and cessation of the heart's 
action. It is a useful remedy in amenorrhea, but is in popular repute as an abortifacient, 
a virtue which it does not possess except in quantity dangerous to life. 



TARAXACUM TEREBINTHINA. 503 

TARAXACUM, Dandelion, — is the root of Taraxacum officinale, a plant of the 
nat. ord. Compositae. All parts of the plant contain a bitter, milky juice, exuding from 
any break or wound. Its constituents are a bitter amorphous principle named Tarax- 
acin, a crystalline principle Taraxacerin, with potassium and calcium salts, Inulin, and 
resinoid bodies, etc. The French name for the plant is " Pissenlit." 

Extractum Taraxaci, Extract of Taraxacum. — Dose, gr. v-xxx. 

Extractum Taraxaci Fluidum, Fluid Extract of Taraxacum. — Dose, gj-^j. 

Taraxacum is a bitter tonic, a diuretic and an aperient. It has been supposed to act 
especially on the liver and is chiefly used in dyspepsia with hepatic torpor. As found in 
the shops it is usually inert. The extract is of value as an excipient for pills. 

TEREBINTHINA, Turpentine,— A Turpentine means a vege- 
table exudation, liquid or concrete, consisting of resin combined with a 
peculiar essential oil named Oil of Turpentine (C 10 H 16 ), and generally- 
procured from various species of the nat. ord. Coniferae (cone-bearers). 
Of the many turpentines two only are official, viz. — 

Terebinthina, Turpentine, — a concrete oleoresin from Pinus palustris 
the Yellow Pine and other species of Pinus, nat. ord. Coniferae. Occurs 
in tough, yellowish masses, brittle when cold, crummy-crystalline in- 
teriorly, of terebinthinate odor and taste. Dose, gr. v-xxx as a stimu- 
lant, antispasmodic or diuretic ; 5ij-iv as an anthelmintic. 

Terebinthina Canadensis, Canada Turpentine, Balsa7n of Fir, — a 
liquid oleoresin obtained from Abies balsa?nea, the Silver Fir or Balm of 
Gilead, nat. ord. Coniferae. A yellowish, transparent, viscid liquid, of 
agreeable, terebinthinate odor and a bitterish and slightly acrid taste, 
slowly drying on exposure, forming a transparent mass ; completely solu- 
ble in ether, chloroform or benzol. Dose, gr. x-xxx. 

Pitch and its preparations are described under the title Pix. 

Unofficial Turpentines. 

Chian Turpentine, — from the Pistacea Terebinthus, a small larch 
tree growing in the islands of Chio and Cyprus; a thick, tenacious, 
greenish-yellow liquid, concreting on exposure to the air into a translu- 
cent solid. Dose, gr. iij-v in emulsion. 

Venice Turpentine, — procured in Switzerland from the Larix 
Europcea or European Larch ; -a viscid liquid of the consistence of honey, 
does not concrete on exposure, and is entirely soluble in alcohol. The 
Venice Turpentine of commerce is usually prepared by dissolving resin 
in oil of turpentine. 

Thus Americanum, Common Frankincense (B. P.), — the concrete 
turpentine scraped off the trunks of Pinus australis and Pinus T&da. 
An ingredient of the Emplastrum Picis of the Br. Phar. 

Official Preparations of Turpentine. 

Oleum Terebinthinae, Oil of Turpentine, commonly called Spirit or Spirits of Tur- 
pentine, — is a volatile oil distilled from Turpentine. A thin, colorless liquid, ofcharac-* 



504 TEREBINTHINA. 

teristic odor and taste ; soluble in 3 times its volume of alcohol, mixes with other volatile 
and fixed oils, and dissolves resins, wax, sulphur, phosphorus and iodine. Bromine and 
powdered Iodine act violently on it, and when brought into contact with a mixture of 
Nitric and Sulphuric Acids it takes fire. It is isomeric with a number of volatile oils, 
has the formula C 10 H 16 — but constantly absorbs oxygen from the air when exposed, be- 
coming thicker and less active from formation of resin. It is a mixture of several hydro- 
carbons, each having the same formula as itself, viz., C ]0 H 16 . 

Oleum Terebinthinae Rectificatum, Rectified Oil of Turpentine, — prepared by 
shaking Oil of Turpentine with 6 times its volume of Lime Water, distilling three-fourths, 
and separating. This preparation should always be dispensed when Oil of Turpentine is 
required for internal use. Dose, as a stimulant or diuretic, ff^v-xv in emulsion 3 to 6 
times daily; — as a cathartic or anthelmintic ^ ss or more, combined with other cathartics. 
A little glycerin and oil of gaultheria will disguise the taste. 

Linimentum Terebinthinae, Turpentine Liniment, — has 35 parts of the Oil of Tur- 
pentine with 65 of Resin Cerate. 

Linimentum Terebinthinae Aceticum, Liniment of Turpentine and Acetic Acid 
(Br. Ph.), — has of the Oil of Turpentine 4, Glacial Acetic Acid I, Liniment of Camphor 4. 
An imitation of St. John Long's celebrated liniment. 

Derivatives of Turpentine, 

Resina, Resin, Colophony, — is the residue left after distilling off the volatile oil from 
turpentine; the portion of turpentine which is fixed by oxidation, consisting in greater 
part of Abietic anhydride (C 44 H 62 4 ). See ante, under its own title. 

Terebenum, Terebene, C 10 H 16 , — is a hydrocarbon obtained by the oxidation of Oil of 
Turpentine by strong Sulphuric Acid, and occurs as a colorless, or light yellow liquid, 
with the pleasant odor of newly cut pine wood; practically insoluble in water, soluble in 
an equal volume of alcohol. It consists chiefly of Pinene, and should contain not more 
than very small proportions of Terpinene and Dipentene (U. S. P.); [consists of Cam- 
phene, Cymene, Borneol and Terpilene (Squibb)]. Dose, rt\,v-xx on sugar, or sus- 
pended in 25 ss of water by the aid of gr. xx of light magnesium carbonate. 

Terpini Hydras, Terpin Hydrate, C 10 H ]8 (OH) 2 .H 2 0, — is the hydrate of the diatomic 
alcohol Terpin (Terebinthene), obtained by distilling oil of Turpentine with an alkali. 
Colorless, lustrous, rhombic prisms, nearly odorless, of slightly aromatic and somewhat 
bitter taste ; soluble in 10 of alcohol and in about 250 of water at 59 F. , in 32 of boil- 
ing water and in 2 of boiling alcohol. Dose, gr. j-x. 

Terpinol (Unofficial), — an oily body obtained from the preceding by the action of 
an acid thereon. Dose, gr. ij-v. 

Sanitas Disinfecting Fluid (Unofficial), — is an aqueous solution of turpentine 
which has been oxidized by exposure to the air. It contains Hydrogen Dioxide, Thymol, 
Camphor and Camphoric Acid, the latter in such small proportion, however, that its 
action cannot be expected. This proprietary preparation has many advantages. It is a 
good oxidizing agent and antiseptic, is not poisonous and does not stain the linen ; 
qualities which recommend it as a disinfectant and for use in surgical operations. 

Official Analogues of Turpentine. 

' These include Juniperus Juniper, Sabina Savine, Pix Pitch and Pix LiquidA 
Tar, which are described under their respective titles. 

Unofficial Analogues of Turpentine. 

Oleum Succini, Oil of Amber, — a volatile oil obtained by the destructive distillation 
of Amber (Succinum), a fossil resin thought to be the exudation of Pinites sziccinifer, an 
extinct coniferous tree. Dose, gtt. v-x. See ante, under Succinum. 

Oleum Thujas, Oil of Thuja, — a volatile oil which is given in doses of Try-v. A 
saturated tincture may be used in drachm doses. Obtained from Thuja occidental's, the 
Arbor Vitae, a coniferous tree. See under Thuja. 

Oleum Pini Sylvestris, Oil of Scotch Fir (B. P.), — a colorless liquid, obtained by 
distilling the fresh leaves of Pinus sylvestris, used externally and by inhalation. 



terebinthina. 505 

Physiological Action. 

Turpentines are stimulant, diuretic, anthelmintic, and hemostatic; in 
large doses laxative and irritant, and externally used are rubefacient and 
antiseptic. Their virtues depend entirely on the volatile oil. 

Oil of Turpentine in small doses causes a sense of heat at the epigas- 
trium, burning in the mouth and salivation by reflex action. In mod- 
erate doses it at first stimulates the vaso-motor nervous system, after- 
wards paralyzing these centres, thus causing a rise and then a fall of the 
arterial tension. It lowers the functions of the brain, spinal cord and 
medulla in the order stated, causing diminution of voluntary movement 
and reflex action, dilatation of the vessels, lowered blood-pressure and 
slowed respiration, the latter often becoming spasmodic. The pulse is 
sometimes slowed, sometimes quickened. Large doses produce gastro- 
enteritis, with vomiting and diarrhea, suppression of urine, pain in the 
lumbar regions, burning in the urethra, hematuria and strangury. The 
muscular power is diminished, coordination impaired and a state of in- 
toxication induced. In toxic dose it acts as a narcotic poison and causes 
complete muscular relaxation, profound insensibility with abolished re- 
flexes, dilated pupils, cyanosed face, labored and stertorous breathing 
and death by paralysis of respiration. It is excreted by the various or- 
gans of excretion, all of which are highly irritated, the kidneys suffer- 
ing particularly. Its vapor inhaled produces nasal and renal irritation, 
frontal headache, also frequently strangury and hematuria. Locally to 
the skin it is rubefacient and even vesicant if applied for any length of 
time or if evaporation be prevented. 

The Oil, when exposed to the air, readily absorbs oxygen in the form 
of ozone, which it retains tenaciously. This ozonized oil of turpentine 
is an antidote to phosphorus, preventing the formation of phosphoric 
acid and converting the phosphorus into an insoluble substance resem- 
bling spermaceti. Worn about the neck in an open vial it is believed to 
prevent necrosis of the jaw and steatosis of the organs in workmen ex- 
posed to phosphorus-fumes. It is supposed to dissolve gall-stones. 

Antidotes and Antagonists. 

In cases of poisoning the stomach should be emptied, anodynes and demulcents admin- 
istered, elimination favored, and special symptoms met as they arise. 

Therapeutics. 

The Oil of Turpentine is employed externally as a rubefacient and 

counter-irritant in many conditions producing pain and inflammation. 

Cloths wrung out of hot water and then sprinkled with the oil (turpentine 

stupes) are useful applications in sciatica and other neuralgias, lumbago, 



( 



506 THEOBROMATIS OLEUM. 

chronic rheumatism, chronic bronchitis, peritonitis with tympanites, 
pleurisy, renal colic, etc. It is one of the most efficient agents in hospital 
gangrene, applied in full strength to the part affected. The liniment is 
in constant use for sprains, neuralgia and other slight local affections. 

Internally it is best employed in ulceration and hemorrhage of the 
intestines and in passive hemorrhages from other organs. Active bleed- 
ing with a plethoric condition and hematuria are states in which it is 
contraindicated. It is often used with ether (i to 3) in biliary and flatu- 
lent colic as an anodyne and antispasmodic. As a vermifuge against 
tape-worm it must be employed in large doses (^ss-ij) with castor oil to 
promote its rapid passage through the intestinal canal. The French acid 
oil, which is old and contains ozone, is used in phosphorus poisoning. 
It is well employed as a stimulant to the heart and vaso-motor system in 
puerperal fever, yellow fever, traumatic erysipelas, pneumonia, capillary 
bronchitis, etc. It is also useful in chronic bronchial catarrh, chronic 
cystitis, subacute gonorrhea and similar affections of the mucous surfaces 
generally. Inhalations of the vapor or atomized oil are beneficial in 
chronic affections of the larynx and bronchi. The pure vapor is too irri- 
tant for inhalation but it may be diluted with steam from an atomizer. 
Chian Turpentine is one of the remedies which have been used for cancer. 

Terebene has been extensively used by Murrell, with excellent results, 
as a remedy for obstinate winter-cough and emphysema of the lungs, in 
flatulence and flatulent dyspepsia, in cystitis and gleet, and as a spray in 
phthisis and post-nasal catarrh, also with cocaine in solution as a spray 
for coryza and hay-fever. Other observers, of several years' experience 
with this remedy, praise it highly as an inhalant remedy in phthisis, 
bronchiectasis, chronic bronchitis and other pulmonary affections char- 
acterized by profuse, purulent expectoration. Rieu employs it exten- 
sively in bronchitis and bronchorrhea, in doses internally of gr. xv-xxx 
per diem, but says that it does not affect the muco-purulent expectora- 
tion of phthisis. It probably has no superior efficacy to creosote, Venice 
turpentine, etc., except that it is without much odor and has no taste. 

Terpin Hydrate- is praised very highly in chronic and recurrent bron- 
chitis, night-cough from habit, catarrhs and kindred affections. In fact, 
all acute and many chronic affections of the respiratory passages form the 
proper field for the therapeutical action of this preparation. 



THEOBROMATIS OLEUM, Oil of Theobroma, Cacao-butter, — is a fixed 
oil expressed from the seed of Theobroma Cacao, the Chocolate- tree, nat. ord. Stercu- 
liaceae, growing in Mexico, the West Indies and South America. The oil is a yellowish- 
white solid, of faint odor, bland taste and neutral reaction. The seeds are oval, about 
the size of almonds, and consist of shells and kernels, in both of which is found the 
alkaloid Theobromine, C-H 8 N 4 2 , which closely resembles Caffeine, the latter being its 
methyl derivative. Chocolate is prepared by roasting the seeds, removing the shells, then 
crushing or grinding the kernels to a smooth paste, which is cast in molds. 



THUJA THYMI OLEUM. $0? 

Oil of Theobroma consists chiefly of Stearin with a little Olein. Its action is demul- 
cent, and it does not become rancid on exposure to the air. Its chief use is as a basis 
for making suppositories. A Cerate is prepared by melting together Cacao-butter 35, 
White Wax 35, Oil of Almond 30, adding a drop of Oil of Rose and coloring with a 
minute quantity of Carmine previously triturated with a drop of Water of Ammonia. 
This is known as Red Lip-salve. 

Theobromine has the same action and uses as Caffeine. [See under Caffea, for this 
principle and for Diuretin.] 

THUJA, Arbor Vitae (Unofficial), — the fresh tops of Thuja occi- 
dentalism a tree of the nat. ord. Coniferae, commonly though incorrectly 
called White Cedar, growing in swampy ground in Canada and in the 
northern U. S. They contain a volatile oil, tannin, wax, resin, etc.; also 
Pinipicrin a bitter principle, and Thujin a yellow, astringent and crys- 
tallizable coloring principle, which is separable into glucose and Thujetin. 

The dose of a saturated, fresh tincture or fluid extract is £j, 3 to 6 times daily. The 
Volatile Oil may be given in doses of Tr\J-v. 

Physiological Action and Therapeutics. 

Thuja resembles Savine in action very closely. It is stimulant, irritant 
and astringent, also aromatic, diuretic and emmenagogue. The oil is a 
gastro-intestinal irritant and produces epileptiform convulsions in warm- 
blooded animals but paralysis in cold-blooded ones. It causes rhythmi- 
cal contraction and dilatation of the vessels, lowers the temperature and 
is anthelmintic. Thuja is indirectly an abortifacient when given in doses 
sufficient to cause violent gastro-enteritis. It is reported to have produced 
an acute urethritis resembling gonorrhea. 

Thuja in decoction has been usefully employed in coughs, rheumatic 
and arthritic pains, dropsy and amenorrhea. It has been given with 
benefit in intermittent fever and as an alterative blennorrhetic in chronic 
catarrh and bronchorrhea. It is highly praised by Phillips for the cure 
of warts with narrow base and pendulous body, a strong tincture being 
applied locally and given internally at the same time in 5-minim doses 
twice daily. Piffard speaks strongly in its favor as a valuable agent for 
non-syphilitic warts (condylomata acuminata) of the penis and vulva, for 
papillomatous growths in general and for gleet dependent on granular 
urethritis. It has been used in chronic gonorrhea and prostatitis with 
asserted success, and is said to have cured epithelioma. The oil has been 
employed as a vermifuge. 

THYMI OLEUM, Oil of Thyme,— is a volatile oil distilled from 
Thymus vulgaris, the Garden Thyme, a common shrub of the nat. ord. 
Labiatae, indigenous to France but cultivated in our gardens. This oil is 
a pale yellow or colorless, thin liquid, having a strong odor of thyme, a 
warm, pungent and afterwards cooling taste and a neutral reaction ; 



( 



508 THYMI OLEUM. 

readily soluble in alcohol. It consists of two portions, the more volatile 
being a mixture of the hydrocarbons Cymene and Thymene, the less vola- 
tile being chiefly Thymol, which is official. 

Thymol, C 10 H u O, — is a phenol contained in Oil of Thyme and in 
the volatile oils of several other plants. It occurs in large, colorless, 
hexagonal crystals, of aromatic odor, pungent taste and neutral reaction ; 
soluble in 1200 of water, in 900 of boiling water, in 1 of alcohol, freely 
in fats and oils, solutions of chloral and alkalies, ether, chloroform, etc. 
It liquefies when triturated with about equal quantities of camphor, 
menthol or chloral. Dose, gr. ss-ij. 

Unofficial Preparations. 

Thymol Solution, —for antiseptic spray, I part in 1000. 

Thymol Ointments, — vary in strength from 5 to 30 grains to the § . 

Thymol Inhalation, — Thymol gr. xx, Alcohol 5pij, Magnesium Carbonate gr. x, 
Water to ^iij. A teaspoonful to a pint of water at 150 F. for each inhalation. 

Volkmann's Antiseptic Fluid, — has of Thymol I, Alcohol 10, Glycerin 20 and 
Water 100 parts. 

Physiological Action and Therapeutics. 

Oil of Thyme has the same properties as the oils of other mints, and 
containing a large quantity of Thymol it is similar to the latter in action. 

Thymol in its action stands between carbolic acid and oil of turpen- 
tine. Like the former it is a powerful antiseptic and disinfectant, also 
a local irritant and anesthetic to the skin and mucous membranes, para- 
lyzing the end-organs of the sensory nerves. When absorbed it paralyzes 
the nerve-centres in the spinal cord and in the medulla, lessening reflex 
action, slowing respiration, lowering the temperature and the arterial 
tension, and in poisonous doses causing weakness, coma and death. 
Internally administered in doses of 20 to 30 grains per diem it produces 
a sensation of epigastric heat, sweating, singing in the ears, deafness, a 
sense of constriction in the forehead and increase of the urinary dis- 
charge, which assumes a dark, greenish hue. It is eliminated by the 
respiratory and urinary organs, which it irritates considerably during the 
process of its excretion. As an antiseptic it is much more powerful and 
permanent than carbolic acid, and much less poisonous. 

Thymol is chiefly employed in lieu of carbolic acid as an antiseptic 
for dressing wounds ; as a gargle, spray or inhalation in laryngitis and 
diphtheria; as an ointment in ringworm, eczema and psoriasis, and as an 
injection in ozena. A solution of 1 part in 1000 is the strength usually 
employed. Internally it has been used with success in diphtheria, typhoid 
fever and other intestinal affections, diabetes, phthisis and vesical catarrh. 
Its fragrant odor renders it a very agreeable antiseptic application for 
ulcerated conditions of the mouth and fauces, but makes it very attractive 



TIGLII OLEUM. 509 

to flies, which fact together with its high price will prevent it becoming 
a favorite in hospital practice. A solution, used as a mouth-wash, is very 
efficient in removing the odor of tobacco from the breath. Thymol is 
almost specific against the intestinal parasite ankylostomiwi duodenale, for 
which it is given in three or four doses of 10 to 30 grains, well triturated, 
in capsules ; care being taken that no alcoholic drink is ingested after- 
wards, in order to avoid its absorption and the consequent poisoning 
thereby. 

TIGLII OLEUM, Croton Oil,— is a fixed oil expressed from the 
seed of Croton Tiglium, a small tree of the nat. ord. Euphorbiacese, a 
native of India. The oil is of a pale or brownish-yellow color, somewhat 
viscid and slightly fluorescent, of fatty odor, acrid taste and slightly acid 
reaction ; soluble in 60 of alcohol, freely in ether, chloroform, or carbon 
disulphide. Its composition is very complex and has not been thor- 
oughly made out, but it is known to contain the glycerides of several fatty 
acids, also a peculiar acid named Tiglinic Acid, C 5 H 8 2 , which is iso- 
meric with Angelic Acid. Dose, rr^ ^— ij, in pill, emulsion or tincture. 

Physiological Action and Therapeutics. 

Externally Croton Oil is highly irritant, producing a pustular eruption 
which heals by scabbing and may leave unsightly cicatrices. Internally 
it is a powerful drastic cathartic, producing in one or two hours copious 
watery stools, in overdoses causing great congestion of the intestinal canal 
and perhaps death from gastro-enteritis. Vomiting usually occurs after 
large doses, so that the irritant hyper-catharsis is not always observed. It 
is absorbed into the blood, and produces glandular hyperemia as well as 
direct inflammation of the intestinal mucous membrane, together with in- 
creased peristaltic action, Its cathartic power is increased by the addi- 
tion of an alkali, and is manifested, though in less degree, when applied 
to the integument. 

Croton Oil is used as a hydragogue cathartic when a speedy and com- 
plete evacuation of the bowels, diminution of arterial pressure and prompt 
derivative action are desired, as in apoplexy, impaction of the intestines, 
dropsy, lead constipation, paralysis, etc. It is contraindicated when 
either debility, organic obstruction or inflammatory conditions of the 
stomach and bowels exist. The smallness of the dose makes it a very easily 
administered and manageable purgative. An inconsiderable fraction of 
a drop, absorbed by a pellet of sugar or bread, may be given in repeated 
doses until the desired effect is obtained. It has been used as a vermi- 
fuge against tapeworm. Externally it is employed as a counter-irritant 
in ovaritis, bronchitis, pleurisy, rheumatism, neuralgia, glandular swell- 
ings and in laryngeal and pulmonary diseases. The Linimentum Crotonis 



5IO TONGA TOXINS. 

of the Br. Phar. contains i part of the oil in 3^ each of alcohol and oil 
of cajuput, and is a useful pustulant preparation, being more manageable 
than the oil itself. 

TONGA (Unofficial), — is a mixed drug said to be obtained from the Fiji Islands, 
consisting of thin barks, root-fibres and leaves, tied into long bundles. The fibrous 
material is believed to be derived from Rhaphidophora vitiensis, a creeping plant of the 
nat. ord. Aracese, containing starch, potassium chloride, and a volatile alkaloid Tongine. 
The barky portion is referred to Premna tatiensis, a shrub or tree of the nat. order Ver- 
benacea;, and contains a little volatile oil, sugar, pectin, etc. A fluid extract is on the 
market, which may be given in doses of "n\xxx-gj thrice daily. 

Tonga was introduced by Ringer and Murrell as a remedy for neuralgia in 1880, stat- 
ing that they had used it with gratifying results. Since then reports have differed con- 
siderably in regard to its efficacy, and from the fact that Dr. Ringer does not mention it 
in the later editions of his Handbook of Therapeutics, it may be inferred that his further 
experience with it has not borne out the claims first made. 

TOXINS (Unofficial). — The toxins are specific poisons produced 
by bacterial metabolism in suitable media, and when circulating in the 
animal organism are the immediate causes of the acute infectious diseases. 
Many of their active principles are of albuminous nature, the so-called 
Toxalbumins. Toxins have been obtained from ripe cultures of the bac- 
teria of tetanus, diphtheria, tuberculosis, cholera, typhoid fever, anthrax, 
pneumonia, glanders and swine-plague, also from cultures of streptococ- 
cus erysipelatis, bacillus prodigiosus, etc. The treatment of diseases due 
to pathogenic microbes by the toxic products of their own particular 
bacteria is based upon the theory that these germs produce substances in 
their culture media which are inimical to their own life. The treatment 
of tuberculosis by Koch's tuberculin and the inoculations of Haffkine 
against cholera are examples of true toxin treatment. The vaccinations 
of Jenner for variola and Pasteur for rabies are of the same nature when 
employed as remedial methods, the material being obtained from a mor- 
bid product of the disease in the one case and from the diseased tissue 
itself in the other, the culture medium in both being the blood and tissues 
of the infected animal organism. 

It has been frequently observed that patients afflicted with malignant 
disease have been greatly benefited by an intercurrent attack of erysipelas, 
in consequence of which the tumors seemed to undergo retrogressive 
changes. This has suggested the employment of the toxins of streptococ- 
cus erysipelatis and bacillus prodigiosus in inoperable cancer, and may 
lead to the treatment of other diseases by the toxins of bacteria hitherto 
unassociated with them. 

The injection of a toxin, in gradually increasing doses at proper inter- 
vals, will confer immunity in many cases upon the animal so treated 
against the corresponding disease and its particular bacteria. This im- 
munity may be transferred to another animal by injecting into its cellular 
tissue the blood-serum of the immunized one, and this serum will also 



TOXINS. 5 1 1 

act remedially on a subject of the disease if administered early in its 
course (Behring). The immunizing and curative action of the serum is 
believed to be due to the existence of an antitoxin in the blood of the 
inoculated animal, elaborated by the living cells of its tissues as a defence 
against the action of the toxin. These facts and hypothesis form the 
basis of the treatment of certain diseases by antitoxic serum (described 
under the title Antitoxins, ante, page 174 et sea.), which now promises 
better results than any other system of bacterio-therapy. 

The toxin produced by any particular bacteria varies greatly in power 
through very slight circumstances. It may be weakened or increased in 
virulence by the cultivation of its bacteria on different culture media or 
on the same media with different surroundings as to oxygen, temperature, 
etc.; also by passing successive generations of these organisms through a 
definite series of animals, chosen for their natural insusceptibility or sus- 
ceptibility thereto. The pathogenic microbes of several diseases are now 
cultivated in test-tubes, forced to acquire an increased or lessened degree 
of virulence or toxin-producing power as required, are separated from the 
poisonous products of their metabolic life-work, and by the inoculation 
of either their progeny or their chemical products (toxins) the cor- 
responding diseases are reproduced upon healthy animals in almost any 
desired degree of intensity. 

Repeated efforts have been made in some cases to separate from these 
bacterial products a germicidal ingredient without its toxic associates, 
which might prove curative for the corresponding disease. The Tuber- 
culocidin and Antiphthisin of Klebs are claimed to be such substances, and 
are described in the following pages. 

Tuberculin, or Koch' 's Lymph, announced as a secret and specific 
remedy for tuberculosis by Professor R. Koch, of Berlin, ten years ago, 
was subsequently stated by him to be an extract of the products of pure 
cultures of the tubercle bacillus, made with glycerin and water. In Koch's 
preliminary statement to the Berlin meeting of the International Medical 
Congress in 1890, the chief point made was that guinea-pigs could be 
rendered immune to inoculated tuberculosis by means of this agent, but 
even this has been denied by other observers. In his extended paper 
published in November, 1890, he stated that the remedy would not di- 
rectly kill the bacilli, but that it acted powerfully and specifically upon 
the living tuberculous tissue, caused a necrotic condition thereof and 
hastened its disintegration ; also that it might be expected to increase 
the resistant power of healthy tissue and thereby starve the bacilli, check 
their increase, and lead in many cases to the cure of the disease. The 
actual result, however, as Virchow and others soon pointed out, was to 
soften and disintegrate quiescent deposits and to disseminate the bacilli 
throughout the body, forming new foci of active infection in other situa- 



i 



1 



512 TOXINS. 

tions. The severe reactions, which followed the injections of the lymph 
in many instances, proved that serious risk must attend its general use ; 
and that, like most remedies for phthisis, it could do good only in a few 
carefully selected cases. A sense of profound disappointment followed 
the enthusiasm at first excited, with the result that the remedial action of 
tuberculin became thoroughly discredited and its use was almost universally 
abandoned. It has lately become of interest again by reason of the per- 
sistent efforts to extract from it a germicidal constituent free from toxins 
(see infra), as also by the results obtained in tuberculosis with the blood 
serum of animals immunized by its repeated inoculation. (See the arti- 
cle on Tuberculosis Antitoxin, ante, page 180.) 

The violent action of tuberculin, together with its source, prove it to 
be a true bacterial toxin. Taken by the mouth it is inert, being probably 
digested in the stomach. In small dose (one milligramme of the original 
lymph) injected hypodermically upon healthy subjects, it gives rise to 
slight pains in the limbs and a transient sense of fatigue ; but the same 
quantity injected upon tuberculous subjects produces a very powerful re- 
action both locally and generally, the constitutional effects being similar 
to those accompanying an acute exacerbation of the disease. About three 
hours after the injection a decided rigor occurs, which is followed by a 
rapid rise of temperature and pulse-rate ; also pains in the limbs, a sense 
of great fatigue, drowsiness, nausea and loss of appetite, these effects 
lasting from 12 to 15 hours. In cases of advanced phthisis with cavities, 
after an injection of tuberculin the temperature has risen to 105. 8° F., 
which falling suddenly collapse has occurred and the patients have died. 
If the case presents a local tuberculous lesion, this swells and becomes 
tender to the touch and the skin over it is inflamed. In pulmonary cases 
the reaction is greater than from the same dose in those having surgical 
tuberculous lesions ; the cough increases, there is great distress and 
dyspnea, the patient feels decidedly worse and occasionally suffers a slight 
collapse. When the reaction has subsided the patient feels comparatively 
well and generally better than before. In cases of lupus the effects of the 
injection are very marked. Within three hours there arises a feeling of 
tightness with heat and burning over the face and nose, and an eczematous 
exudation sets in, which continues about 48 hours and dries into crusts 
on the surface of the lesion. After two days these symptoms begin to 
subside, and after nine days the crusts have fallen off and the affected 
tissue appears shrunken, red and shiny, like the surface of a lupus patch 
which has been scraped with a Volkmann's spoon. 

The principal lessons taught by the history of Koch's tuberculin are 
pathological rather than therapeutical, and cannot be set forth here. 
An important one is that any treatment in tuberculosis which promotes 
destructive changes instead of conservative ones, shown in this case by 



TOXINS. 513 

the breaking down of the lung tissue and its appearance on a large scale 
in the sputum, cannot be other than detrimental to the patient, as the 
area of infection, instead of being limited as it was, is thereby considerably 
widened. As a diagnostic agent it is certainly of value in showing the 
presence or absence of latent tuberculosis, but for this purpose it should 
only be used in veterinary practice, for the ordinary means of diagnosis 
are already so reliable that so dangerous a procedure is not justifiable 
on human subjects. 

Professor Koch has acknowledged that tuberculin is only serviceable in 
the initial stage of phthisis and in cases of simple infection, also that 
when the case is complicated by the presence of other microbes it is of 
no service and often does harm. Professor Ewald has stated that so far 
as clinical and experimental testimony had gone it possesses no specific 
curative action, and that its use must finally be abandoned on account 
of the dangers attending its administration. The physicians of the 
Hospital for Consumption and Diseases of the Chest at Brompton, Eng- 
land, reported on its systematic employment in 30 cases of pulmonary 
tuberculosis and lupus, with the following conclusions : " That the tuber- 
culin did not favorably influence the course of the disease in the majority 
of cases; that in some the effects were detrimental \ and that even in the 
stationary and improved cases it was difficult to ascribe any distinct im- 
provement to the injections which might not have been equally attained 
under the treatment ordinarily employed in the hospital." 

Koch's Tuberculin was distributed in the form of a brown solution, which by evapora- 
tion and filtration had been concentrated to one-tenth the volume of the ripe culture fluid. 
One part of this original lymph, added to nine parts of distilled water containing ]/ z to I 
per cent, of carbolic acid, made the so-called "mother solution," in which form, though 
too powerful for use, it will keep a long time, being still further diluted as required. One 
part of this 10 per cent, solution added to nine parts of distilled water makes the dilute 
I per cent, solution used for injection. If, as Koch estimated, the original lymph con- 
tains but one per cent, of the dry, active substance, its proportion in the injection solution 
would be only one in ten thousand. The dose of the latter solution ranged from 0.1 cc. 
to I.o cc, corresponding too. 001 cc. and 0.01 cc. of the original lymph ; and was admin- 
istered by a sterilized hypodermic syringe of special form, under strict aseptic precautions, 
beneath the skin of the back between the scapula. In early lung cases a period of about 
four to six weeks completes the course of treatment. Koch's syringe contains 1.0 cc. 
and is graduated in tenths, each division representing one minimum dose (0.1 cc.) of the 
I per cent, solution. When large doses are reached the stronger 10 per cent, solution 
may be used in appropriate quantity. For cases of lupus much heavier doses were 
employed at first, even ten times the quantities mentioned above, but necessarily at much 
longer intervals. These large doses, however, gave rise to most formidable and danger- 
ous symptoms, and caused fatal results in some cases. Dr. Whitla believes that better 
results would have been obtained by the use of much smaller doses. 

Tuberculin- R. Professor Koch has produced three new tuberculins, named Tuber- 
culin-A, Tuberculin-0 and Tuberculin-R. The last-named is the only one of thera- 
peutic value, and is prepared by extraction of pure cultures of tubercle bacillus with 40 
to 50 per cent, glycerin and repeated precipitation by alcohol. The result is a snow-white 
mass which turns a light gray color upon drying. It is soluble in water, but the aqueous 
solution is unstable ; a solution in 50 per cent, glycerin remains unchanged. It is* 
administered subcutaneously in the muscles of the back between the shoulder-blades. 

33 



< 



5 14 TOXINS. 

After injection the point is covered with iodoform collodion and bandaged with iodoform 
gauze. This preparation proved decidedly active in immunizing against the tubercle 
bacilli. Decided benefit was obtained from it in every case of lupus treated, also in the 
early stage of pulmonary tuberculosis. Maragliano states that there is no real difference 
between the new tuberculin and the old one, and that the latter is the best of the two. 
Experience with it in Erb's and von Leyden's clinics did not show any striking results, 
Kernig warns against its use, and Bouchard terms it "an impure, bacteria-infected 
product, entirely unsuited to scientific investigations." Dose, gr. ^io - T5 > i to I m S- 

Tuberculocidin. After Koch's tuberculin became discredited, its 
composition became the subject of analytical research with the view of 
separating out its toxic constituents and obtaining a remedial agent from 
it. These investigations were made principally by W. Hunter, Watson 
Cheyne and E. Klebs of Zurich. The latter treated the crude tuberculin 
with platinum chloride, which precipitates the alkaloidal constituents or 
toxins, leaving a solution which he named Tuberculocidin, on account of 
its supposed antagonism to the tubercle bacillus. With this solution he 
treated 75 cases of phthisis, and reported 14 as cured, 45 improved, 14 
unimproved, and 2 died. During experiments on animals with it he 
claims to have observed the complete regression of an apparently advanced 
tuberculosis. Langermann used it in four cases of pulmonary tuberculosis 
with varied results. He admits that it does not cause either serious con- 
stitutional effects as tuberculin does or irritation at the site of injection, 
but as to its curative action he has great doubt. Klebs has apparently 
abandoned this agent in favor of Antiphthisin, his more recent but 
similar product. 

Antiphthisin is the latest result of Klebs' long-continued efforts to 
extract a non-toxic and curative substance from tuberculin, which, accord- 
ing to his most recent analysis, contains (1) tox-albumins, precipitated by 
sodic iodide of bismuth, (2) alkaloids, (3) an albuminoid derived from 
the bodies of the dead bacilli, (4) a soz-albumin, precipitated by absolute 
alcohol after the removal of the toxic ingredients. It is claimed by 
Klebs that an aqueous solution of this soz-albumin, prepared by him and 
named Antiphthisin, possesses the germicidal and curative properties of 
tuberculin without any of its toxic effects. With this product he claims 
to have caused the complete cure of tuberculosis in guinea-pigs, and to 
have obtained 90 per cent, of good results (whatever that may mean) 
for all stages of phthisis in the human subject. He states however that 
it will produce its fullest benefits in the very early stages of the disease, 
for which stages alone it is recommended as a specific remedy ; and that 
in advanced and complicated cases the prospects for its successful use are 
less certain. In asking physicians to give it a trial he requests that they 
will not try the remedy except in cases of pure tuberculosis, excluding 
for the present cases of mixed infection, septic cases, and all such as have 
amyloid degeneration or are so far reduced that they must die of the 
complications or exhaustion present. These requirements may be good 



TOXINS. 515 

for the reputation of the remedy, but are most difficult to observe in 
practice, as they confine it to a class of cases which seldom come to the 
physician in that stage and which are not easily diagnosed with accuracy 
when seen. Von Ruck, who is associated with Klebs, reports as his 
experience of nearly 100 cases of phthisis treated with this remedy, that 
it has an unmistakable influence over the fever, that under its use percus- 
sion dulness becomes perceptibly less, bronchial and harsh breathing give 
place to puerile and then vesicular respiration, the lung-capacity increases, 
the cough diminishes, the sputum loses its purulent character and lessens 
in quantity, while the bacilli therein diminish in number and show 
marked signs of degeneration. Denison, of Denver, reports that most 
of the cases treated by him with antiphthisin gave evidence of its germi- 
cidal and healing effects, "in the lessening of the number of germs to 
the field found, and their degenerative or incomplete forms thrown off 
when good sized doses were reached, as well as in the clearing up of con- 
solidated or infiltrated tubercular lung tissue." 

Antiphthisin is prepared by Professor Klebs, who explains the process of manufacture 
as follows : " We take the ripe culture of the tubercle bacillus and reduce it to one-tenth 
of the original amount by evaporation in a vacuum and filter. This really is the tuber- 
culin as prepared by Professor Koch. To the filtrate we now apply an acid solution 
of sodic iodide of bismuth and obtain a precipitate which is filtered out. This precipi- 
tate represents the toxic properties of tuberculin, as proved both in the animal experiment 
and in its application to the human being for diagnostic purposes. . . . After the 
tox-albumins are filtered out, we precipitate further by the addition of absolute alcohol 
an organic substance resembling in its chemic reaction a peptone, and this organic sub- 
stance redissolved in distilled water is antiphthisin. In the animal experiment we find 
that this alcoholic precipitate does not produce fever or toxic symptoms of any kind. 
Antiphthisin cannot be given by the mouth, being an albuminoid substance it would be 
digested in the stomach. The remedy has no diagnostic properties, there is no reaction 
to its use. I think my remarks will make it plain, that the diagnostic value lies in the 
toxins, and the curative substance separated from the toxins is antiphthisin." (From 
Klebs' remarks in German, before the Section on Diseases of Children at the Baltimore 
meeting of the American Medical Association, May, 1895, translated by Von Ruck.) 

The daily dose for an adult is o. I cc. at first, increased daily or every other day until 
0.5 cc. is reached. This dose may be repeated daily for a week, and is then gradually 
increased to 1 .0 cc. , which latter dose is again continued for a time, before being again 
increased. It is seldom necessary to go beyond 2.0 cc, though a dose of 10 cc. has been 
given. The administration may be intermitted for a time after 50.0 cc. have been used. 
If, under a certain dose, the improvement is rapid and satisfactory, there is no reason 
to increase the quantity given ; and physical examination should constantly accompany 
and control the future course. The remedy may be administered hypodermically under 
aseptic precautions, or by rectal injection. It is put up in vials containing 15, 30, and 
50 cc, and is sold at the rate of fifty cents per cubic centimeter. 

Erysipelas and Prodigiosus Toxins. Malignant tumors have 
occasionally been observed to disappear after the patient had suffered from 
an intercurrent attack of erysipelas. When the discovery was made that 
artificial erysipelas could be produced by the inoculation of pure cultures 
of the streptococcus erysipelatis, this inoculation was practised upon sub- 
jects of cancer as a remedial measure. The results, though favorable,, 
were not so complete as in the cases acted upon by accidental erysipelas, 



( 



5 16 TOXINS. 

and the inoculated disease often proved fatal to the patient. Coley then 
employed the toxin of the streptococcus instead of the culture itself, 
and reported a number of apparent cures of malignant disease thereby. 
Later it was found by Roger that the bacillus prodigiosus has the power 
of intensifying the virulence of the streptococcus erysipelatis, and by 
using a mixture of the toxins of both these germs, Coley obtained a 
more beneficial effect than from the erysipelas toxin alone. The remedial 
action is much more efficient in sarcoma than in carcinoma, though some 
cases of the latter disease are reported as apparently cured by this treat- 
ment. Including all the cases of sarcoma in which these mixed toxins 
have been employed by Coley, there are 43 such reported of which 11 
were apparently cured. Professor Senn of Chicago has found negative 
results in his own experience of this treatment, and states that in all 
his cases these injections failed to effect even temporary improvement. 
Coley prepares these toxins in the usual manner, and avoids the danger 
of inoculating erysipelas itself by subjecting the cultures to a tempera- 
ture (136. 4 F.) sufficient to destroy the germs. The commencing dose 
is 1 or 2 minims, injected once daily into the tumor or subcutaneously in 
its vicinity and gradually increased. This method should be employed 
only in cases which are manifestly unfit for operative interference. 

Richet and Hericourt injected a serum obtained from animals inoculated with the fil- 
tered emulsion of an osteo-sarcoma into a recurrent sarcoma of the chest-wall and also 
into a supposed carcinoma of the stomach. The tumors were thereby reduced in size 
and general improvement followed, but in neither case was there any microscopical 
examination made, hence the diagnoses are uncertain. 

Emmerich and Scholl claim that excellent results were obtained by them in the treat- 
ment of both sarcoma and carcinoma by injecting into the growth an antitoxic serum 
obtained from sheep inoculated with the toxins of virulent erysipelas streptococci. Other 
experimenters, including Bruns and Angerer, do not confirm their statements in this 
respect ; and as their observations were limited to a few weeks, it is impossible to regard 
their cases as presenting evidence of cure. 

Cholera Toxin. An extended series of inoculations against cholera 
was carried out in India by Dr. Haffkine, whose procedure comprises 
the preparatory use of a weak virus followed by a second inoculation with 
a stronger one. He obtained the weak virus by passing air and oxygen 
over a culture of the comma bacillus on agar at a high temperature, which 
so modified the microbes that when injected they produced only slight 
local puffiness, followed by a mild reaction. The second inoculation 
was made five days after the first, and with a virus of such intensity that 
it killed a guinea-pig in eight hours. This virus, used on the human 
subject subsequent to the preparatory inoculation, caused only slight 
local and constitutional disturbance, thereby proving that the first inocu- 
lation had conferred a certain degree of immunity against its effects. 
The symptoms subside in another five days, and not until then can it be 
said that the operation of preventive inoculation against cholera is com- 



TOXINS. 517 

plete. Dr. Haffkine made 42,445 such inoculations, without a single 
instance of mishap or injury to health resulting therefrom. The results 
obtained were highly favorable, the statistics demonstrating for this pro- 
cedure a remarkably protective power against cholera in a country where 
that disease is endemic. The figures are furnished, not by Dr. Haffkine, 
but by responsible British medical officers assigned to the duty of veri- 
fying the result in each case. 

Rabies Toxin. Although no microbe has yet been found associated 
with rabies, there is abundant evidence to prove that the specific virus of 
this disease is a micro-organism, inasmuch as it behaves exactly like one. 
Pasteur found that the virus is most abundant in the spinal cord of the 
rabid animal and showed that its inoculation upon a healthy animal will 
produce the characteristic symptoms of the disease, also that the virus 
may be attenuated in virulence by drying the spinal cord containing it. 
He also found that by inoculating on each successive day the virus from 
a cord dried during a shorter period than that used on the previous day, 
the animal so treated may be gradually made almost certainly secure 
against rabies, either from the bite of a rabid animal or from any method 
of subcutaneous inoculation. Upon these facts he founded his preven- 
tive treatment of this disease commenced by him in Paris in 1885, which 
consists in the daily inoculation of the bitten person with emulsions of 
gradually increasing virulence, made from the dried spinal cords of rab- 
bits that have died from inoculated rabies. By this procedure chemical 
substances (toxins), produced during the life of some specific organism 
and known to be inhibitory of its growth, are introduced into the system 
of the patient (V. Horsley). 

During the eight years from 1886 to 1893 inclusive there were treated 
by this method at the Pasteur Institute in Paris 14,430 bitten persons 
from many countries with 72 deaths resulting, a mortality rate of ^ of 
1 per cent, for the entire number ; the mortality for each year having 
steadily decreased from 0.94 per cent, in 1886 to 0.25 per cent, in 1891, 
0.22 per cent, in 1892, and 0.24 per cent, in 1893. During the four 
years from 1892 to 1895 inclusive, there were treated at the Pasteur 
Institute in New York 424 bitten persons from all parts of the United 
States and Canada, among whom only 2 deaths occurred. 

The patient bitten by an animal supposed to be rabid should be sent 
at once for treatment to one of the Pasteur Institutes, and should be 
accompanied if possible by a piece of the medulla oblongata of the 
biter animal, in order to determine by experimental methods whether 
the animal was rabid or not. The specimen should be removed with an 
aseptic knife and placed in a mixture of equal parts of pure glycerin 
and water, previously sterilized by boiling. The period of treatment is 
usually 15 days, during which from 2 to 6 inoculations are administered 



< 



1 



5 I 8 TRAGACANTHA. 

daily with viruses of gradually increasing intensity ; the number depend- 
ing on the time which has elapsed between the infliction of the bite and 
the commencement of the treatment. 

The Hydrophobia Committee, appointed by the British Parliament in 1887 to investi- 
gate Pasteur's treatment of rabies, consisted of Sir James Paget, chairman, Sir Joseph 
Lister, Dr. Lauder Brunton, Sir Richard Quain, Dr. Geo. Fleming, Sir Henry Roscoe 
and Dr. Burdon Sanderson, with Professor Victor Horsley as secretary. Their report 
to parliament, made after an extended investigation in Paris and much experimental 
research, states as follows : " It may hence be deemed certain that M. Pasteur has dis- 
covered a method of protection from rabies comparable with that which vaccination 
affords against infection from small-pox. It would be difficult to overestimate the impor- 
tance of the discovery, whether for its practical utility or for its application in general 
pathology. . . . From the evidence of all these facts we think it certain that the 
inoculations practiced by M. Pasteur on persons bitten by rabid animals have prevented 
the occurrence of hydrophobia in the large proportion of those who, if they had not been 
so inoculated, would have died of that disease." Professor Victor Horsley, the secretary 
of the committee, said three years afterwards in Fowler's Dictionary of Medicine, that 
"its adoption has reduced the mortality among those bitten by indubitably rabid dogs 
from 15 per cent, to 1.3 per cent." 

Tizzoni and Cantani have published reports of experiments on the cure of rabies after 
its actual outbreak. They found that an alcoholic precipitate from the serum of highly im- 
munized animals not only caused protection against rabies but also cured it, even after 
the first symptoms of the disease had made their appearance. It has also been announced 
that at Bologna a cure of rabies in the advanced stage was effected by a special mode of 
the Pasteur treatment. A man bitten by a rabid dog, who had subjected himself to the 
inoculations, was seized with the phenomena of paralytic rabies. Paralysis having pro- 
gressed from the lumbar region over the whole organism, bladder and rectum included, 
intravenous injections of the fixed virus were administered, whereupon the painful symp- 
toms diminished and finally a perfect cure was accomplished. 

Mallein is an extract in glycerin of the products of cultures of the 
bacillus mallei, the microbe associated with glanders. This toxin, when 
injected into animals affected with glanders, produces a strongly marked 
febrile reaction, similar to that caused by tuberculin in tuberculous sub- 
jects. It is extensively employed in veterinary practice for the purpose 
of testing horses suspected of being infected with the disease. However, 
a case occurred in London in which ten horses in one stable showed the 
typical reaction after the use of mallein, but subsequently developed none 
of the symptoms of glanders. 



TRAGACANTHA, Tragacanth, — is a gummy exudation from Astragalus gum- 
mifer and from other species of Astragalus, shrubs of the nat. ord. Leguminosse, growing 
chiefly in Asia Minor and Persia. It occurs in shell-like, curved or contorted bands, 
swelling with water to a gelatinous mass, which is tinged blue by test-solution of iodine, 
and consists of a mixture of Arabin, or gum-arabic, which is soluble in water, and 
Bassorin, a gum which is insoluble in water but swells up in it, also a little starch. 

Mucilago Tragacanthse, Mucilage of Tragacanth, — Tragacanth 6, Glycerin 18, 
Water to 100. Dose, ^j or more. 

Tragacanth is demulcent, but in large quantities may cause indigestion. It is chiefly em- 
ployed to suspend resins and heavy powders in emulsion. The mucilage may be used as a 
vehicle for active agents in gargles for pharyngitis, and to cause cohesion in the prepara- 
tion of pills, troches, etc. It is a constituent of 12 of the 15 official troches, and is a 
better agent than acacia for making emulsions of cod-liver oil. 



TRITICUM ULMUS UVA URSI. 519 

TRITICUM, Couch-grass, — is the rhizome, gathered in the spring and deprived 
of its roots, of Ag ropy rum repens, the Couch-grass, a perennial plant of the nat. ord. Gram- 
inese, abounding in meadows and cultivated grounds, where it ranks as a weed though 
of the same genus as wheat. It contains much sugar and a gum-like principle, Triticin. 
Dose, 3]-%']> in infusion or decoction. 

Extractum Tritici Fluidum, Fluid Extract of Triticum. — Dose, gj— ^j, well 
diluted. 

Couch-grass is demulcent, emollient and a feeble diuretic. It is chiefly used in cystitis 
and irritable bladder. The infusion is a popular fever-drink in Europe, and has had of 
old a considerable reputation in dysuria. 

ULMUS, Elm, Slippery Elm, — is the inner bark of Uhnus fiilva, an indigenous 
tree of the nat. ord. Urticaceae. It contains a large quantity of mucilage which it readily 
parts with to water. 

Mucilago Ulmi, Mucilage of Elm, — Elm 6, Water to 100, digested for an hour and 
strained. Dose, ad libitum. Should be freshly made when wanted. 

Slippery-elm Bark is demulcent, slightly astringent and somewhat tonic. It is used 
internally in diarrhea, dysentery and affections of the urinary passages, and externally in 
the form of poultice as an emollient application in cases of inflammation. It is also 
employed in the dilatation of fistulse, strictures and the os uteri. 

UVA URSI, Bearberry, — the leaves of Arctostaphylos Uva-ursi, 
a low, evergreen shrub of the nat. ord. Ericaceae, inhabiting the northern 
latitudes and high mountains of Europe, Asia and America. They con- 
tain tannic and gallic acids and 3 principles, viz., Arbutin, a bitter glu- 
coside, neutral, crystalline, soluble in warm water and resolvable into 
glucose and Hydroquinone ; Ericolin, bitter and amorphous; Ursone, 
resinous, neutral, crystalline and tasteless. The Californian Manzanita 
{Arctostaphylos glaucd) is an allied plant and also contains arbutin and 
tannin. Dose of the powdered leaves, gr. X-3J in infusion or decoction. 

Prepa7'ations. 
Extractum Uvae Ursi, Extract of Uva Ursi. — Dose, gr. ij-x. 
Extractum Uvae Ursi Fluidum, Fluid Extract of Uva Ursi. — Dose, VC\x-£]. 
Infusum Uvae Ursi, Infusion of Uva Ursi (Unofficial), — ^j to Oj. Dose, ^j-ij. 
Arbutinum, Arbutin, C 24 H 32 O u (Unofficial). — Dose, gr. iij-v. 

Uva Ursi is astringent, tonic and feebly diuretic. Used in large quan- 
tity it produces vomiting and purging and is alleged to have oxytocic 
power. Arbutin is an efficient diuretic, and is decomposed in the body 
yielding hydroquinone, excreted by the kidneys as hydroquinone-sul- 
phuric acid, which is non-toxic and imparts a brown color with antiseptic 
and slightly irritant qualities to the urine. 

Bearberry was formerly used in all calculous affections and chronic dis- 
orders of the urinary passages. It has some reputation as an antilithic, 
and is useful in gravel, chronic nephritis, cystitis and urethritis. It 
relieves incontinence of urine, dysuria and strangury, and has proved 
serviceable even in uterine hemorrhages. Arbutin has been successfully 
employed in cardiac dropsy as a diuretic, also in urethritis. 



( 



520 VALERIANA. 

VALERIANA, Valerian, — is the rhizome and roots of Valeriana 
officinalis, a large, herbaceous plant of the nat. ord. Valerianese, having 
small, white, or rose-colored flowers. The plant is a native of Europe, 
but is cultivated in Vermont and New York. It contains a Volatile Oil, 
from which are developed by oxidation Valerene, C 10 H 16 a terpene, 
Valerol or Baldrian Camphor, C 12 H 20 O, and Valerianic Acid, C 5 H 10 O 2 , 
which occurs also in many other plants and in cod-liver oil. The Vale- 
rianic Acid of pharmacy is obtained as a product of the oxidation of 
amylic alcohol, and from it are formed the various valerianates. It is not 
identical with the natural acid. Dose of the powdered root, gr. x-xxx. 

Preparations of Valerian. 

Extractum Valerianae Fluidum, Fluid Extract of Valerian. — Dose, u\x-gj. 

Tinctura Valerianae, Tincture of Valerian, — strength 20 per cent. Dose, gss-ij. 

Tinctura Valerianae Ammoniata, Ammoniated Tincture of Valerian, — has of 
Valerian 20, Aromatic Spirit of Ammonia to 100. Dose, ^ss-ij. 

Oleum Valerianae, Oil of Valerian (Unofficial), — the volatile oil, sp. gr. about 0.950, 
a greenish or yellowish, thin liquid, having the odor of valerian, an aromatic taste and a 
slightly acid reaction, readily soluble in alcohol. Dose, mjj-v. 

The Oil is by far the best preparation for use, as the tinctures are extremely nauseous 
and the fluid extract is too bulky. The taste is best covered by Cinnamon. 

Preparations of Valerianic Acid. 

Valerianates of Ammonium, Ferrum, Quinine and Zinc are official and are described 
under the titles of their respective bases. They are made with the artificial valerianic 
acid and do not represent the action of the plant but rather that of the bases from which 
they are prepared. 

Physiological Action and Therapeutics. 

Valerian is antispasmodic and a gentle stimulant to the nervous and 
circulatory systems. It is sedative to reflex excitability, antagonizing the 
action of strychnine, brucine, thebaine, etc., and is laxative, diaphoretic 
and anthelmintic. Its taste and odor are very disagreeable but cats are 
extravagantly fond of it. In these animals it greatly excites the sexual 
appetite, probably from a resemblance between its odor and theirs when 
under venereal excitement. After a time it produces in them violent 
spasms and convulsions. In full doses it increases the action of the heart 
and raises the temperature, in most persons producing exhilaration (in 
some, slight mental disturbance), with formication of the hands and feet. 
Long used it induces a condition of melancholia. Large doses cause 
hiccough, diarrhea, nausea and vomiting, frequent micturition with 
tenesmus of the bladder and lithates in the urine, mental disturbance 
even to delirium, reduced motility and sensibility and lessened reflex 
excitability. The Oil in large doses is paralyzant to the brain and the 
spinal cord, lowers the blood-pressure and slows the pulse. 

The Valerianates follow their bases in general action but are supposed 
to possess some of the sedative qualities of their acid constituent. 



VANILLA VERATRUM VIRIDE. 521 

Valerian was formerly employed in epilepsy but was probably useful 
only in the hysterical form of that disease (hystero-epilepsy). It is a 
valuable remedy in all forms of hysteria, especially in young and delicate 
women. It is useful in the flatulence of infants and in that of hypo- 
chondriacal and hysterical subjects, also for coughs of nervous type, 
whooping-cough, diabetes insipidus, convulsions due to worms and in 
delirium with vital depression. In the coma of typhus fever the oil 
proved remarkably efficient in a series of 135 cases out of 172 cases 
treated by it. Ammonium Valerianate is used in the same class of dis- 
orders as is Valerian. It is often a good remedy for nervous headache, 
administered in 10-grain doses in an elixir. Zinc Valerianate has been 
supposed to combine the antispasmodic power of valerian with the nerve- 
tonic effect of a zinc salt. It has been used in cholera, epilepsy and 
neuralgia, frequently with considerable success. The Ferric and Quinine 
Valerianates are used as are the other salts of their respective bases. 

VANILLA, — is the fruit of Vanilla planifolia, a perennial climbing plant of the 
nat. ord. Orchideae, native of the West Indies and tropical America, but cultivated in 
Java, etc. Its characteristic odorous principle is Vanillin, the methyl-ether of protocate- 
chuic aldehyd, which oxidizes slowly in damp air to Vanillic Acid, and may be resolved 
into methyl chloride and protocatechuic acid. Vanillin may be made synthetically from 
Coniferin or from Eugenol. Dose, indefinite. 

Tinctura Vanillae, Tincture of Vanilla, — 10 per cent. Dose, a few drops, accord- 
ing to the strength of flavor desired. 

Trochisci Ferri, Troches of Iron, — contain about -^ per cent, of Vanilla. 

Vanilla is an aromatic stimulant, with considerable influence on the nervous system. 
It is chiefly employed as a perfume and for flavoring purposes but has been used with 
benefit in hysteria and low fevers. 

VERATRUM VIRIDE, American Hellebore,— is the rhizome 
and roots of Veratrum viride, the Indian Poke (Poke-root, Swamp Helle- 
bore), an indigenous plant of the nat. ord. Liliacese. It contains the 
alkaloids Veratrine (Cevadine) C 32 H 49 N0 9 , Jervine, Pseudojervine and 
Pubijervine, also resin, gallic acid, sugar, etc. 

Allied Plants. 

Veratrum Album, White Hellebore, — is a native of the mountainous 
regions of continental Europe, and so closely resembles V. Viride in 
appearance and characteristics that it may be considered a variety of the 
same plant. The rhizome was official in the U. S. P. 1870. It contains 
the alkaloids Protoverairine C 32 H 51 NO n , Jervine, Pseudojervine, Rubi- 
iervine, Protoveratridine and others. 

Veratrum Sabadilla, Cevadilla (Asagrcea officinalis'), — is a bulbous 
plant of the nat. ord. Liliacese, indigenous to Mexico and Central 
America. It contains the alkaloids Veratrine (Cevadine), Cevadilline, 
Sabadine, Sabadinine and another base known as Wrighfs Veratrine. 



i 



( 



522 VERATRUM VIRIDE. 

This plant is the source of the official mixture of alkaloids called Vera- 
trine (see below). 

Veratrine can be decomposed into Angelic Acid and Cevine, a base allied to aconine ; 
Protoveratrine is probably a combination of Isobutyric Acid and a similar base. Vera- 
trine and Protoveratrine are powerful alkaloids, the latter almost rivalling aconitine in 
toxicity. Jervine, Sabadine and Sabadinine possess some action on the organism. Cev- 
adilline has not been examined ; the others are said to be inert. 

The nomenclature of the various veratriae alkaloids is confusing, having undergone 
considerable modification. That given above is the most recent, but many authors follow 
Bullock, who gave the names Jervine and Veratroidine to the chief constituents of vera- 
trum viride and Veratralbjne to the principal alkaloid of veratrum album. The sub- 
stance officially termed Veratrine is not the alkaloid so named but is a mixture of 
alkaloids. 

Preparations. 

Extractum Veratri Viridis Fluidum, Fl. Ext. of Veratrum Viride. — Dose, try-iv. 

Tinctura Veratri Viridis, Tinct. of Veratrum Viride, — 40 per cent. Dose, tryj-x. 

Norwood's Tincture of Veratrum Viride (Unofficial), — has a very high reputation 
for efficiency, — Dose, TT\v, increased by rt\j every 3 hours, until pulse is down to 65, 
when the original dose will hold it there. Larger doses in puerperal convulsions. 

Veratrina, Veratrine , — is a mixture of alkaloids prepared from the seeds of Asagrcea 
officinalis (see p. 521). A white, or grayish- white, amorphous powder, highly irritant 
to the nostrils, of very acrid taste, producing tingling and numbness of the tongue and 
constriction of the fauces ; slightly soluble in cold water, soluble in 3 of alcohol, in 6 
of ether, in 2 of chloroform, in 96 of glycerin and in 56 of olive oil. Dose, gr. -jo - rV' 

Unguentum Veratrinae, Veratrine Ointment, — Veratrine 4, Olive Oil 6, Benzoinated 
Lard 90. For local use. 

Oleatum Veratrinae, Oleate of Veratrine, — Veratrine 2, Oleic Acid 98. Local use. 

Physiological Action. 

Veratrum Viride is closely allied to Aconite in action, being a powerful 
cardiac depressant and spinal paralyzant. It differs from Aconite in affect- 
ing the respiration to a much less degree, in being a systemic emeto- 
cathartic, in paralyzing the motor system centrally, impairing the reflexes 
but leaving sensation unimpaired, and in having little or no diaphoretic 
or diuretic action in ordinary medicinal doses. It causes great muscular 
depression but is seldom fatal; when death does result from its use it 
occurs by paralysis of the respiration. In small doses Veratrum reduces 
the force of the pulse, but does not at first affect its rate. If continued 
for some time, the pulse becomes very slow, soft and compressible; rising 
on the least exertion to be very rapid and feeble. At the same time there 
is great muscular weakness, and frequently nausea and vomiting. Large 
doses increase these symptoms very much, the pulse becoming very rapid 
and so small as to be almost imperceptible ; the skin is cold and clammy, 
and constant vomiting, extreme debility, giddiness, impaired vision, and 
partial unconsciousness ensue. 

Veratrum Album contains the powerful alkaloid Protoveratrine. Its 
general action is similar to that of its congener, but it is much more 
irritant to the gastro-intestinal mucous membrane, causing violent 
vomiting and purging, intense abdominal and esophageal pain, greatly 



VERATRUM VIRIDE. 523 

reduced temperature and pulse, collapse and death from cardiac and 
respiratory paralysis. 

The official Veratrine is an acrid and intensely irritant powder, con- 
sisting of a mixture of alkaloids. It causes violent sneezing, a burning 
sensation, and free salivation. It affects the heart and circulation simi- 
larly to the other Veratriae and in addition seems to be a direct poison 
to muscular tissue and to cause violent convulsions before the muscular 
paralysis sets in. 

The action of the alkaloid Veratrine on the central nervous system 
and sensory nerve terminations resembles that of Aconitine very closely. 
Locally applied it causes the same prickling, warm sensation, followed 
after a time by a feeling of numbness and cold in the part. In con- 
tact with the mucous membrane of the nose and throat it gives rise to 
violent sneezing and coughing. Internally administered the character- 
istic prickling, burning sensation is soon felt in the mouth and throat, 
followed by a sense of heat in the stomach, salivation, nausea and vom- 
iting. The prickling sensation spreads to the skin all over the body and 
profuse perspiration often occurs. The pulse becomes slow and irregular, 
the respiration slow and labored. In veratrine poisoning the bowels are 
more affected than with aconitine, severe colic and violent catharsis 
being usually experienced. Fibrillary contractions of the muscles and 
convulsions are commonly observed, and collapse occurs, followed by 
coma and finally by failure of the respiration. 

Veratrine stimulates the central nervous system and the sensory nerve 
terminations, but by large doses this stimulation gives way to paralysis. 
Applied directly in solution to the peripheral nerves it abolishes their 
irritability. It increases the catabolic changes in striated muscular tissue, 
producing prolongation of the period of contraction and causing an 
increase in the height and absolute strength of the contractions. The 
result is that the muscles remain shortened for a time after contraction 
and resist the action of their opposing muscles, so that the animal cannot 
extend a limb immediately after flexing it and its locomotion is greatly 
impaired. 

Protoveratrine is much more poisonous than veratrine and acts on the 
same general lines as aconitine. It does not paralyze the motor nerve 
terminations even when applied to them in quantity. It shortens the 
contraction period of muscular tissue instead of prolonging it as vera- 
trine does, and it increases the muscular force temporarily but induces 
its early exhaustion. Jervine, Sabadilline and Sabadinine have the same 
action as veratrine but are much less poisonous. 

Antagonists and Incompatibles. 
Opium, Alcohol, Belladonna and Ammonia counteract the cardiac depression. Mor- 
phine and Atropine should be administered hypodermically, or Laudanum internally with " 



( 



( 



524 VERBASCUM. 

alcoholic stimulants ; the recumbent position should be enforced, and dry heat applied to 
the body. Caustic alkalies are incompatible, as they decompose the alkaloids. 

Therapeutics. 

Veratrum Viride is inferior to Aconite in most of the fevers and inflam- 
mations, by reason of its lacking power over excretion. It renders good 
service in the early stages of many parenchymatous and serous inflamma- 
tions when occurring in sthenic subjects, especially pneumonia. It is 
highly esteemed in puerperal fever and in simple hypertrophy, irritable 
heart and other cardiac disorders. It has been used with remarkably 
good results in acute mania and puerperal convulsions, and it is of service 
in aneurism to depress the circulation to the lowest point, but in this case 
the recumbent position must be strictly observed in order to secure 
safety. It should always be administered in small doses and its effects 
carefully watched. In puerperal eclampsia large doses have been admin- 
istered without danger and with decided benefit, as much as 20 drops of 
Norwood's tincture every hour for 5 consecutive days and nights in one 
case, the patient making a good recovery. The same preparation may 
be given hypodermically, in doses of TrLij-iv. 

Veratrum Album is the Hellebore of the ancient physicians, and was 
employed by them as a derivative in insanity. It is rarely used at present 
except by the homeopathists, who give it in the cold stage of cholera, in 
colic, in the vomiting and purging of summer diarrhea, in whooping- 
cough and in asthma. 

Veratrine is chiefly used externally. The ointment or oleate is applied 
with benefit in many cases of superficial neuralgia, myalgia and head- 
aches, a small quantity being rubbed in over the seat of the pain. It 
may be absorbed through an abrasion of the cuticle and give rise to 
dangerous symptoms. Internally it has been employed as a cardiac seda- 
tive in fevers and inflammation, also in acute articular rheumatism, 
dropsies, dysmenorrhea and various nervous affections, but its uncertainty 
of action and the dangerous depression which it may produce have caused 
it to lose favor as an internal remedy. 



VERBASCUM, Mullein (Unofficial),— the leaves of Verbasaim Thaspus, the 
Mullein-weed, a plant of the nat. ord. Scrophulariaceae, having large woolly leaves and 
yellow flowers in dense spikes. Its chief constituent is mucilage, but the flowers contain 
an oil in very small quantity. An infusion of 5 iv of fresh leaves to the pint of milk is 
the form in which it has generally been given ; a pint to be taken thrice daily. 

Mullein is emollient and demulcent, perhaps also slightly anodyne. It has long been 
a popular Irish remedy in pulmonary affections. Under its use the weight steadily in- 
creases in phthisis and other wasting disorders, while expectoration is rendered more 
easy, cough is palliated and the general condition improved. It is recommended in 
cystitis, irritable bladder, and diarrhea, and is employed as an enema in dysentery and 
as a poultice for hemorrhoids. The dried leaves may be smoked with benefit in aphonia 
from laryngeal irritation. 



VIBURNUM OPULUS XANTHOXYLUM. 525 

VIBURNUM OPULUS, Cramp Bark,— is the bark of Viburnum Opulus, a 
shrub of the nat. ord. Caprifoliacese. 

Extractum Viburni Opuli Fluidum, Fl. Extr. of Vihcrmim Opulus. Dose, gss-ij. 

Viburnum Opulus is highly valued by many practitioners as a remedy for uterine and 
abdominal pains. The so-called Viburnum Compound of Dr. Hay den is stated by its 
manufacturers to consist of "the active principles of the Viburnum Opulus, Dioscorea 
Villosa, Scutellaria Lateriflora, and a combination of aromatics, prepared by a process 
peculiar to ourselves." This they call publishing the formula of the preparation. 



VIBURNUM PRUNIFOLIUM, Black Haw,— is the bark of Viburnum pru- 
nifolium, an indigenous shrub of the nat. ord. Caprifoliaceae. It contains tannic, oxalic, 
citric and malic acids, sulphates and chlorides ; also two resins, one named Vibumin, 
and Viburnic Acid which is identical with Valerianic Acid. 

Extractum Viburni Prunifolii Fluidum, FL Extr. of Vib. Prim. Dose, 3 ss-ij. 

Viburnum Prunifolium is considered to possess nervine, antispasmodic, astringent, 
diuretic and tonic properties, and to be especially useful in preventing abortion, in the 
nervous diseases of pregnancy, and in spasmodic dysmenorrhea. It may be administered 
with cannabis indica, morphine, nerve-sedatives or simple aromatics. No exact observa- 
tions have been made regarding its action, and its therapeutical claims are denied by 
many who have used it. It often excites nausea and vomiting. 



VIOLA TRICOLOR, Pansy (Unofficial),— is the wild-grown, flowering herb of 
Viola tricolor, the Heart' s-ease Pansy, a plant of the nat. ord. Violaceae, native in 
Europe, but naturalized in the southern U. S. It contains an active alkaloid, Violine, 
allied in many respects to Emetine, and poisonous. Dose, gr. x-gj, in decoction. 

Viola is mucilaginous, emollient, expectorant and slightly laxative. Its active prin- 
ciple is emeto-cathartic, but exists in very small quantity. A decoction of the fresh herb 
in milk, with a poultice of the same, was formerly recommended highly in crusta lactea 
and impetigo. It is used with benefit in some forms of eczema, especially in that of the 
head and face, and has had some reputation in bronchitis and constitutional syphilis. 

Viola Cucullata, the common Violet, is used in Pennsylvania with success as an in- 
ternal antidote against rattlesnake venom. The leaves are eaten, and a poultice of salt 
and indigo is applied to the wound. 



VISCUM, Mistletoe (Unofficial), — occurs in two species, (1) Viscum album, the 
European Mistletoe, a small, parasitic, evergreen shrub, of the nat. ord. Loranthacese, 
growing chiefly on deciduous-leaved trees, and (2) Viscum flavescens, the American 
species, growing on oaks, elms, etc. They contain mucilage, starch, fixed oil, resin, 
salts, etc., and Viscin, or Bird-lime, which occurs also in Ilex aquifolium, Gentianalutea 
and other plants. Dose, gr. x-^j in decoction, or Tt^v-xxx of a ten per cent, tincture. 

The berries of the mistletoes have produced emeto-catharsis, with great thirst, tenes- 
mus, bloody stools, convulsions and even death in young children. The leaves and twigs 
have been used in epilepsy, hysteria, chorea, asthma and other nervous affections. The 
American plant is asserted to possess qualities similar to those of Digitalis and to incite 
uterine contractions. It has been used in cardiac affections, dropsies, uterine hemor- 
rhages and amenorrhea, also as an abortifacient. 



XANTHOXYLUM, Prickly Ash,— is the bark of Xanthoxylum 
ame7'icanum the northern species, and of Xanthoxylum Clava-Herculis 
the southern species, of an indigenous shrub of the nat. ord. Rutacese. 
It contains a volatile oil, a fixed oil, resin, gum, coloring matter and the 
alkaloid Xanihoxyline, which is identical with Berberine. Dose, of the 
powdered bark, gr. x-xxx. 



< 



( 



526 ZEA MAYS. 

Preparations. 
Extractum Xanthoxyli Fluidum, Fluid Extract of Xanthoxylum. — Dose, gss-j. 
Decoctum Xanthoxyli, Decoction of Xanthoxylum (Unofficial), — Jj to the quart. 
Dose, a pint during 24 hours in divided doses. 

Physiological Action and Therapeutics. 

Xanthoxylum is a stimulant and aromatic bitter, a local and systemic 
sialogogue, also diaphoretic, diuretic and emmenagogue. Its taste is 
aromatic, soon becoming acrid and bitter, causing profuse salivation, 
tingling in the tongue and increased secretion from the stomach, intestines, 
liver and pancreas. It increases the cardiac action and raises the arterial 
tension, and is classed among the vegetable alteratives with mezereum, 
guaiac, stillingia, etc. 

Xanthoxylum has a high reputation in chronic rheumatism, myalgia, 
lumbago and similar disorders, also in jaundice from catarrh of the bile- 
ducts, in dropsies, chronic pharyngitis and constitutional syphilis. In 
old cases of pharyngitis, the mucous membrane being glazed and dry, the 
decoction should be used as a gargle and ttlx-xxx of the fluid extract 
taken internally thrice daily. The bark, used as a masticatory, is a popu- 
lar remedy for toothache and has been frequently successful in paralysis 
of the tongue. 

ZEA MAYS, Maize, Indian Corn. — This w,ell-known species of 
the nat. ord. Graminese, though itself unofficial, is the source of the offi- 
cial Starch (see Amylum), and of two drugs, one official, viz. — 

Zea, Corn-Silk {Stigmata Maydis), — the styles and stigmas of Zea 
Mays, gathered when the tassels have shed their pollen. Its active 
principle is thought to be Maizenic Acid. There are no official prepara- 
tions. 

Extractum Zese Fluidum, Fluid Extract of Zea (Unofficial), — is made by the 
general rule for fluid extracts. Dose, gj-ij. 

Ustilago, Corn Smut (Unofficial), — is Ustilago Maydis, nat. ord. 
Fungi, a smut grown upon the stems, the pistils and the male inflorescence 
(tassel) of Zea Mays. Its odor and taste are unpleasant, and it contains 
fixed oil, resin, pectin, gluten, sugar, an acid resembling the sclerotic 
acid of ergot, and a volatile principle called Secaline, which is supposed 
to be identical with trimethylamine. 

Extractum Ustilaginis Fluidum, Fluid Extract of Ustilago (Unofficial), — may be 
prepared by the general rule for fluid extracts. Dose, TTbx-sjj. 

Physiological Action and Therapeutics. 
Zea is a certain but mild diuretic when given in full doses at short 
intervals. It is by some observers considered demulcent and anodyne, 



ZINCUM. 527 

and is generally believed to have a specific or alterative influence over 
many disorders of the genito-urinary passages and the urinary bladder. 
It has been used with success for incontinence of urine, uric and phos- 
phatic gravel, gout, rheumatism, urethritis, pyelitis, acute and chronic 
cystitis, cardiac dropsy and obstructive valvular disease of the heart. 

The properties of Ustilago, so far as examined, resemble those of ergot 
and nux vomica combined. It is a spinal excitant and exalts sensibility 
and reflex action, producing tonic convulsions on the least irritation of 
the skin. It slows the heart by stimulation of the pneumogastric, dilates 
the pupils, causes muscular paresis and death by tetanus of the respiratory 
muscles or by exhaustion. Experiments on its reputed oxytocic action 
have not substantiated the claims made for it in this respect, though it is 
said to have produced abortion in cows after they had eaten the diseased 
grain. As a therapeutic agent Ustilago has been very little used, but 
when employed it has been as a substitute for ergot. 

ZINCUM, Zinc, Zn, — is metallic Zinc, in the form of thin sheets 
or irregular, granulated pieces, and is a bluish-white metal, having the 
sp. gr. 6.9. It occurs native as a sulphide {Blende), as a Carbonate and a 
Silicate {Calamine'), as a Red Oxide {Zincite), and as a mixture of Zinc 
Oxide with Oxide of Iron and Manganese {Franklinite). Zinc is soluble 
in the weakest acids and therefore should never be used for culinary ves- 
sels. Its salts are all more or less actively poisonous. Metallic Zinc is 
official but is not employed as a medicine. 

Zinc Salts and their Preparations. 

Zinci Acetas, Zinc Acetate, Zn(C 2 H 3 2 ) 2 -)- 2H 2 0, — soft, white, micaceous or pearly, 
six-sided tablets or scales, somewhat efflorescent in dry air, of faintly acetous odor, sharp 
metallic taste and a slightly acid reaction ; soluble in 3 of water and in 36 of alcohol at 
59 F.,in i}i of boiling water and in 3 of boiling alcohol. Used locally as an astringent 
in solution of gr. j or ij to the ^ , or internally in doses of gr. }4,-i]. 

Zinci Carbonas Praecipitatus, Precipitated Zinc Carbonate, — a white, impalpable 
powder, permanent in the air, odorless and tasteless, insoluble in water or alcohol, but 
soluble in acids with copious effervescence. Used locally as a protective. 

Zinci Chloridum, Zinc Chloride, ZnCl 2 , — a white, granular powder, or porcelain-like 
masses, odorless, of intensely caustic properties ; very soluble in water and in alcohol ; 
very deliquescent. Is tonic and escharotic. For internal use a solution in Spirit of Ether 
is the most convenient form, strength gj to the 3 , of which four to eight minims may 
be given twice daily in water. Strength of injections and collyria, gr. j-ij to the ^ . 

Liquor Zinci Chloridi, Solution of Zinc Chloride, — is an aqueous solution, contain- 
ing about 50 per cent, of the salt. A clear, colorless, odorless liquid, of a very astringent, 
sweetish taste and an acid reaction. A powerful disinfectant for sinks, drains, etc. Used 
also as an injection in gonorrhea, leucorrhea, etc., in dilute solution, ^ to I per cent. 
Bti?'netfs Disinfecting Fluid is similar to the above but slightly stronger. 

Zinci Iodidum, Zinc Iodide, Znl 2 , — a white, granular powder, very deliquescent, of 
sharp, saline and metallic taste and acid reaction ; very soluble in water and in alcohol. 
Dose, gr. ss-ij in syrup. 

Zinci Oxidum, Zinc Oxide, ZnO, — an amorphous, white powder, odorless and taste- 
less ; insoluble in water or alcohol ; soluble without effervescence in dilute acids also in - 
ammonia water. Dose, gr. j-x, in pill. 



i 



( 



528 ZINCUM. 

Unguentum Zinci Oxidi, Ointment of Zinc Oxide, — has of Zinc Oxide 20, Ben- 
zoinated Lard 80. 

Oleatum Zinci, Oleate of Zinc, — has of Zinc Oxide 5, in Oleic Acid 95. For ex- 
ternal use. 

Zinci Sulphas, Zinc Sulphate, ZnS0 4 4" 7H 2 0, — small colorless prisms or acicular 
needles, efflorescent in dry air, odorless, of sharp, saline, nauseous and metallic taste and 
acid reaction; soluble in 0.6 of water, insoluble in alcohol. Dose, as an emetic gr. 
x-xxx ; as a tonic and astringent gr. T ^-ij, in pill. For Vitiate' 's Solution, see under 
Cuprum. 

Zinci Valerianas, Zinc Valerianate, Zn (C 5 H 9 2 ) 2 + 2H 2 0, — white, pearly scales, 
having the odor of valerianic acid, a sweetish and styptic taste and acid reaction ; soluble 
in about loo of water and in 40 of alcohol. Dose, gr. j^-ij, in pill. 

The Bromide is described under Bromum, and the Phosphide under Phosphorus. 

Physiological Action and Therapeutics. 

Zinc Salts are astringents, but milder ones than the salts of lead. Its 
soluble compounds (the Chloride, Iodide, Sulphate and Acetate) are cor- 
rosive poisons, causing violent gastro-enteritis and in some cases profound 
nervous depression. The Chloride is a powerful and painful escharotic 
or rather mummifier of the tissues, having great affinity for water, coagu- 
lating albumin and shrivelling the vessels. It is a very active disinfectant. 
The Sulphate is also an escharotic and a specific emetic, acting promptly 
by direct irritation of the stomach, without much depression or after- 
nausea. In small doses it is tonic and astringent, in larger ones it would 
be a severe irritant but for its causing prompt emesis. The Acetate re- 
sembles the sulphate in action. The Oxide used externally is a mild, 
soothing astringent ; used internally it enters the blood as a lactate or 
chloride, acting as a mild astringent and as a nervous sedative. Being 
almost insoluble in the stomach, it has but feeble diffusive power and 
consequently but slight activity. The Carbonate resembles the oxide in 
action. The Iodide locally is a powerful escharotic and has been sup- 
posed to possess some alterative power when given internally, in addition 
to its astringent qualities as a zinc salt. The Valerianate acts as a nervous 
sedative, but its properties are in all probability due to its zinc base and 
not to the acid combined with it. 

The continued use of Zinc salts produces symptoms similar to those of 
chronic lead-poisoning, but of much less gravity. These salts manifest 
less tendency to accumulate in the system than other metallic salts and 
are excreted much more rapidly. Elimination takes place chiefly by the 
liver and intestinal glands. 

The actions of the Bromide and Phosphide are described respectively 
under the titles Bromum and Phosphorus. 

Antidotes and Incompatibles. 

Lime-water, mucilaginous drinks, soap, Tannic Acid, milk, Potassium and Sodium 
Carbonates, if given early, are the antidotes in poisoning by the salts of zinc. Incom- 
patibles are — Lime-water, Alkalies and their carbonates, Silver Nitrate and vegetable 



ZINCUM. 529 

astringents. Lead Acetate produces double decomposition with zinc salts, but it is often 
used in solution with the Sulphate as an injection. 



Therapeutics. 
Zinc salts are chiefly employed in weak solution as mild astringent 
applications in catarrhs of mucous membranes, as conjunctivitis, gonor- 
rhea, etc., also as unguents and lotions in skin diseases, particularly 
eczema, impetigo, herpes and erythema. The Chloride is made into a 
paste with flour and glycerin for the destruction of lupus, epithelioma and 
other morbid growths, also for opening abscesses in locations where punc- 
ture or incision might be dangerous. The cuticle, if unbroken, should 
be removed by strong water of ammonia before the paste is applied, as it 
will not act through the epidermic tissue. It is a commonly used disin- 
fectant and deodorant, and in weak solution (n^iij-v of the liquor to Jj 
of water) makes a good lotion for putrid ulcers, and still weaker (gr. j-ij 
to the pint) is an excellent injection for gonorrhea. The Iodide is not em- 
ployed as an escharotic, nor has it ever been a favorite remedy for internal 
use. It is chiefly employed in solution as an application to enlarged tonsils, 
and as an ointment (1 part to 8 of lard) for the reduction of glandular 
enlargements. The Sulphate is used locally as an astringent to mucous 
surfaces generally, internally as an emetic in narcotic poisoning and 
croup, and in small doses as a tonic and antispasmodic in convulsive 
diseases, as chorea, hysteria, epilepsy, angina pectoris, asthma, etc. In 
diarrheas and dysentery it is a good astringent and is frequently com- 
bined with opium and ipecac. The Acetate is used for the same pur- 
poses as the sulphate, but is usually preferred for collyria. The Oxide 
may be employed as a dusting powder in intertrigo, also as an ointment 
in eczema and excoriated surfaces generally. In combination with bis- 
muth and pepsin it is an excellent remedy for the summer diarrhea of 
children, and with aromatic powder and morphine it is very efficient in 
gastralgia. It is a good remedy in 3-grain doses for the night-sweats of 
phthisis, and has been successfully employed in epilepsy and neuralgia, 
in whooping-cough, hysteria and nervous headache, and in bronchorrhea 
to check the profuse secretion. It is much employed as an ingredient of 
cosmetics. The Carbonate is by some preferred to the oxide for local use 
in skin diseases. Calamine Ointment, which is a mixture of the impure 
carbonate (calamine) with the oxide and an unguent basis, was until 
recently a favorite application as a soothing, protective to abrasions and 
inflammations of the integument. The Valerianate has been used in 
chorea, epilepsy, neuralgia, and various anomalous nervous affections, 
such as the nervous headache of hysterical women, nervous coughs and 
aphonia due to uterine and ovarian irritation. 
34 



i 



{ 



530 ZINGIBER. 

The Bromide and Phosphide are employed for the effects of their 
respective non-metallic bases, under' which titles their uses are described. 

ZINGIBER, Ginger, — is the rhizome of Zingiber officinale, a plant 
of the nat. ord. Scitammese, having dingy-yellow flowers on a leafless 
flower-stalk and long, lanceolate leaves on a separate stem. The plant 
is a native of Hindostan, but is cultivated in Jamaica, Sierra Leone, etc. 
It contains an aromatic volatile oil, and a resin. 

Prepa rations. 

Extractum Zingiberis Fluidum, Fl. Ext. of Ginger, — alcoholic. Dose, TT^x-^ss. 

Tinctura Zingiberis, Tincture of Ginger, — 20 per cent. Dose, rrLxx-gij. 

Syrupus Zingiberis, Syrtip of Ginger, — has of the Fluid Extract 3 per cent, in sugar 
and water. Dose, gss-ij. 

Trochisci Zingiberis, Troches of Ginger, — each troche contains of the Tincture 2 
minims, with Tragacanth, Sugar and Syrup of Ginger. 

Oleoresina Zingiberis, Oleoresin of Ginger, — is extracted by ether and contains all 
the virtues of the root. Dose, n\ss-j, well diluted. 

Ginger is also a constituent of Pulvis Aromaticus and Pulvis Rhei Compositus. 

Ginger is sialogogue when chewed, sternutatory when inhaled and ex- 
ternally a rubefacient. Internally it is a grateful stimulant and carmina- 
tive, produces a sensation of warmth at the epigastrium and promotes the 
expulsion of flatus. It is employed as a carminative in colic, as a mastic- 
atory to increase the secretion of saliva and in relaxed conditions of the 
throat, also internally in atonic dyspepsia, to relieve flatulence, and as an 
adjunct to purgative agents to correct their griping properties. The 
syrup is in common use as a flavoring adjuvant in prescriptions. 

Ginger Beer is a favorite temperance beverage, but most of the preparations sold 
under its name are simply carbonated water flavored with ginger. The following recipe 
is furnished by Dr. William Hardman, of Blackpool, in whose family it has been used for 
over fifty years, and the excellence of which he guarantees : 

Take l x / 2 oz. of the best ginger well bruised, I oz. of cream of tartar, and ij4 lb. of 
cane loaf sugar. Put all the ingredients into an earthen vessel and pour on a gallon of 
boiling water ; when nearly cold add a gill of yeast, cover over with a blanket and let it 
stand in a warm place until next morning. Then skim it and run it through a filtering 
bag, bottle it, cork well with good corks and tie down the corks with string. In three 
days it will be fit for use. The bottles must be clean and sweet. A little lemon juice is 
considered an improvement by some. {Lancet.) 



I 



PART II. 



PHARMACY AND PRESCRIPTION WRITING. 



Pharmacy (Pharmakon, a medicament), — may be defined as the art 
of selecting and preserving medicines, and preparing them for adminis- 
tration. It may be divided into — 

Official or Galenical Pharmacy, — dealing with the processes and prepa- 
rations of the Pharmacopoeia j and — 

Extemporaneous or Magistral Pharmacy, — which includes the opera- 
tions of compounding and dispensing remedies as directed by the ex- 
temporaneous prescriptions of physicians. 

Pharmacopoeias and Dispensatories. 

A Pharmacopoeia is an official list of the drugs and their prepara- 
tions recognized by the medical profession of a certain country. In 
foreign countries the Pharmacopoeias are published under government 
auspices and have the force of a legal standard ; in the United States its 
publication is left to the medical and pharmaceutical professions and it is 
revised every ten years by a convention called for that purpose. The 
official Pharmacopoeias in the English language, with the dates of their 
latest revision or additions, are as follows, viz. — 

The Pharmacopoeia of the United States of America, 7th Decennial 
Revision, 1890; official from January 1, 1894. 

The British Pharmacopoeia, 1898 

Besides the above there are — The Pharmacopoea Germanica, 1890, supplement, 1 895 ; 
the Pharmacopee Frangaise (Codex Medicanientarius), 1884, supp. 1895 ; the Austrian, 
Pharmacopcea Austriaca, 1889; Russian, Ph.Rossica, 1891 ; the Swedish, Ph. Suecica, 
1879 ; the Norwegian, Ph. Norvegica, 1895 '■> the Danish, Ph. Danica, 1893 ; the Belgian, 
Ph. Belgica, 1885 ; the Swiss, Ph. Helvetica, 1893 ; the Spanish, Farmacopea Espafiola, 
1884'; the Portuguese, Ph. Portugueza, 1876; the Indian, Ph. of India, 1868; the 
Hungarian, Ph. Hungarica, 1888; the Netherlands', Ph. Neerlandica, 1889; the Rou- 
manian, Ph. Romafia, 1874; the Finnish, Ph. Finnica, 1885; the Chilian, Farmaco- 
pea Chilena, 1886 ; the Greek, Ph. Hellenica, 1868 ; the Japanese, Ph. Japonica, 1891 ; 
the Mexican, Neuva Farmacopea Mexicana, 1896; the Croatia-Slavonian, Ph. Croatico- 
Slavonica, 1888 ; and the Italian, Farmacopea Italiana. 1892. 

53< 



532 WEIGHTS AND MEASURES. 

A Dispensatory is a commentary on one or more pharmacopoeias, 
giving in extenso the physical and medicinal history of drugs and prepara- 
tions, with their doses, physiological action and therapeutics, and includes 
similar information about many drugs which are not official in any phar- 
macopoeia but are of occasional use or general interest. A dispensatory 
is a private publication, of authority according to the reputation of its 
author. The principal dispensatories are American publications, and are 
veritable drug-encyclopaedias, so elaborately do they deal with every 
subject embraced therein. Those of acknowledged value are — 

The Dispensatory of the United States of America, by Dr. Geo. B. Wood and 
Dr. Franklin Bache. l8th edition, revised and largely rewritten, by Professors H. C. 
Wood, J. P. Remington and S. P. Sadtler. Philadelphia, J. B. Lippincott & Co. 1899. 

The National Dispensatory. 5th edition, revised by Professors Stille, Maisch and 
Caspari. Philadelphia, Lea Bros. & Co. 1896. 

The American Dispensatory, by King & Lloyd, Cincinnati, is the recognized au- 
thority of the "eclectic" practitioners. 18th edition, 1899. 

A Companion to the U. S. Pharmacopoeia, by Drs. Oldberg and Wall ; New 
York, Wm. Wood & Co. — is an excellent book, but not so exhaustive as the others in its 
method of treating the subjects embraced in it. 

A Companion to the British Pharmacopoeia, by Peter Squire; 17th edition, 
London, 1899; is the nearest English approach to the American dispensatories, and is 
the standard text-book on the general materia medica in Great Britain. Although a 
very good book it does not compare as a work of reference with either of the two great 
American Dispensatories first above named. 



WEIGHTS AND MEASURES. 



The working formulae of the U. S. Pharmacopoeia of 1880 were con- 
structed on the system of parts by weight for all articles, whether solids 
or fluids, except in the case of fluid extracts, for which the metric weights 
and measures were employed. On this system it really made no differ- 
ence what unit of weight was adopted in official pharmacy. The phar- 
macopoeia of 1890 has, however, in most cases employed definite weights 
for solids, and measures for liquids, in terms of the metric system. In 
certain cases, where weighing is decidedly more convenient or where the 
product is adjusted to a percentage by weight which would be rendered 
uncertain if the ingredients were taken by measure, liquids are ordered 
to be weighed. In some cases (Aqua Destillata, Aqua Aurantii Florum, 
etc.) the quantities are directed simply by volume. In most cases, there- 
fore, solids are officially directed to be weighed by grammes, and liquids 
to be measured by cubic centimeters. At the same time, however, the weights 
and measures generally used by physicians in prescribing and by phar- 



WEIGHTS AND MEASURES. 



533 



macists in dispensing medicines, are and will doubtless continue to be, 
in the United States those of the Apothecaries' or Troy System of 
weights, (having 480 grains to the ounce and 5760 grains to the pound) ; 
and the Wine Measure. The drachm (60 grains) and the scruple (20 
grains), are intermediate units of weight which are still used but are 
becoming obsolete. 

The units of the Wine Measure are the minim (r^), which in water at 
its maximum density equals gr. 0.95 ; the fluidrachm (60 minims) and 
the fluidounce (8 fluidrachms or 480 minims). The signs used to denote 
these units are ttl minim, 9 scruple, 3 drachm, g ounce, and in the case 
of liquids an f to denote fluid is often placed before the sign, thus fg for 
fluidrachm, fg for fluidounce. The relations between these units of 
weight and measure are as follows : — 



( 



i 



Measure. Weight. 
y, One" minim = 0.95 grains. 
\), One fluidrachm = 56.96 " 
;j, One fluidounce = 455.69 " 


Weight. 
grain j = 

l\ = \ 


Measure. 
I.05 minims. 
63.20 " 
505.60 " 




Table of Troy or Apothecaries' Weight. 




Pound. 
Libra. 

lb 

1 


Ounce. Drachm. 
Uncia. Drachma. 

1 \ 
= 12 = 96 

i = 8 

I 


Scruple. 
Scrupulmn. 

= 288 = 
= 24 == 


Grain. 
Granum. 

g r - 

5760 

480 

60 






I = 


20 




Table of Apothecaries' or 


Wine Measure. 




Gallon. 

Congius 

C. 

I 


Pint. Fluidounce. 

Octarius. Fhiiduncia. 

0. 1% 

= 8 = 128 

1 = 16 

1 


Fluidrachm. 
Fluidrachma. 

= 1024 = 

= 128 = 

= 8 = 


Minim. 
Minimum. 

61440 

7680 

480 

60 



The British Pharmacopoeia recognizes only the Imperial Standard 
(avoirdupois) weights, having 487}^ grains to the ounce, 16 ounces to the 
pound (instead of 12), and 7000 grains to the pound; and the Imperial 
Measure, having 20 ounces to the pint (instead of 16, as with us). 



Table of British Pharmacopoeial Weight. 
Troy grain , Avoirdupois ounce and pound. 



Pound. 
Libra. 

lb 

1 



The Troy ounce contains 42^ grains more than the avoirdupois ounce, but the Troy 
pound contains 1 240 grains less than the avoirdupois pound. The grain is the only unit- 
common to both. 



Ounce. 
Uncia. 




Grain. 
Granum. 


0Z. 

16 

I 


= 


g r - 
7000 

437^2 



534 



WEIGHTS AND MEASURES. 



Table of British Imperial or Pharmacopceial Measure. 

Gallon. Pint. Fluidounce. Fluidrachm. Minim. 

Congius. Octarius. Fluiduncia. Fluidrachma. Minimum. 

C. 0. floz. fldr. min. 

1 = 8 = 160 = 1280 = 76800 

1 = 20 = • 160 = 9600 

1 = 8 = 480 

1 = 60 

The Metric, or Decimal System of Weights and Measures, is now 
the official system in the United States, having been adopted throughout 
the last revision of the U. S. Pharmacopoeia. It is in general use on the 
continent of Europe and is employed by French and German physicians 
in this country. Its three standard units are as follows, — 

A Meter, the standard unit of linear measure and also of the whole system, is the ten- 
millionth part of the quadrant of the earth, i. e., the forty-millionth part of the earth's 
circumference around the poles. One-tenth of the Meter is the Decimeter, one-hundredth 
is -the Centimeter, and one-thousandth is the Millimeter. 

A Liter, the unit of measure of capacity, is the volume of one kilogramme of pure 
water at the temperature of its maximum density, in vacuo. Theoretically, the Liter is 
equal to one cubic decimeter, or 1000 cubic centimeters. Per contra one- thousandth of 
a Liter is the Milliliter (or Cubic Centimeter), which measure of pure water at its maxi- 
mum density weighs one Gramme. 

A Gramme, the unit of weight, is the weight of the one-thousandth part of a liter of 
water at its maximum density. Its tenth is the Decigramme, its hundredth is the Centi- 
gramme, and its thousandth part is the Milligramme. 

The original and French spelling is metre, litre, gramme ; the Anglicized form is 
meter, liter, gram. The U. S. Ph. of 1890 sanctions a combination of both, thus — 
meter, liter, gramme. 

The metric terms used in pharmacy are few, and are generally confined 
to the Gramme, the Cubic Centimeter (or fluid-gramme) and the Milli- 
gramme ; but the system embraces many other terms of increase and de- 
crease, which are set forth in the following table, viz. — 







1 0000. 


Myrialiter. 








1 0000. 


Myriameter. 


1000. 


Kiloliter. 








IOOO. 


Kilometer. 


100. 


Hectoliter. 








100. 


Hectometer. 


10. 


Dekaliter. 


1 0000. 




Myriagramme 


10. 


Dekameter. 


1. 


Liter. 


1000. 




Kilogramme. 


1. 


Meter. 


.1 


Deciliter. 


100. 




Hectogramme 


.1 


Decimeter. 


.01 


Centiliter. 


10. 




Dekagramme. 


.01 


Centimeter. 


.001 


Milliliter (Cubic 


1. 




Gramme. 


.001 


Millimeter. 




Centimeter). 




01 
ooi 


Decigramme. 
Centigramme. 
Milligramme. 



The relations between the Metric Weights and Measures and the 
Apothecaries' are as follows, — 

I grain = 0.06479895 gramme. 

I minim = 0.061613 cubic centimeter. 



I meter = 39.370432 inches. 
I liter = 2. 1 13433 pints. 
I gramme = 15.43234874 grains. 



The Metric System is making way but slowly in this country although 
progress is aided by every process of forcing which scientific bodies 



WEIGHTS AND MEASURES. 



535 



can bring into action, and it remains to be seen how much its adoption 
in the last edition of the U. S. Pharmacopoeia will influence the medical 
profession in its behalf. With all the influence brought to bear in its 
favor it certainly has not yet been adopted by any considerable propor- 
tion of native-born and home-educated physicians and pharmaceutists. 
One of its greatest difficulties for the physician is the absence of any 
correspondence or relation between the unit of weight (gramme) and the 
unit of measure (liter), and the consequent want of fluid denominations 
below the cubic centimeter, corresponding with the decigramme, centi- 
gramme and milligramme of the weight scale. Its chief disadvantage is 
one which is inherent to any decimal system, — that the number ten 
cannot be divided more than once without producing a fraction. This 
is partly compensated for by the practice of dividing five into the three 
parts 2, 2 and i, and on this principle metric weights are usually con- 
structed. 



< 



< 



Approximate or Domestic Measures become necessary in appor- 
tioning doses for a patient, when liquid medicines are used. Of these 
the measure most commonly employed is the teaspoonful, which is gen- 
erally taken as equivalent to a fluidrachm, though in most cases as now 
manufactured the teaspoon contains about 75 minims, or 25 per cent, 
more than the theoretical quantity. The dessertspoonful is about equal 
to 2 teaspoonsful, and the tablespoonful to about 4 teaspoonsful or 
f^ss, while the wineglass is supposed to contain about f gij. The use of 
graduated medicine glasses is strongly recommended instead of these 
approximate measures. They may be obtained at a trifling cost in any 
well-stocked drug store. 

Drops (Guttse) are very variable in size, though popularly supposed 
to equal minims ; the variations in their relative dimensions being due to 
the viscidity of the liquid, the shape and surface of the orifice from which 
they escape and sundry other circumstances. The Syrups and Mucilages 
produce large drops, while Bromine, Chloroform and other heavy mobile 
liquids produce very small ones. These differences are well illustrated in 
the following table, which gives the number of drops in a fluidrachm of 
several liquids of certain classes. [See the Appendix for a fuller table.] 



Syrupus Acacise, 44. 

Syrupus Scillse, 75. 

Aqua, 60. 

Liquor Potassae, 62. 

Liquor Hydrargyri Nitratis, 13] 

Acetum Opii, 90. 

Vinum Opii, 100. 

Tmctura Opii Deodorati, 1 10. 

Tinctura Opii Camph., no. 



Oleum Ricini, 77. 
Oleum Copaibae, 123. 
Oleum Juniperi, 148. 
Spiritus Camphorae, 143. 
Spintus Chloroformi, 150. 
Ext. Digitalis Fluid., 134. 
Ext. Ipecac. Fluid., 120. 
Ext. Cinchonas Fluid., 138. 
Ext. Zingiberis Fluid. , 142. 



536 PRESCRIPTIONS. 

Tinctura Opii, 130. Ext. Buchu Fluid., 150. 

Tinctura Iodi, 148. Ext. Hyoscyami Fluid., 160. 

Tinctura Aconiti, 146. ^Ether, 176. 

Alcohol Dilutum, 137. Bromum, 250. 

Alcohol, 146. Chloroformum, 250. 

» 

Specific Gravity is the relative weight of equal bulks of different 
bodies. The specific gravity of water at a certain temperature (generally 
59 F.) is taken as i,and that of all other substances is expressed in terms 
of this unit. The Pharmacopoeia gives very complete tables of percent- 
ages and specific gravities of Alcohol, Ammonia Water, Acetic, Hydro- 
bromic, Hydrochloric, Nitric, Sulphuric and Phosphoric Acids, and aque- 
ous solutions of Potassa and Soda. The specific gravity of any substance 
is expressed by the quotient obtained by dividing the weight of a given 
measure of the substance by the weight of an equal measure of water. , In 
pharmacy the specific gravity of solids is not of any importance, but that 
of liquids is a matter of constant value, and is determined in most cases 
by means of a specific gravity bottle or by a hydrometer, instruments 
which are described in any standard work on chemistry or physics. 
Modifications of the hydrometer with scales adapted to particular work 
are the urinometer, saccharometer, lactometer, etc. 

Specific Volume is the relative bulks of equal weights of different 
bodies. In pharmacy it means the volume of the weight of a liquid com- 
pared with the volume of an equal weight of water at 59 F. The specific 
volume of a body is therefore inversely as its specific gravity, and is ex- 
pressed by the quotient obtained by dividing unity by the specific gravity. 
—^- = sp. vol. and therefore sp. gr. X sp. vol. — 1. 

A table of the specific gravity and specific volume of several liquids 
will be found in the Appendix. 



PRESCRIPTIONS. 



Extemporaneous Prescriptions are formulae written on the instant 
(ex tempore) to meet the requirements of individual cases. 

A prescription should begin with the name of the person for whom it 
is designed and the date on which it is written. Then follows the Latin 
word J?ea'pe, usually abbreviated to the sign R, and signifying " Take;" 
next the names and quantities of the ingredients to be used, which are 
also expressed in Latin ; then the directions to the compounder, followed 



PRESCRIPTIONS. 537 

by the directions to the patient, the last being now usually expressed in ^ 

English ; and finally the signature and address of the prescriber. 
A prescription then has four component parts, as follows : the — 

Superscription, — consisting of the name of the party for whom it is designed, the date 

and the sign R signifying " Take thou." 
Inscription, — the body of the prescription, consisting of one or more of the following 
subdivisions : the — 

Basis, — or chief, active ingredient. 
Adjuvant, — to assist the action of the basis. 

Corrective, — to correct some injurious quality of the other ingredients. 
Vehicle or Excipient , — giving the prescription a suitable form. 
Subscription, — the directions for the compounder, usually expressed in contracted Latin. 
Signature, — the instructions for the guidance of the one administering the medicine, 
expressed in English, followed by the signature of the prescriber. 

A prescription may, however, contain the base alone, or the base with 
the adjuvant, or the base with a simple vehicle or diluent. A single 
ingredient may serve a double or a triple office, as the Syrupus Rhei 
Aromaticus with Quinine, in which case the syrup serves as an adjuvant 
to increase the action of the quinine, as an excipient to cover the taste, 
and as a vehicle to facilitate the administration of the dose directed. 
Again, the basis may need no aid in doing its work and may require no 
corrective of its action nor any special vehicle. On the other hand, 
there is no limit to the number of ingredients which may be used, pro- 
vided that the prescriber has a clear idea of something to be accomplished 
by each one, and if there is no chemical or medicinal incompatibility 
between them. In olden times prescriptions were very complex and 
contained a great many curious and incongruous ingredients. As Dr. 
Piffard well says, "the tendency of the present age is toward mono- 
rather than poly-pharmacy, and prescriptions with the orthodox adjuvans 
and corrigens are less frequently seen than formerly." There is danger, 
however, in carrying this simplicity too far, for there is no doubt but 
that proper combinations of medicines will often produce effects for 
the patient's good which could not be obtained from the use of any 
one remedy. 

Procedure in Writing a Prescription. 
In writing an extemporaneous prescription, the first step is to write the 
patient's name and address, the date and the sign R. Then the title of 
each ingredient should be written in Latin and in the genitive case, except 
that when a certain number only of an ingredient is ordered the name 
of the ingredient should be in the accusative case, for example, "Vitel- 
lum unum, — one yolk-of-egg." Next, the quantity of each ingredient 
sufficient for one dose should be mentally determined and multiplied by 
the number of doses which the mixture is to contain, and the result set 



53^ PRESCRIPTIONS. 

down in signs and Roman numerals. The directions to the pharmacist 
and patient being added and the preserver's name or initials affixed, 
the prescription is completed ; but when very active agents are used, it 
is a good plan to go over the calculations a second time before letting 
them leave the hands of the person most responsible for the result. For 
pills or powders the same process should be employed, slightly varied 
according to the requirements of each case. Frequently the ingredients 
and quantities for but one pill, powder or suppository are named, with 
instructions to make a certain number after the formula. When an un- 
usually large dose of any poisonous drug is prescribed, it is customary to 
underline the quantity, so as to call the attention of the compounder to 
the fact that the prescriber is aware that the dose is above the average. 

An Example will perhaps make the foregoing more comprehensible, 
and at the same time serve to indicate the style of writing usually em- 
ployed. The following formula is that ordered in the U. S. Pharma- 
copoeia for the preparation known as Black Draught, but officially styled 
the Compound Infusion of Senna; approximate weights and measures 
being substituted for the pharmacopceial metric weights. 



Superscription. 



For Mrs. Gray. July jth, i8q8. 

Recipe, Take, — 

f Sennce, serniunciam, 

,-p . v !• Of Senna, half an ounce, 
(Basis.) X ir ■■ r V, ,. ' 

v ' J Alagnesii Sulpkahs, 

[_ Of Magnesium Sulphate, 

, . ,. . -v f Manna, ana unciam unam, 

(Adjuvant.) < ^ r , T ' , , \ Inscription. 

v J ' ( Or Manna, or each an ounce, 

,p . > I Fceniculi, drachmam unam, 

^ "■' \ Of Fennel, one drachm, 

,y -J • I x f Aqu<z Bidlientis, fiuiduncias octo, 

^ '' \ Of Boiling Water, eight fluid-ounces. 

Macera per horam in vase clauso, deinde cola. 

Macerate for an hour in a closed vessel, then strain. 



Subscription. 



Signetur, Let it be entitled, — A wineglassfzil every four hours 

until it operates. \ SIGNATURE. 

/. F. Wood, M. D. 

Abbreviated in the style usual among physicians, the above prescription 

would read as follows, — 

For Mrs. Gray. July yt/i, i8q8. 

R . Sennce, ^ ss. 

Magnesii Sulphat., 

Mannce, , aa ^j. 

Funiculi, Z']. 

Aauce Bull., f 3 viij. 

Mac. per hor. in vase clauso, deinde cola. 
Sig. — A ivineglassful every four hours, until it operates. 

Wood. 

As the result of the above is nearly identical with the official prepara- 
tion, we might write the same prescription more simply, as follows, — 
R . Infusi SenncB Compos., 3 viij. 



PRESCRIPTIONS. 539 

with the proper superscription and signature ; this being the manner of 
prescribing the official preparations. 

It will be noticed that in the above analysis the term basis covers two 
ingredients; but it is obvious that either of them might be considered 
the principal agent, and the other one classed as an adjuvant. 

" These four parts of a formula are intended to accomplish the object 
of Asclepiades, curare cito, tute et jucunde ; in other words, to enable the 
basis to cure quickly, safely and pleasantly." (Pareira.) 

Another Example will illustrate the mental operations which should 
always be followed by a prescriber ; for no matter how good a memory 
he may have, he will surely make a grievous mistake some day if he fol- 
lows the practice of writing prescriptions from memory. Furthermore, 
the unscientific character of the latter habit will, when appreciated, pre- 
vent any educated physician from indulging in it. Every prescription 
should be written with a definite purpose in view, consequently the mind 
of the prescriber should weigh each step carefully and should avoid all 
slavish subjection to ready-made formulae. 

Suppose, then, that we wish to order for Miss Graham an emulsion of 
Castor Oil, flavored and sweetened so as to make it less disagreeable 
to the taste than it naturally is. If the ingredients were simply mixed 
together, as in the previous example, the result would be an unsightly 
preparation, consisting of sweetened and flavored water with the oil float- 
ing on top. So we require that the process of emulsification be first 
accomplished, by which the oil is minutely subdivided and suspended in 
the water by the aid of the emulsifier, which may be any viscid excipient, 
as gum, soap, or yolk-of-egg. Taking the last-named for the emulsifying 
agent, we would begin by writing down in order the following terms, as 
stated below in italics, viz.: — 

For Miss Graham. June 10th, iSg8. 

ft . (Take thou—) 

Olei Ricini, (of Oil of Castor), 
Vitelluni , (Yolk-of-egg) , 
Tere bene simul ; dein adde — (Rub well together ; then add — ) 

Having gone so far, we begin to think of an agreeable vehicle, and 

choosing from the many Syrups at our disposal that of Ginger, and from 

the flavored Waters that of Cinnamon, we write further for these as the 

ingredients to be added, thus — 

Syrupi Zingiberis, (of Syrup of Ginger), 
Aquce Cinnamomi, (of Cinnamon Water). 

The ingredients are now all entered upon the prescription, but their 
respective quantities have not yet been decided on. We proceed then 
by first taking into consideration the total quantity of the medicament 
required, — which, in this case, as the preparation is intended to purge 



54° PRESCRIPTIONS. 

the patient, need not embrace more than one or two doses. As it is well 
to provide for a repetition of the dose, in case the medicine should not 
act sufficiently, we will decide upon two doses in all. Now, the average 
adult dose of Castor-oil is about a tablespoonful or half-an-ounce, and as 
we want two such doses we insert the sign and numerals fgj, or simply §j, 
opposite the title of the oil which is written in the genitive case. But 
to emulsify it properly we need about one-half as much of the emulsify- 
ing agent, and we may express this by writing for half-an-ounce of yolk- 
of-egg, or for the yolk of one egg, or for one yolk-of-egg, which weighs 
about half-an-ounce. This would be expressed in Latin by either of the 
following methods, — 

Vitelli semi-unciam (^ss). One-half-ounce of Yolk-of-egg. 
Vitelhim ovi uniits, ( j). The Yolk of one egg. 
Vitellum unum, (j). One Yolk-of-egg. 

As the word Vitellus means Yolk-of-egg, we may omit the word Ovi, 
and accepting the latter as the best style, insert the numeral j opposite 
the word Vitelhim, which is properly in the accusative case. The whole 
quantity so far specified is one ounce and a half, and if we add two and 
a half ounces of diluent we shall have a four-ounce mixture, or the full 
of a regular-sized bottle as found in the shops. There being consider- 
able viscidity already present in the emulsion we do not need much 
syrup, so we assign to the Syrup of Ginger the odd half-ounce, leaving 
two ounces of the Water to make up the total bulk of four fluid-ounces. 

The prescription now only requires for its completion that the subscrip- 
tion and signature be added. We proceed to admonish the dispenser by 
telling him to mix the ingredients together, writing therefore the word 
Misce or the abbreviation M commonly used therefor ; and to further 
point out the nature of the preparation we add, Let be made an emulsion, 
or in Latin, Fiat emulsum, — the passive verb taking as predicate-nomina- 
tive the thing into which the making is to be. The final direction Label 
or Write thus, is expressed by the term Signetur, Let it be entitled, fol- 
lowed by the instructions for the patient or the person who is to admin- 
ister the medicine, which should be in English though they may be 
written in Latin. Our completed prescription will stand thus, — 

For Miss Graham. June 10th, i8q8. 

&. Olei Ricini, gj. 

Vitelhim, j. 

Tere bene simul, dein adde — 

Syrupi Zingiberis, % ss. 

Aquce Cinnamomi, . 3 ij- 

M. Fiat emulsum. 

Sig. — " One-half at once, to be repeated next day if re- 
quired. ' ' Potter. 

The last entry of the inscription might be written — Aqua Cinnamo??ii, 
quantum sufficiat ad §iv, meaning " of Cinnamon-Water as much as may 



PRESCRIPTIONS. 54 1 

be necessary to [bring the whole quantity to] four ounces," usually 
expressed in contracted style, thus — 

Aq. Cinnamomi, q. s. ad %iv. 

This style is preferred when any of the quantities are approximations, 
and the final item cannot be exactly stated to secure a certain total. In 
the foregoing case, the one yolk-of-egg might measure a little more than 
the half-ounce assigned to it; but by using the q. s. ad style at the end, 
we make sure of getting a total of exactly four fluid-ounces. 

The Use of Latin in Prescriptions. 

The use of the Latin language in writing prescriptions is a sore point 
with a certain class of patients who like to know what they are taking, or 
wish to exercise their critical judgment upon the prescription of a phy- 
sician in whose learning, skill and judgment they professed to have con- 
fidence when they consulted him. This feeling crops out frequently in 
our State legislatures, where bills are periodically introduced making it a 
crime for a physician to write a prescription in any other than the ver- 
nacular language. It is well for the student to know the reasons for 
maintaining the use of a dead language in the ordinary affairs of life. 
These reasons are as follows : — 

The names of plants vary in every modern language, and even in the 
same language several different plants not infrequently receive the same 
common name. For example, — the name " Starwort " is given to Aletris 
farinosa and Helonias dioica; " Colic-root " is one of the names of Aletris 
farinosa, also of Dioscorea villosa and Liatris spicata; "Mandrake" is 
applied to Podophyllmn and Mandragora ; " Winter-green " to Chimaphila 
and Gaultheria ; and "Snake-root" to five different plants, — Asarum, 
Cimicifuga, Eryngium, Senega and Serpentai'ia. There are many other 
instances of this diverse nomenclature in English, and as each plant has 
a different name in French, another in German, and still another in 
Italian, Spanish, Dutch, etc., the confusion, in so polyglot a country 
as this, would cause innumerable errors if any but a generally understood 
language were used in prescriptions. Latin is such a language, it is the 
accepted language of science throughout the world, the Latin names of 
plants are definite and cannot be confounded, and a prescription written 
in Latin by a physician of any nationality, in any part of the civilized 
world, can be readily understood and correctly compounded by a phar- 
macist in any other civilized country. 

Another reason, formerly more potent than at present, is the protection 
to the patient which the secrecy of a Latin prescription affords. A pre- 
scription ordering mercury and potassium iodide in plain language would 
be an awkward thing to send by one's child or servant to be put up, or* 



542 PRESCRIPTIONS. 

to have ordered by telephone to be sent to Mrs. C. B. of a certain number 
and street. Again, there exists in many cases a strong prejudice against 
certain names of drugs, usually born of ignorance but none the less 
potent, and in such it becomes necessary for the patient's good to con- 
ceal from him the name of the medicine he is taking. In this age of free 
education in all branches and the consequent smattering of everything 
possessed by almost everybody, the use of Latin does not afford the neces- 
sary secrecy, and the physician who does not dispense his medicines is often 
compelled to resort to private formulae deposited by him with a certain 
druggist. In France it is a criminal offense to make known or expose 
the contents or nature of a prescription to any person other than the 
party for whom it was written, the law recognizing the fact that pre- 
scriptions may betray secrets which should be carefully guarded. 

Opium, Morphine, Cocaine, and other agents likely to cause drug- 
habits, should never be ordered on written prescriptions for neurotic or 
hysterical subjects. The physician should keep such drugs in his own 
hands and thereby retain the absolute control of their administration in 
every case in which he finds it necessary to use them. He should protect 
his patient from such a result as drug-slavery by every means in his power. 
Many of the worst cases of the cocaine-habit, known to the author, were 
acquired by the use of cocaine in nasal sprays prescribed by physicians ; 
and similar methods are responsible for many of the wrecks made by 
indulgence in opium and morphine. 

There is no royal road to prescription-writing ; practice, care and knowl- 
edge of the whole subject are necessary to enable one to turn out habitu- 
ally those elegant prescriptions which are properly termed " magistral," 
being the work of a magister or master of his business. A fair knowledge 
of the Latin language is a sine qua non to every professional man but 
especially to the physician. It is pitiable to see a Doctor write ignorantly 
of even the genitive-case endings of the drug-names which he uses. The 
teaching of Latin is not within the scope of this work, and this part of 
the subject will be concluded with the advice to the physician who is 
ignorant of that language to write his prescriptions wholly in English if 
he cannot write them in decent Latin. A very full table of the Latin 
words, phrases and contractions used in prescription-writing, also a table 
of genitive case endings, will be found in the Appendix; but for a com- 
plete treatment of the subject the reader should consult Pareira's Selecta 
e Prcescriptis, in which every detail of prescription- writing is explained. 

Principles of Combination. 
The principles of combination are so well laid down by Dr. H. C. 
Wood, that his words are appended verbatim, as follows: — 

The art of combining medicines is not a difficult one; but in practice 



PRESCRIPTIONS. 543 

certain principles should not be lost sight of. Chief of these are, to pre- 
scribe as few remedies as possible, and to use no powerful drug without a 
very distinct idea of what it is intended to do. Whenever it is desired 
to give a powerful remedy in increasing doses until its physiological effect 
is produced, it should always be given by itself. Thus, it may be neces- 
sary to give Arsenic so as to impress the system, at the same time that 
Iron is indicated ; but the two remedies should be given separately, so 
that the dose of either can be increased or diminished independently of 
the other. The principles of combination formulated below were long 
ago enunciated by Dr. Paris, but are to-day as imperative as ever. 
Medicines are combined — 

First. To augment, correct, or modify the action of a medicine. 
Thus, purgatives act much more kindly when a number of them are 
united together. The chief reason of this probably is, that as different 
remedies affect different portions of the gut, the whole intestine is best 
reached by a union of the diverse substances. It may take an intense 
irritation of the mucous membrane to purge as actively as does a mild 
irritation of both the mucous membrane and the muscular coat. 

There are powerful medicines which act similarly upon some parts of the organism 
but dissimilarly upon other parts. By combining such remedies powerful effects can be 
obtained at the points where the two lines of action cross each other, without influencing 
to a great extent other portions of the system. Thus, Chloral produces sleep by its action 
upon the brain, and also has a distinct influence upon the heart but none upon the intes- 
tinal tract. Morphine acts upon the brain and does not influence the heart, but has a 
powerful effect upon the intestinal tract. By combining Chloral and Morphine we get 
an overwhelming conjoined influence upon the brain in producing sleep with, the least 
possible disturbance of the heart and of the intestinal tract. 

Secondly. To obtain the joint action of two or more diverse remedies. 
Thus, in a cough mixture Morphine may be included to quiet the cough, 
whilst Ipecacuanha and Squill (in accordance with the first principle) are 
added to affect the mucous membrane. The application of this principle 
requires caution, or the practitioner will be led into that chief abomina- 
tion — polypharmacy. It is worse than futile to attempt to prescribe for 
every symptom. The underlying cause of the disorder or the understratum 
of bodily condition must be sought out and prescribed for simply. 

Thirdly*. To obtain a special combination, which is really a new remedy, 
or which experience has shown acts almost as a new remedy. Thus, when 
to Iodide of Potassium in solution Corrosive Sublimate is added, a new 
chemical compound is formed, which experience has shown to be of great 
value in syphilitic diseases. Griffith's antihectic mixture is another in- 
stance of the use of chemical changes, the Proto-carbonate of Iron being 
formed out of the Sulphate of the metal and' the Carbonate of Potassium. 
In the famous Dover's powder no chemical change occurs, but the ordi- 
niry action of Opium upon the skin is so enhanced that the combination 
may be looked upon almost as a new remedy. 



544 PRESCRIPTIONS. 

Fourthly. To afford a suitable form. Thus, Acacia is added to make 
an emulsion or Confection of Rose to make a pill. In the choice of 
excipientscare should be exercised to select a substance free from medical 
properties, having no chemical incompatibility with the medicinal agent, 
and of suitable physical character. Bread crumbs often make a good 
basis for pills, but with Nitrate of Silver they are chemically incompati- 
ble, on account of the chlorides in them. 

When writing a prescription, the utmost care should be taken to use such excipients 
that the combination should not only be attractive to the eye, but also as little repulsive 
to the palate as may be. Whenever possible, the pill-form should be employed with 
bitter or disagreeable medicines. The pill may be readily coated with silver-foil ; tonic 
pills may be coated with Iron by shaking or rolling them in Ferri Pulvis while soft and 
sticky. Sugar-coated pills and " compressed pills" are apt to get so hard and insoluble 
that their use requires caution. In regard to mixtures, flavoring oils should be freely 
used, and the power of Glycerin to conceal the disagreeable taste of many substances 
should be remembered. ( Wood'' s Therapeutics, nth edition, page 68, et sea.) 



Metric Prescriptions. 

Metric prescriptions are written or compounded with sufficient accu- 
racy by considering a Milligramme as equal to the -g^th of a Troy grain, 
a Gramme as equivalent to 15 Troy grains, and a Cubic Centimeter (fluid 
gramme, millimeter) as equal to 15 minims or i^th of a fluidrachm. All 
other metric terms, units and prefixes may be wholly ignored by the phy- 
sician and the pharmacist. In fact the terms centigramme and decigramme 
are rarely used at all, the former being generally expressed by 10 milli- 
grammes and the latter by 100 milligrammes. The term Gramme when 
abbreviated is printed and written Gm., the term Milligramme , Mg., and 
the term Cubic Centimeter, Cc. In expressing quantities by metric weight 
or measure in writing the common or Arabic numerals are used, and are 
always placed before the term or abbreviation designating the unit, thus — 
2.50 gm., 30 cc. When apothecaries' weight is employed the numerals 
are placed after the sign or symbol designating the unit, and in Roman 
characters, thus — gr. x, 9ij, ^jss, §vj. The decimal point after the figure 
representing the number of grammes or cubic centimeters should be 
replaced by a line, in order to avoid such errors as might arise#from the 
misplacement of a point, the dropping of ink, or the intrusion of a fly- 
speck, which might cause serious results in many cases. The simplest 
rule for writing a prescription in metric terms by one who is not prac- 
ticed in the use of the system, is the following, — 

Write as though prescribing but one dose of each ingredient in grains or 
minims and decimals thereof ; then substitute the term ' ' grammes ' ' or 
11 cubic centimeters " for grains or minims, and the prescription is correct 
for 15 doses in metric terms. 

Of course, when writing for a mixture or solution, the proper quantity 



PRESCRIPTIONS. 545 

of vehicle must be added to complete the one dose, and must also be 
expressed first in grains or minims. For example, — 

One dose. 15 doses metric. 

ij . Quininse Sulphatis, gr. j, I 1 . 

Strychninse Sulph gr. ■£% or 0.016, 016 

Ext. Glycyrrhizse FL, TT^iv, 4 

Syrupi, TT\,lx, 60 

This gives a two-ounce mixture approximately, of which the dose would be a tea- 
spoonful. 

One dose. 15 doses metric. 

R . Quininae Sulphatis, gr. j, I I 

Massse Ferri Carb., gr. ij , 2 | 

Ext. Nucis Vomicae, gr. % or 0.25, J25 

Ft. pil. no. xv. Sig. — One pill thrice daily after meals. 

The above rule will answer for all liquids except those which are very 
heavy, as Syrups and Chloroform, or very light, as Ether. Measures may 
be entirely discarded, and all fluid quantities expressed in grammes. The 
average drop of water may be considered equivalent to 0.05 cubic centi- 
meter (or gramme), the average teaspoonful to 5 cc, the tablespoonful 
to 20 cc, the Troy j§ to 30 grammes, the fluidounce to 30 cc, and 8 
fluidounces to 250 cc. 

In prescribing Syrups or Chloroform, each Troy fluidounce should be 
reckoned at something more than 30 grammes — say 40; and if this be 
done, the difficulty of converting one scale into the other will be obviated. 
As to Syrups, Chloroform, etc, the following table shows the actual 
weight in grammes of each fluidounce of the substances named : — 




Water. 
(Grammes.) 


Tinctures. 
(Grammes.) 


Syrup. 
(Grammes.) 


Chloroform. 
(Grammes.) 


Ether. 
(Grammes.) 


29.52 

59- °4 
118.08 


28.OO 

56.OO 

II2.00 


38.OO 

76.OO 

152.OO 


43-70 

84.40 

174.80 


22.14 
44.28 
88.56 


236.16 


224.OO 


304.OO 


349.60 


177.12 



A table of equivalents between Apothecaries' and Metric Weights and 
Measures will be found in the Appendix. 

Abbreviations. 
Abbreviations, though very commonly used by physicians in prescrib- 
ing, are a source of much annoyance to the compounder, and frequently 
one of great danger to the patient. Physicians who never knew anything 
of the Latin grammar, or those who have forgotten its rules, are very apt 
to use abbreviations to conceal their ignorance of case-endings. Many 
others use them through sheer laziness and some from force of habit. The 
educated and conscientious man will take pride in turning out a full and 
clear prescription, free from cabalistic letters and all elements of uncer- 
tainty. In the Appendix will be found a list of the Latin terms used in 
35 



546 PRESCRIPTIONS. 

prescriptions, with. the abbreviations in vogue and the English meanings. 
Ambiguous contractions may result fatally to the patient, as is readily 
seen by studying the following list, which gives a few examples of the 
dangers of careless abbreviation: — 



A co nit. . 
A mm on. 
Aq. Chlor. 
Aq. Fontis. 



Chlor. 



Hyd. Chlor 



Acid. Hydroc. — may mean 

f Aconitine. 
' \ Aconitum. 
j Ammonia. 
\ Ammoniacum. 
J Aqua Chlori. 
\ Aqua Chloroformi. 

Might easily be read 
Aqua Fortis. 

Chlorine. 

Chloral. 

Chloroform. 

Calomel. 

Corrosive Sublimate. 

Hydrate of Chloral. 



J Acidum Hydrochloricum. 
\ Acidum Hydrocyanicum. 

Hydrargyrum. 



Hydi 



Sod. Sulph. 



Sidph. 



Hydras. 

Hydriodas. 

Hydrochloras. 

Hydrocyanas. 

Sodium Sulphate. 

Sodium Sulphite. 

Sodium Sulphide. 
f Sulphur. 
J Sulphide. 
j Sulphate. 
[ Sulphite. 



Zinci Phos. .....J ?! nC ll° SV l at /- 

{ Zinc Phosphide. 



Renewals of Prescriptions. 

It would be advisable for physicians to always write the words Non 
Repetatur, or some similar direction, on all prescriptions which should 
not be repeated without their sanction. By so doing they would doubt- 
less cut off a good many renewal charges from the receipts of druggists 
who would fear the legal consequences of disobeying the mandate. This 
inconvenience to the drug-seller would be more than compensated for in 
the advantage resulting to the drug-taker, who too frequently carries in 
his pocket-book a stock of receipts for his various complaints; and in 
protection to the physician, who by giving up the dispensing of his own 
medicines has placed it in the power of the druggist to connive at a direct 
robbery of the just reward of professional skill and knowledge. 

It is doubtless a fact familiar to every observer, that the old-time con- 
fidential relations between the professions of physician and pharmacist 
have almost passed into oblivion. In fact, the tendency of pharmacy 
now-a-days is towards the position of a mere money-making trade, instead 
of in the exalted direction of a profession. The indiscriminate renewing 
of prescriptions, the open sale of quack nostrums and homeopathic pel- 
lets, the readiness with which counter-prescribing is indulged in, the in- 
sinuations too frequently made over the drug-counter in reflection on 
physicians, and many other similar practices, have caused the non-com- 
batant profession to regard the average druggist with suspicion. If phy- 
sicians boldly took the dispensing of medicines more into their-own hands 
many of these evils would soon eliminate themselves from the drug-stores. 
Right here it may be said that there is nothing unprofessional or deroga- 
tory in the dispensing of his own medicines by the physician. In England 



PRESCRIPTIONS. 547 

it has been the universal practice for centuries in all places except the 
largest cities, and it has been given up by a part of the medical profession 
only as a matter of convenience to themselves, not as a right belonging 
to the pharmacist. The homeopaths fought for the reclamation of this 
practice as a right belonging to the medical profession, and succeeded in 
securing its legality, but not from a worthy motive. They dispense 
their own medicines in order to cover up the many frauds of which they 
are daily guilty, and to give them the power of administering full doses 
of powerful drugs in a form which is apparently " homeopathic," with 
no tell-tale prescription on file in a drug-store to give mute but danger- 
ous evidence against their honesty. In this way they administer several 
grains of calomel or eighth-grain doses of morphine, or correspondingly 
large quantities of active alkaloids, triturated with sugar of milk, or dis- 
solved as many of the latter may be in alcohol. Chemistry, by isolating 
the active principles of plants, and furnishing them to commerce in the 
form of soluble salts, has enabled the homeopath to practice this fraudu- 
lent method of dispensing drugs, which the innocent and ignorant patient, 
who believes in the power of the minimum dose, supposes to be infinites- 
imal in amount. But the physician of the regular profession is too apt 
to think that if he uses a practice which charlatans have appropriated to 
themselves, he may be classed with them by his professional competitors. 
Hence, many regular physicians are absolutely afraid to use such drugs as 
Aconite, Belladonna, Gelsemium, Arnica, Rhus, etc., all of which are 
official, and most of which are older in medicine than homeopathy; and 
avoid pocket-cases, drachm-vials and triturations, as badges of charlatan- 
ism. It is high time that we asserted our independence in all these mat- 
ters, and made use freely of those means which are recommended by our 
individual judgments as promotive of the best results to our patients and 
to ourselves. With a small stock of reliable fluid extracts, and an equally 
moderate supply of gelatin-coated pills and compressed tablet-triturates 
from the best houses, physicians could check-mate the unscrupulous prac- 
tices of many druggists to a great extent, save their patients many dol- 
lars, and retain many a dollar for their own pockets which under the 
present system goes to their enemies. The homeopaths understand the 
money part of the argument well. When their patients' medicine is 
exhausted, the doctor must be seen for a fresh supply, meaning of course 
another consultation about symptoms, a change perhaps from Mercurius 
Dulcis to Mercurius Vivus, and another fee. The expense is nothing, 
sugar of milk being cheap, and there is no prescription in the patient's 
pocket-book, to be renewed scores of times (paying toll however every 
time to the druggist), and finally to be copied by aunts, mothers, and 
friends, as a " sovereign remedy" for a cough, or a " really wonderful 
receipt " for a case of croup. 



548 incompatibility. 

Prescription Blanks. 

After many years' experience in prescribing on blanks furnished by 
druggists, the writer has come to the conclusion that it is much better, 
for many reasons, for the physician to have his own blanks, without the 
address of any drug-store thereon. These blanks should be furnished 
with stubs on which to write the prescription at first in rough, afterwards 
copying it out cleanly on the main blank. A careful prescriber always 
writes a formula twice before letting it go out of his hands. If he does 
the first writing on the stub of a book of blanks he will always have a 
copy of the prescription in his possession, for which he may afterwards 
be thankful. The blank used by the writer measures 4^ inches by 3^, 
joined by a perforated edge to a stub 3^ inches by 2^ inches. On the 
main blank the physician's name and address are printed, together with 
his office-hours, and a place for number and date, also the sign R., and 
a line for signature. On the stub there are printed the words, " Copy of 
Pi'escription No For " 

These blanks are bound up in books of 100 each, with a flexible morocco 
cover, from which the book of stubs may be slipped and a fresh book 
inserted as required. The size is ample for all ordinary requirements, 
and permits of the book being carried in the breast-pocket. 



INCOMPATIBILITY. 



Incompatibility may be Chemical, Pharmaceutical or Therapeutical, 
according as the prescribed combination results in chemical decomposi- 
tion, physical disassociation or antagonistic action. In the first case the 
incompatibility may be unintentional or intentional on the part of the 
prescriber, for in many cases the result of the chemical action affords the 
substance desired. 

Instances of intentional incompatibility are the mixtures of Calomel or Corrosive Sub- 
limate with Limewater, producing the Black and Yellow Oxides of Mercury respectively, 
and commonly known as Black Wash and Yellozv Wash. Such a combination should 
not be filtered (as a novice might suppose), but should be dispensed with a Shake-label, 
in order that the precipitate may be uniformly distributed before using. 

Chemical Incompatibility generally results from neglect on the part 
of the prescriber of the most common chemical reactions, such as that — 

1. Acids tend to combine with bases and to form salts. 

2. Weak acids or bases are displaced from their combinations by 



INCOMPATIBILITY. 549 

stronger ones, so that salts in solution when brought together generally 
exchange their radicles, especially if by doing so an insoluble compound 
can be formed. 

3. A salt in solution is easily decomposed by a strong alkali if the salt 
is one having a weak or volatile base. 

4. A substance in solution may be decomposed by another without 
precipitation, the product being soluble in the solution. 

5. Alkaloidal salts are precipitated from their solutions by the addition 
of fixed alkalies, their salts, or salts which produce insoluble compounds. 
Oxides of the fixed alkalies decompose salts of the metals proper and 
those of the alkaloids, precipitating their bases; but the base may be 
soluble in an excess of the alkali. 

6. Tannic and Gallic Acids and vegetable substances containing them 
precipitate albumin, alkaloids and most of the metallic oxides, and form 
inky solutions when brought into contact with the persalts of Iron. 
Tannic Acid precipitates gelatin. 

7. Glucosides are incompatible with free Acids or Emulsin. 

Examples of the neglect of these principles are seen in the prescribing of Quinine Sul- 
phate in mixture with Potassium Acetate, resulting in a voluminous precipitate of Quinine 
Acetate which cannot be poured from the bottle ; — Vinegars or Syrups containing Acetic 
Acid (Syr. Allii, Syr. Scillse) added to a solution of alkaline carbonates, causing decom- 
position of the latter with evolution of C0 2 ; — the addition of Liquor Potassse to a solu- 
tion of Ammonia-alum, setting free gaseous ammonia ; the mixing of Strychnine Sul- 
phate and Potassium Bromide in solution, causing the decomposition of the alkaloid sul- 
phate and precipitation of strychnine ; — preparations of Cinchona with salts of Iron, 
forming an inky tannate of iron ; — Elixir of Chloral with Alkalies, causing the elimination 
of chloroform and its subsequent evaporation. 

Insoluble Salts. — The following more or less Insoluble Salts will be 
formed whenever the materials of which they are composed are*brought 
together in solutions: — the Hydrates, Carbonates, Phosphates, Borates, 
Arsenates and Tannates of most earthy and heavy metals and alkaloids, 
and the metallic Sulphides; the Sulphates of Calcium and of Lead, and 
the subsalts of Mercury; the Chlorides, Iodides, and Bromides of Bis- 
muth, Silver, Lead, and subsalts of Mercury ; the Iodides of Quinine, of 
Morphine, and of most alkaloids. 

Instances are — Limewateror Aromatic Spirit of Ammonia with Tincture of Chloride 
of Iron, or solutions of Mercury salts, or neutral solutions of Quinine or Morphine salts. 

Ammonium, Potassium, and Sodium Carbonates or Bicarbonates with Limewater. 

Solutions of Magnesium Sulphate, Alum, Zinc Acetate or Sulphate, with solutions of 
salts of Iron, Manganese, Bismuth, Antimony, Lead, and most alkaloids. 

Ammonium or Sodium Phosphates with solutions of Iron Salts, with Limewater, solu- 
tion of Magnesium Sulphate, of Alum, etc. 

Liquor Potassii Arsenitis with Limewater, with solutions of basic salts of Iron, and with 
solutions of neutral salts of Quinine and Morphine, etc. 

Solutions, Decoctions, Tinctures, and Extracts containing Tannic Acid with solutions 
of salts of Iron, Mercury, Antimony, Lead, also with solutions containing albuminous 
substances and Gelatin. 



550 



INCOMPATIBILITY. 



Limewater with solutions of Quinine or Morphine Sulphates. 

Solutions of Lead Acetate with Zinc Sulphate or Alum. 

Sodium Chloride with Silver Nitrate. 

Morphine Hydrochlorate with Lead Acetate. 

Alkaline Iodides or Bromides with Bismuth Carbonate or Subnitrate, with Lead Ace- 
tate, with Subchloride of Mercury, or with neutral solutions of Quinine, Morphine and 
Strychnine salts. 

Table of Precipitant Solutions. 

The following table shows the most important instances of solutions which mutually 
precipitate each other, the letter P meaning " forms a precipitate with " — 





<n 




TJ 


u 


g 


i 


c 


ri 




O 


c 
.2 




> 


3 


Sj 


E 

3 


rt 


Solutions of — 


W5 


£ ^ 
to £ 




to 
oj3 


u . 


§2 

CtO 


< 

o 


O 
o 








nco 


3CO 


^2 CO 


2 £ 


2 






£ M 


a be 


;o 


_o 


o 


5.2 


o 


o 




< 


V 


JE, 


3 


3 


3 


ti 


"3 




2 


o 

CO 


o 
co 


O 
CO 


O 
CO 


*o 

CO 


*o 

CO 




P 
P 
P 


p 
p 
p 


P 
P 
P 
P 


P 
P 
P 
P 


p 


p 








P 


p 


Carbonic Acid and Carbonates, .... 
Sulphuric Acid and Sulphates 


p 
p 


p 






Phosphoric Acid and Phosphates, . . . 
Boric Acid and Borates, 


P 


p 


P 


P 


p 


p 






P 


p 


P 

P 

I 


P 
P 
P 
P 
































Hydriodic Acid and Iodides, 


P 
















p 


P 


p 














p 
p 


P 
P 


P 
P 



































Explosive Compounds result from the admixture of powerful oxid- 
izing agents with substances which are readily oxidizable. The most 
important members of these two classes are as follows: — 



Oxidizers. 
Chlorine and its Oxides. 
Free Hydrochloric Acid. 
Nitro-hydrochloric Acid. 
Chlorates. Hypochlorites. 
Chromates. Chromic Acid. 
Permanganates. 
Nitric Acid. Nitrates. 
Bromine. Bromates. 
Iodine. Iodates. 
Silver Oxide. 
Peroxides (Dioxides). 



Oxidizable or Combustible. 
Phosphorus. Hypophosphites. 
Sulphur. Sulphides. 
Glycerin. Sugar. Alcohols. 
Oils. Ethers. Tannin. 
Cork. Charcoal. Creosote. 
Dry Organic Substances. 
Powdered Iron and Zinc. 
Arsenous Acid. 
Cyanides. 
Oxalates. 
Ferrous, Mercurous and Stannous salts. 



Explosions have resulted from mixing Fluid Extract of Uva Ursi with certain sam- 
ples of Spirit of Nitre, Chromic Acid with Glycerin, Potassium Permanganate with 
Glycerin, Nitric Acid with Glycerin, Silver Nitrate with Creosote, Silver Oxide in pill 
with Extract of Gentian, Potassium Chlorate with Glycerin and Tincture of Fe7-ric Chlo- 
ride. Calcium Chloride triturated with Sulphur in a mortar has exploded, so also has 
Calcium or Sodium Hypophosphite when triturated alone. Tincture of Iodine with 
Ammonia forms the Iodide of Nitrogen, which is highly explosive, especially if triturated 
in the presence of water. Catechu and Potassium Chlorate in a dentifrice have exploded 
in the mouth from the friction produced by a dry tooth-brush. Lozenges of Potassium 
Chlorate, carried in the pocket with a box of safety matches, have exploded by rubbing 
on the composition on the outside of the box, causing an extensive burn of the thigh. 



INCOMPATIBILITY. 5 5 I 

Hydrogen Peroxide (Dioxide) is peculiar in that it acts both as an oxidizer and as an 
oxidizable agent. It reduces oxidizing agents and is itself reduced at the same time, 
hence it is incompatible with all the substances mentioned above. Nitrites may act in 
the same way under favorable circumstances. 

Poisonous Compounds may be formed by the admixture of many 
substances in solution, such as — 

Potassium Chlorate with Potassium Iodide, in solution together do not 
react at ordinary temperatures, but in the system they evolve a poisonous 
agent, probably Potassium Iodate. 

Potassium Chlorate with Syrup of Ferrous Iodide, liberates Iodine from 
the Iodide in the warm stomach, causing severe gastric irritation, perhaps 
gastritis of dangerous degree. 

Dilute Hydrocyanic Acid or Potassium Cyanide with Calomet, forms 
the Bichloride and Bicyanide of Mercury, both virulent poisons; — with 
metallic hydrates, carbonates, sub-nitrates or sub-chlorides, cyanides of 
the metals are formed which are even more poisonous than the acid itself 
in its usual diluted form. 

Pharmaceutical Incompatibility differs from chemical incompati- 
bility in the absence of chemical action, and is generally produced by 
adding one substance to another which, through differences in solubility, 
causes a precipitation of solid matter or a separation of part of the liquid. 
The separated constituents may be active and hence important, or inert 
and therefore unimportant. 

Instances of this are — the addition of an acid to a Quinine and Liquorice mixture, 
resulting in precipitation of the Glycyrrhizin (relied on to cover the taste of the Quinine) 
by the acid ; or the use of Quinine, Tincture of Ferric Chloride and Liquorice together ; 
— or the prescribing of solutions of Chloral and Potassium Bromide with an alcoholic 
preparation, the Chloral separating to the top as an alcoholate, and therefore dangerously 
in excess for the first few doses ; — or the neglect to prescribe Acacia or some other emul- 
sifier in mixtures of an alcoholic fluid extract of a resinous body with an aqueous prepara- 
tion, which would result in the separation of the resin to the surface and an overdose 
with the first teaspoonful. 

When a fluid extract is diluted with a liquid differing in composition 
from those used in the fluid extracts, the gum, albumin, resin and mucil- 
age are often separated. In such a case as Fluid Extract of Cannabis 
Indica the active resin would be thrown out of its alcoholic solution and 
floating on top might cause serious symptoms ; but in many other in- 
stances the precipitate would be inert and filtration would be in order. 
Water is the solvent for albuminous, gelatinous, gummy and saccharine 
bodies and for a large number of inorganic salts ; while Alcohol is the 
solvent for volatile oils and resins, gum-resins, resinoids, balsams and all 
drugs containing these as their active principles. The solvent power of 
either Alcohol or Water for their particular substances decreases in pro- 
portion to the amount of the other added. 



552 INCOMPATIBILITY. 

Instances of Pharmacezitical Incoznpatibility . 

Resinous Tinctures or Fluid Extracts with aqueous solutions. 
Tincture of Guaiac with Spirit of Nitrous Ether. 
Compound Infusion of Gentian with Infusion of Wild Cherry. 
Compound Infusion of Cinchona with Compound Infusion of Gentian. 
Essential Oils with aqueous liquids in quantities exceeding I drop to £]. 
Fixed Oils and Copaiba with aqueous liquids (except excipients). 
Tinctures made with Alcohol with those made with Diluted Alcohol. 
Alcoholic Tinctures and Fluid Extracts with aqueous preparations. 
Spirit of Nitrous Ether with strong mucilages. 
Infusions generally with metallic salts. 

Therapeutical Incompatibility arises when two agents are admin- 
istered together which oppose each other in their action on the human 
system, — as for instance Belladonna in any form with Physostigma. But 
in many cases physiological antagonists are designedly prescribed together, 
one as a guard against the action of the other, as in the hypodermic ad- 
ministration of Morphine guarded by Atropine. The antagonists to each 
of the active medicinal agents may be found in the section on Materia 
Medica under their various titles, and also in Part III, under the title 
Poisoning. They are summarized in the table of antagonistic poisons 
on Page 35. 

The Dangers of Incompatibility may in great measure be avoided 
by the use of the utmost simplicity in prescribing. The subject can only 
be glanced at within these pages, but the following simple rules may help 
the burdened memory of the student and the practitioner. 

Never use more than one remedy at a time, if one will serve the purpose 
for which you are prescribing. 

Never use Strong Mineral Acids with other agents, unless you know ex- 
actly what reaction will ensue. They decompose salts of the weaker acids, 
and form ethers when combined with alcohol. Never combine Free Acids 
with hydrates or carbonates. 

Select the simplest solvent, diluent or excipient you know of, remem- 
bering that the solvent power of alcohol and of water for their respective 
substances decreases in proportion to the quantity of the other added. 

Generally do not combine two or more soluble salts ; for such salts in 
solution, when brought together, usually exchange their radicles thereby 
forming an insoluble compound. .[See ante, page 549.] 

Never prescribe a drug with any of its Tests or Antidotes. 

Never prescribe a Glucoside (as Santonin, Colocynthin, etc.) in com- 
bination with Free Acids or with a substance containing Fmulsin, as these 
agents will decompose it. 

Aconite should be ordered in water alone, Corrosive Mercuric Chloride 
by itself in water or in simple syrup. The latter drug is incompatible 
with almost everything, even the Compound Syrup of Sarsaparilla being 
said to decompose it. 



INCOMPATIBILITY 



553 



Potassium Iodide decomposes most of the metallic salts, and is one of 
the drugs which are best administered alone. 

The following-named substances are incompatible with so many others 
that it is best to always prescribe them alone ; they are best given in sim- 
ple solution : — 



Alum. 

Dilute Hydrocyanic Acid. 

Dilute Nitro-hydrockloric Acid. 

Sulphuric Acid. 

Mercuric Chloride (Corr. Sub.). 

Iodine and Iodides. 

Syrup of Ferrous Iodide. 

Potassium Permanganate. 

Potassium Acetate. 

Potassium Bromide. 

Tartar Emetic. 

Tincture of Guaiac. 



Morphine Acetate. 
Morphine Hydrochlorate. 
Quinine Sulphate. 
Liquor Calcis. 
Liquor Potassse. 
Liquor Potassii Arsenitis. 
Liquor Ferri Nitratis. 
Tinct. Ferri Chloridi. 
Zinc Acetate. 
Iron and Quinine Citrate. 
Free Chlorine in solution. 
Tannic and Gallic Acids. 



Silver Nitrate and Lead Acetate and Subacetate, though incompatible 
with almost everything, may be combined with Opium, the latter forming 
therewith a compound which though insoluble is therapeutically active as 
an astringent and anodyne lotion. Silver JVitrate-wiih Creosote forms an 
explosive compound. 

Tannic and Gallic Acids, and substances containing them (as the 
astringent bitters), precipitate albumin, alkaloids and most soluble metal- 
lic salts. They may be prescribed with the proto-salts of Iron, but not 
with its per-salts. Calumba is the best vegetable tonic to use with ferric 
salts, as it contains neither tannic nor gallic acid. Tannic Acid precip- 
itates gelatin. 

Iodine and the soluble Iodides are incompatible with the alkaloids and 
substances containing them, also with most metallic salts. 

Alkalies neutralize free acids, and precipitate the alkaloids and the 
soluble non-alkaline metallic salts. Oxides of the Alkalies decompose 
salts of the metals proper and salts of the alkaloids, precipitating their 
bases ; but the base may be soluble in an excess of the alkali. 

Resinous Tinctures or Fluid Extracts, (e. g., Tinct. Cannabis Indicse), 
when combined with aqueous solutions should always have Acacia or 
some other emulsifying agent added, to prevent the separation of the 
resin, which otherwise will be deposited on the sides of the bottle or will 
float on top of the mixture. 

Tincture of Digitalis should not be mixed with aqueous or syrupy solu- 
tions, for in such cases precipitation or decomposition of the active 
principles may occur. This tincture is injured by admixture and is best 
administered on sugar or dropped on a piece of bread. 



554 EXTEMPORANEOUS PHARMACY. 

EXTEMPORANEOUS PHARMACY. 



This is the most important division of the whole subject of Pharmacy, 
embracing as it does the preparation and dispensing of those medicines 
which are designed for immediate use and are compounded on the pre- 
scriptions of physicians. Hence it comprises the chief portion of the 
daily work of the pharmacist, and can be learned only at the dispensing 
counter under the personal supervision of a competent master. In the 
following pages are given the most important of the general directions 
pertaining to this subject, with the object so far as the limits of the book 
will admit of enabling the young medical practitioner to familiarize him- 
self with the compounding and dispensing of drugs. The drug-store of 
the present day has degenerated so much from its legitimate business that 
ere long physicians will be compelled in self-defence to dispense their 
own medicines, thereby protecting themselves and their patients from the 
patent-medicine vending, the counter-prescribing, and the many other 
nefarious methods which have degraded the pharmacist from his old pro- 
fessional position to that of a mere trader in drugs and nostrums. The 
first outfit of every young doctor should include a few pharmaceutical in- 
struments and a small stock of drugs. By the daily handling of these, 
the tools of his profession, he will insensibly become familiar with the 
technique of the art, and even if he does not continue to dispense his 
medicines in after years he will never regret possessing the practical 
knowledge which such a course will give him. 

Compounding means the mixing or preparing of the drugs ordered 
in a prescription, and comprises all the operations of official pharmacy 
together with many other manipulations which will be described in their 
appropriate places. 

Dispensing is the operation of putting up and issuing the drugs or- 
dered in a prescription, and may apply to the already compounded prepa- 
rations of official pharmacy as well as to those prepared extemporaneously. 

Filling a Prescription means a combination of operations which 
requires great care, undivided attention, and a special practical appren- 
ticeship at the dispensing desk. In the following discussion of extem- 
poraneous preparations such hints are incorporated as are particularly 
applicable to the compounding of each article under consideration ; and 
they may be prefaced by a few general suggestions which will serve to 
point out the most approved method of dealing with this important part 
of the druggist's work. 



EXTEMPORANEOUS PHARMACY. 555 

The prescription should first be slowly read over in a critical spirit, but 
no word or action of unfavorable criticism should reach the ears or eyes 
of the messenger. To shrug the shoulders when scanning the items, to 
laugh or even smile at the phraseology, to question the person offering it 
as to whom it is for, or what complaint it is given for, are instances of 
such flagrant treason to the prescriberas would justify the most complete 
professional ostracism of the offender. The compounder has no business 
whatever with the propriety of the prescription for its purpose. It might 
have been given as a. placebo for reasons eminently wise and judicious; or 
if not so constituted it has at least been ordered by one who is in posses- 
sion of facts about which the druggist knows nothing, even if by educa- 
tion and experience the latter were competent to judge in the matter, 
which he seldom is. His criticism should be directed only to the dosage 
and the pharmaceutical compatibility of the ingredients. Even in the lat- 
ter case he must remember that incompatibles are often prescribed with the 
view of forming another agent from the chemical reaction produced. If 
he thinks that there is any mistake, or that the quantities ordered are in 
any degree poisonous, it is his duty to make an excuse for delay to the 
messenger and at once communicate with the physician. This course, in 
these days of telephones, is nearly always practicable. 

After reading the prescription, it is well to first number it and then 
write the label. This gives time for the label to dry, and avoids the use of 
blotting paper, which ofter mars the writing and renders the directions 
all but illegible. 

A clearly defined method should next be decided on by which to com- 
pound the prescription. Directions for such plans of procedure will be 
found in the succeeding pages under the titles of the various preparations. 
Next, the ingredients should be carefully weighed or measured out, each 
one being checked off so as to avoid the danger of its being duplicated. 
In many cases the excipient is not specified, its choice being left to the 
druggist ; but in all such a note should be made on the prescription to 
show the article used, in order that in the event of a renewal being ordered 
there may be no difference perceptible. No alteration or addition should 
be made which would in any degree affect the medicinal action of the 
prescription or interfere with the intention of the prescriber. 

The labelling of the package and the numbering and filing of the pre- 
scription are matters of mechanical detail which are best learned at the 
counter. Various devices for simplifying these operations are in vogue 
and may be seen in any well-appointed drug-store. Poisonous articles 
sold by druggists should always be labelled Poison, and the transaction 
entered in a book usually required by law to be kept for that purpose ; 
but in the case of prescriptions the word " Poison " should not appear on 
the package or label unless so directed by the prescriber. 



55^ OFFICIAL PHARMACY. 

Stock Solutions of the salts most frequently prescribed are kept in 
many establishments for convenience in dispensing. Those most gener- 
ally used are the following : — 

Alum, — 3 ijss in a quart of distilled water. Of this solution each fluidounce repre- 
sents g ss of the salt. 

Potassium Bicarbonate, — 3J in f^ivof distilled water; of which ^ss contains 
3J of the salt. 

Potassium Chlorate, — I in 24 of distilled water, will not crystallize as the tempera- 
ture changes. 

Potassium Bromide, — I in 3 of distilled water, makes a very convenient solution 
for dispensing purposes. 

Chloral Hydrate, — I in I of distilled water, of which each minim contains one grain 
of Chloral Hydrate ; or I in 6 of distilled water, of which each 5 contains 10 grains. 

Morphine Sulphate, — gr. xvj in ^j of distilled water, with a grain of Salicylic Acid 
or 3 drops of Carbolic Acid to prevent change. Of this solution, known as Magendie's, 
each minim contains gr. 3L of the salt, and TTlx contain gr. y^. A safer solution, as it 
requires less mental calculation, is one of one -half the above strength, viz. — gr. viij'in 
^j, of which each fluid-drachm contains gr. j of Morphine Sulphate. 

Carbolic Acid, — 3J in f^ivof glycerin, makes a convenient solution which will 
mix with water in all proportions. Ttyvss represent gr. j of Carbolic Acid. 

Tannic Acid, — g] in f ^ iv of glycerin, dissolved by the aid of a gentle heat. TTLivss 
represent gr. j of Tannic Acid. 

Rules for the Pharmaceutical Student. The following rules are 
quoted from the Chemist's and Druggist' s Diary, and are well worth re- 
membering by the student: — 

Read through a prescription, rapidly and in a manner suggesting no suspicion or doubt. 

Write directions invariably before dispensing. Avoid thus the use of blotting paper ; 
a good dispenser uses almost none. 

If a mixture contains readily soluble ingredients, never use a mortar. 

Avoid effecting solution by heat, for fear of recrystallization. 

With syrups and also ingredients not water, arrange in dispensing to rinse out the 
measure and leave it clean ; a skilled dispenser shows very little traces of his work. 

Carefully clean and put away weights and scales after each operation. 

Hold the scales firmly by the left hand, never lift them high above the counter, and 
judge of the weight as much by the indicator as by the position of the scale. 

Select glass pans for scales, preferably of heavy make, and discard flimsy brass 
material, which corrodes speedily and becomes inaccurate. 

Learn to judge of the quantity to be weighed with tolerable accuracy ; train the eye 
as well as the hand. 

If in doubt, always begin with that about which you have no doubt. 

Be rapid in manipulation. Finish wrapping, tying, or sealing quickly. Slow dispens- 
ing is bad dispensing, and arises either from deficient practice or want of knowledge. 

Never, when in a shadow of doubt, hesitate to ask advice from a fear of compromising 
your own dignity. 



OFFICIAL PHARMACY. 



Official Operations are those processes which are directed in the 
pharmacopoeia to be used in the preparation of medicines. Many of them 
are processes which are common to both chemistry and pharmacy, as 
precipitation and crystallization, — while others are peculiar to pharmacy, 



PHARMACEUTICAL OPERATIONS. 557 

as percolation, trituration, etc. The most important of the pharmaceuti- 
cal operations are briefly described below ; for full details of the various 
apparatus used the student is referred to the more exhaustive treatises on 
Pharmacy. 

PHARMACEUTICAL OPERATIONS. 
Carbonization is the heating of organic substances without exposure 
to the air until the volatile constituents are driven off, and the residue 
assumes the characteristic appearance of carbon. 

Clarification is the separation from liquids of solid matter which 
prevents their being transparent, without using filters or strainers. It may 
be effected by heat (as in the case of Mel Despumatum), by adding a 
lighter liquid, by adding albumin, gelatin, milk, or paper-pulp, by fer- 
mentation, or by the subsidence of the particles in the form of a sediment 
through long standing. 

Colation or Straining is usually a very simple operation, so familiar 
to every one of ordinary experience as to be scarcely worth describing. 
The strainers are made of cotton flannel, fine muslin, gauze, woolen felt 
and other fabrics. 

Comminution is the process by which the aggregation of the particles 
of a solid body is overcome, and the body is reduced to pieces of varying 
sizes. Its object is to increase the area of the surface exposed to the 
action of solvents, and it includes the operations of cutting, rasping, 
grating, crushing, stamping, grinding, pulverizing, triturating, levigating, 
elutriating, granulating, etc. Apparatus of various kinds, as cutters, 
mortars and pestles, mills, etc., are used for the comminution, while 
spatulas are employed to loosen the particles, and sieves to sift the coarser 
from the finer. These last-named contrivances are of five sizes, desig- 
nated by the number of their meshes to the inch, 80, 60, 50, 40 and 
20, respectively permitting the passage of powders termed very fine, fine, 
moderately fine, moderately coarse and coarse. 

Crystallization is the process which bodies undergo in passing from 
the liquid or the gaseous state to the geometrical forms called crystals. 
Six systems of crystals are recognized by crystallography, which has 
assumed the dignity of a separate science. Bodies which are not capable 
of crystallization are termed amorphous. Every crystallizable body 
assumes its own peculiar form, or some other form derived from or re- 
lated to it. The process of crystallization is effected (1) by fusion and 
partial cooling, as in the cases of some metals and Sulphur; (2) by sub- 
limation, as Benzoic Acid, Mercuric Chloride, etc. ; (3) by deposition 
from hot saturated solutions while cooling ; (4) by deposition from a 



558 PHARMACEUTICAL OPERATIONS. 

solution during evaporation ; (5) by deposition caused by passing a gal- 
vanic current through the solution; (6) by precipitation, as in the case 
of Mercuric Iodide; (7) by the addition to the solution of a substance 
having a strong affinity for water, as the adding of Calcium Chloride to 
an aqueous solution of Sodium Chloride, or Alcohol to a solution of 
Potassium Nitrate or to an aqueous syrup. In a few cases amorphous 
solids may crystallize without undergoing liquefaction, as Sulphur, Barley- 
sugar and Iron wire. The methods most frequently employed are those 
by deposition from supersaturated solutions, and by deposition during 
evaporation. The more slowly the process is carried on the larger and 
more regular will be the crystals. The process is facilitated by use of 
foreign bodies as nuclei around which the crystals are deposited; a familiar 
instance being the thread in the centre of a mass of rock-candy. 

The Water of Crystallization is the H 2 with which most substances combine in 
the act of crystallization, and the number of molecules thereof differs for each body and 
for the same body frequently under different conditions. Exsiccation is the removal of 
this combined water by heat, the crystals assuming thereby the form of a dry powder. 
Efflorescence is a similar process occurring spontaneously on exposure of the crystals to 
the air, the effloresced portion appearing as a dry powder on the surface of the crystals. 
Deliquescence, on the other hand, is the act of absorbing water from the atmosphere, a 
property possessed by some substances which are therefore said to be hygroscopic. 

Decantation is the pouring or drawing off a supernatant liquid into 
another vessel. If done by pouring, a guiding-rod for the liquid to run 
on is an effective adjuvant ; if by drawing, the siphon in some form is 
usually employed. 

Decoloration, or the removal of coloring-matter from liquids or from 
solids in solution, is effected by the use of animal charcoal, which in small 
operations may be arranged in a funnel or a percolator, and the liquid 
placed thereon. It should not be forgotten that charcoal absorbs many 
other principles besides coloring-matter, especially alkaloids, bitters and 
astringents, so that the process of decoloration may be one of serious 
injury to the efficiency of the preparation. 

Deflagration is the heating of an inorganic substance with another 
which yields oxygen (usually a nitrate or a chlorate), the result being 
the decomposition of the body with violent and sudden combustion. 

Desiccation is the process of removing moisture from solids, and has 
for its object either the preservation of the substance, the reduction of 
its bulk or the facilitation of its comminution. The operation should be 
conducted at as low a temperature as possible. Roots, leaves and seeds 
are generally dried by being placed in trays of wire network and exposed 
to a uniform temperature in a room heated by steam. A better method 
is to suspend organic substances from the ceiling of an attic during warm 



PHARMACEUTICAL OPERATIONS. 559 

weather ; a slow process, but one which does not result in much loss of 
the active volatile principles. Crystals and precipitates require a higher 
temperature and are usually dried on a water-bath. When the water of 
crystallization is to be expelled, as in desiccating Alum and Ferrous Sul- 
phate, a temperature of about 400 F. is required. In absorbing water 
from alcohol Potassium Carbonate and slaked Lime heated are employed, 
and in several instances Sulphuric Acid is the desiccator used. 

Dialysis is a process by which crystallizable substances are separated 
from non-crystallizable ones, by suspending a solution containing both 
upon a porous diaphragm having its under surface in contact with water. 
The crystalloids pass through the diaphragm, while the non-crystalline 
remain above it, and are termed colloids. Examples of the latter class 
are gelatin, gum, glue, starch, dextrin, albumin and extractive matters, 
which are generally the inert and valueless constituents of vegetable 
drugs. Parchment-paper and bladders are used for the diaphragm ; the 
whole apparatus being termed the dialyzer, while the water into which the 
crystalloids pass is called the diffusate. 

The unofficial preparation known as Dialyzed Iron {Ferrum Dialysahtni) is a colloidal 
substance obtained by treating Ferric Chloride in solution with Ammonia, whereby Ferric 
Hydrate is precipitated and then dissolved by agitation. The mixture being placed on a 
dialyzer, the crystalloids formed (Ammonium Chloride and Ferric Chloride), together 
with any free acid present, pass into the diffusate, leaving the neutral colloidal liquid 
(solution of Ferric Oxychloride) above on the septum. 

Distillation consists of two processes, (i) the evaporation of a liquid, 
(2) the condensation of the vapor into a liquid in a separate vessel. The 
agent used in the first part of the operation is heat, in the second part 
cold. Its object is to separate mixed volatile and fixed substances, or to 
combine volatile substances which cannot otherwise be mixed, as in the 
preparation of some of the Waters. The apparatus used is of great variety, 
from the simple retort and receiver to the elaborate and costly stills. 

Destructive or Dry Distillation is a process of decomposing an organic substance 
by heat into volatile products, which are collected in a separate vessel, the residue being 
said to be carbonized. It is employed only by large manufacturers, for the preparation 
of Acetic and Succinic Acids, Oil of Amber, Wood Tar, etc. 

Fractional Distillation is the separation by distillation of substances which are 
volatile at different temperatures, each being separately driven over and received in a 
vessel by itself. Different degrees of heat are successively employed in accordance with 
the volatilizing points of the substances to be obtained. 

Expression is the forcible separation of liquids from solids, by sub- 
jecting them to pressure. Hand-pressure through straining-cloths may be 
employed, but mechanical presses are more efficient and are coming into 
general use. Oils obtained in this manner are called expressed or fixed 
oils, to distinguish them from the volatile oils obtained by distillation. 



560 PHARMACEUTICAL OPERATIONS. 

Exsiccation or Calcination is the process of depriving a solid of its 
moisture or other volatile constituents by the application of heat without 
fusion. The term Exsiccation is usually applied to the vaporization of 
the water of crystallization from a crystalline body ; Calcination to such 
operations as the expulsion of carbonic acid and water from carbonates, 
as in the manufacture of Lime, Magnesia, etc. 

Filtration is a process of straining through a medium so fine as to 
deliver the filtrate in transparent condition. The filters are made of paper 
usually, though charcoal, asbestos, sand and other articles are sometimes 
employed, and are supported in a funnel of glass or other material held by 
the ring of a retort-stand. The best filtering-paper is made in Sweden by 
Munktell, and is white; but a good paper for ordinary use is the Prat 
Dumas White, which should always be employed for filtering alkaline 
or alkaloidai solutions. The gray French papers answer well enough for 
fluid extracts, tinctures or colored liquids, but should never be used for 
solutions containing free alkali. 

Filtering- paper is folded by doubling a sheet upon itself, and then folding it again 
directly in the middle. When opened four distinct sections appear, one of which is 
separated from the other three, and the filter thus formed is placed in a funnel. This 
arrangement is known as a plain filter, which by repeated creasing is converted into the 
plaited filter ; the latter being the form generally used in pharmaceutical operations of 
small extent. In large laboratories special processes of filtration are employed with 
apparatus of more or less complexity for hot filtration, rapid filtration, etc. 

Fusion is the process of liquefying solids by the application of high 
heat without the use of a solvent. It is employed in making ointments, 
plasters, etc., in purifying resins, and for the purpose of decomposition. 
The degree of heat required varies from a temperature of 90 F., sufficient 
to melt lard in an open vessel, to one of 8oo° F., employed in fusing Zinc 
in an earthen crucible ; and may be regulated by the aid of the water-, 
steam- or sand-bath. The two former appliances limit the degree of heat 
applied, while the sand-bath prevents sudden changes in the temperature. 
Oil-baths and glycerin-baths are employed in fractional distillation. 

Granulation is a process of reducing a coarsely crystalline substance 
to a granular powder, by dissolving it in water and evaporating the solu- 
tion with constant stirring until the product becomes perfectly dry. Many 
salts are thus treated for convenience in dispensing, as the Bromide, the 
Iodide, the Carbonate and the Citrate of Potassium. Ferrous Sulphate, 
though generally dispensed in the exsiccated powder, may be granulated 
into minute crystals by filtering an aqueous solution of it into alcohol. 

Ignition in pharmacy means the process of strongly heating solids or 
semi-solid substances, the residue left being the product desired. It is 



PHARMACEUTICAL OPERATIONS. 56 I 

used in the official quantitative tests for Phosphoric Acid, Ammonium 
Phosphate and purified Antimony Sulphide. 

Incineration is the heating of organic substances with access of air 
until the carbon is consumed, the ashes being the product desired. 

Maceration is one of the processes of extracting the soluble princi- 
ples from drugs, and consists in steeping the comminuted substance in a 
suitable liquid called the menstruum, generally alcohol, for a period vary- 
ing from 2 to 14 days, during which it is occasionally agitated. The 
liquid is then poured off, the residue is expressed, and the mixed liquors 
are filtered. Several of the official tinctures are prepared by this method, 
and many others by maceration first and percolation afterwards. A few 
active principles may be extracted by water alone (<?. g. morphine), and 
in some cases the addition of acids or alkalies to the water will effect the 
chemical solution of many ingredients which are insoluble in plain water. 
As a rule however Alcohol is the most generally applicable of all simple 
solvents, but from its hardening the cell-membranes instead of softening 
them it prevents the osmosis of their contents. Drugs subjected to alco- 
holic or other menstrua should have their cells thoroughly broken or torn, 
so that the solvent may be brought into actual contact with the principles 
contained in them. The degree of disintegration required depends upon 
the size of the cells, ducts, tubes, intercellular spaces, etc., in which the 
active principles are enclosed. A very finely powdered state is open to 
objection from the packing of the particles together into an almost im- 
penetrable mass when treated by the solvent. The average size of vege- 
table cells is about -g-J-g- of an inch, while resin cells and other cavities are 
larger, averaging about y^- inch. The Pharmacopoeia prescribes in each 
instance the degree of fineness of the powdered drug employed in making 
certain of its preparations, or its bruising, slicing, etc., when such opera- 
tions will answer. [Compare the article on Comminution on p. 557.] 

Percolation or Displacement is a process of obtaining the soluble 
constituents of a powdered substance by the descent of a solvent through 
it. Though an ancient process for the making of lye from wood-ashes 
(lixiviation), it has only within the last forty years been adopted as an 
official process in pharmacy, but it is gradually taking the place of macera- 
tion as a means of extracting the soluble principles of drugs. The vessel 
used to hold the powdered drug is called the percolator, of which there 
are many forms employed by the manufacturers. The liquid used as a 
solvent is called the menstruum, and when coming from the percolator it 
is termed the percolate. The U. S. Pharmacopoeia gives very full directions 
concerning this process. 
36 



562 PHARMACEUTICAL OPERATIONS. 

Precipitation is the process of separating solids from their solutions, 
and is usually effected by chemical reaction, though it may be accom- 
plished by other methods, as by adding a second liquid in which the 
substance is insoluble, by heating albuminous solutions, or by exposing 
solutions of silver salts to the action of light. The most familiar example 
of chemical precipitation is the addition of a solution of Mercuric Chloride 
to one of Potassium Iodide, the result being a double decomposition of 
the salts and the formation of Mercuric Iodide, which falls to the bottom 
of the vessel as a brilliant, red, insoluble and crystalline powder. The 
Precipitate is the separated substance, which is usually thrown down, but 
it remains suspended in some cases, and in others it rises to the top. The 
Precipitant is the substance which is added to produce the precipitation. 
A Magma is a thick, tenacious precipitant remaining behind after the 
supernatant liquid is removed by decantation or otherwise. Precipitates 
are termed flocculent, gelatinous, curdy, granular, crystalline, etc., accord- 
ing to the forms assumed. In small operations they are usually collected 
on plain filters, and washed by the repeated addition of water. 

Separation of liquids which do not mix with each other is a simple 
mechanical process performed with pipettes of various forms, or with 
funnels having stop-cocks in their necks. Special forms of receivers are 
used for the separation of volatile oils from the water which may accom- 
pany them during distillation. 

Solution is the dissolving of a solid or a gaseous substance in a liquid, 
and may be Simple when the substance undergoes no alteration, being 
recovered unchanged on evaporation ; or Chemical when the dissolved 
body is chemically altered by the solvent or some other substance present, 
and cannot be recovered on evaporation. Simple Syrup is an instance of 
simple solution, the Syrup of Lime one of chemical solution. The liquid 
employed is termed a Solvent before the substance is added to it, after 
the operation is completed the combined preparation is called a Solution. 
If fully charged with the dissolved substance so that it will retain no 
more, it is known as a Saturated Solution. One liquid may be dissolved 
in another, or a gas may be dissolved in a liquid. The solution of solids 
is greatly facilitated by pulverization and by stirring the menstruum. 
Heat generally aids solution, most substances being more soluble in 
hot liquids than in cold ones. A saturated solution of one substance 
may still be capable of dissolving others. Rapid solution of solids 
without chemical change causes reduction of temperature, while chemi- 
cal solution produces elevated temperature. Circulatory Solution is 
performed by suspending the substance to be dissolved near the surface 
of the solvent in a gauze bag or on a porous shelf. The portion first 



PHARMACEUTICAL OPERATIONS. 563 

acted on descends and produces a circulatory movement in the fluid, 
facilitating the solution of the whole. 

Solvents employed are chiefly Water, Alcohol, Glycerin, Acids and Oils. Others 
less frequently used are Ether, Chloroform, Benzin and Carbon Disulphide. 

Sublimation is the distillation of a volatile solid, the product being 
termed a Sublimate. Its objects are to purify volatile solids from 
impurities and to collect such as result from chemical action at high 
temperatures. The operation is carried on in iron, glass or stoneware 
retorts, and results in Cake Sublimates or Powder Sublimates according 
as the temperature of the condensing surface is high or low. 

Testing and Assay are directed by the Pharmacopoeia in certain 
cases, for the purpose of determining the identity and purity of its drugs 
and their preparations. In the main portion of the book such Tests are 
frequently directed, according to a specified method in each case ; but 
processes of Assay are confined to Cinchona, Nux Vomica, Opium and 
such of their preparations as are considered to require it. The Pharma- 
copoeia contains also a very complete section on Reagents, in which 
full directions are given for the preparation and use of Test solutions 
and Volumetric solutions; also instructions for Gasometric estimations, 
and for the determination of the Optical Rotation of organic substances. 

Pharmacopceial testing and the volumetric method of determination 
are necessary to the work of the practical pharmacist, and as the appar- 
atus used is simple and the operations are those in the line of his daily 
work, he should be familiar therewith. On the other hand the proxi- 
mate analysis of organic substances for their principles, and the ultimate 
analysis of the same bodies for their elements, require a high degree of 
skill and long experience, and should be left to the professional chemist. 

The apparatus used in testing consists of graduated flasks and jars, 
burettes, pipettes, funnels, beakers, test-tubes, capsules, crucibles, re- 
agent-bottles, etc. The metric system is directed for all work, and the 
apparatus employed should be graduated accordingly. 

Torrefaction or Roasting is the application of heat, in a less 
degree than for carbonization, to an organic substance for the purpose 
of modifying some of its constituents, as in the roasting of coffee and of 
rhubarb. The latter substance, when subjected to this process, loses its 
cathartic properties, but retains its astringency, and is known as Torrefied 
Rhubarb. 

Trituration is the comminution of a solid to an extremely fine powder 
by continued rubbing in a wedgewood mortar with an inert and gritty 
powder, Sugar of Milk being the substance directed to be used. The 



564 PHARMACEUTICAL OPERATIONS. 

product is called a Trituration (see that title under Official Prepara- 
tions). The surfaces of the mortar and pestle-head should coincide closely, 
and the thorough comminution of the trituration is best accomplished by 
a circular motion of the pestle in gradually increasing circles, until the 
side of the mortar is reached, then reversing the motion and gradually 
lessening the circles until the pestle reaches the centre again. The pro- 
cess is greatly facilitated by having the pestle attached to a long handle 
playing in an opening made in a piece of wood which is nailed at a con- 
venient height. A weight may be fixed on top of the handle if a greater 
degree of friction is desired. 

Pulverization by Intervention is only another name for trituration when performed 
in a mortar and with solid bodies, the foreign substance used being subsequently removed. 
Potassium Sulphate may be employed as the medium for the pulverization of Gold, and 
is then dissolved out with water. Alcohol or Chloroform may be added to Camphor to 
aid its pulverization, and then removed by evaporation. Phosphorus may be pulverized 
by placing it in water, gently heating the latter until the phosphorus is melted, and agi- 
tating the whole while cooling. 

Levigation is trituration of a substance made into paste with water or some other 
liquid, and resembles the old process of grinding od paints by hand on a slab of stone. 
The process is used for coarse materials, as chalk, etc. where the refuse is rejected, or for 
such substances as Red Mercuric Oxide, Zinc Oxide, etc. When performed with a por- 
phyry slab and muller it is termed Porphyrization. 

Elutriation is a water-sifting process for separating the coarser particles of insoluble 
substances from the finer. The substance is mixed with water and after the larger par- 
ticles have fallen to the bottom, the liquid is decanted into another vessel, in which the 
light and powdery particles are collected. 

Vaporization includes the various operations by which volatile matters 
are separated from fixed substances or from other matters which are less 
volatile, heat at varying temperatures being the agent used. The opera- 
tions under this head are — Evaporation, Distillation, Desiccation, and 
Sublimation, of which the last three have been described. 

Evaporation in pharmacy is the process by which the more volatile 
constituents of a liquid are driven off by heat for the purpose of reducing 
its volume or of purifying it, as in the preparation of extracts and fluid 
extracts, the crystallization of salts, etc. The vessels used should be shal- 
low so as to expose a large surface of the liquid to the atmosphere. The 
heat used may be regulated by a water-bath, a steam-bath or a sand-bath, 
and ordinarily should be kept below but near to the boiling point of the. 
liquid treated. As organic substances are usually injured by long heating, 
small portions only of vegetable preparations should be subjected to this 
process, and the liquid should be frequently stirred in order to hasten the 
operation. In large laboratories vacuum-pans are employed to remove 
the atmospheric pressure, enabling the evaporation to be accomplished at 
a much lower degree of heat than if the liquid were exposed to the air. 
Ebullition or Boiling is a form of evaporation. 

Spontaneous Evaporation is the evaporation of a liquid without the direct applica- 
tion of strong heat, but at the temperature of the room or closet used for the purpose. It 



PHARMACEUTICAL PREPARATIONS. 565 

is especially applicable to cases in which the residue is liable to injury or loss from much 
heat, or in order to secure finer crystals than can be obtained by the quick evaporation 
of their solution. 

Washing is a simple mechanical process for separating soluble from 
insoluble matter, by pouring upon it a liquid which will dissolve the solu- 
ble portion. Various methods of doing this are in vogue and are often 
dignified with very high-sounding terms, as Lotion, Affusion, Ablution, 
etc. An ordinary wash-bottle, with the two glass tubes perforating the 
cork, is a convenient implement for directing a continuous stream upon 
a precipitate, while for c6ntinuous washing a combination of bottles with 
a funnel may be used. 



PREPARATIONS. 



The Official Preparations may be presented under various methods 
of classification, one of the simplest being that which divides them into 
liquids and solids, the former being subdivided into groups named after 
their principal bases, viz.: — 

Liquid Preparations. 

Aqueous, — Waters, Solutions, Infusions, Decoctions, Syrups, Honeys, Mucilages, 
Emulsions, Mixtures ; the last five containing sweet or viscid substances. 
Alcoholic, — Fluid Extracts, Tinctures, Wines, Spirits, Elixirs. 
Ethereal, — Oleoresins, Collodions. 
Oleaginous, — Liniments, Oleates. 
Acetous, — Vinegars. Glycerines, — Glycerites. 

Solid Preparations. 



Extracts. 


Pills. 


Powders. 


Ointments. 


Resins. 


Troches. 


Triturations. 


Cerates. 


Masses. 


Confections. 


Suppositories. 


Plasters. 
Papers. 



In the following descriptions of the pharmaceutical groups the com- 
position and dosage of the various preparations are omitted, as they are 
fully detailed in the section on Materia Medica, under the title in each 
case of the principal constituent. 

PHARMACEUTICAL PREPARATIONS. 

The Pharmaceutical Preparations include the pharmacopce ial (official) 
as also those of extemporaneous pharmacy (unofficial). Both classes are 
described together in alphabetical order, for the sake of easy reference. 

Aceta, Vinegars, — are solutions of the active principles of certain 
drugs in Diluted Acetic Acid. They are made by percolation and each 



566 



PHARMACEUTICAL PREPARATIONS. 



contains the soluble principles from 10 per cent, of drug. Acidulous 
menstrua form soluble salts with the alkaloids and possess antiseptic 
qualities. The official Vinegars number 2, viz.: — 



Acetum Opii. 



Acetum Scillae. 



Aquae, Waters, — are aqueous solutions of volatile substances, which 
may be solids, liquids or gases, dissolved by solution in cold or hot 
water, by filtration through an absorbent powder, by percolation through 
cotton saturated with the substance, or by distillation. The official waters 
number 19, including two forms of Aqua itself, viz. — 



Aqua. 

Aqua Destillata. 

Aqua Ammoniae. 

Aqua Ammonias Fortior. 

Aqua Amygdalae Amarae. 

Aqua Anisi. 

Aqua Aurantii Florum. 

Aqua Aurantii Florum Fortior. 

Aqua Camphoras. 

Aqua Chlori. 



Aqua Chloroformi. 

Aqua Cinnamomi. 

Aqua Creosoti. 

Aqua Foeniculi. 

Aqua Hydrogenii Dioxidi. 

Aqua Menthae Piperitae. 

Aqua Menthas Viridis. 

Aqua Rosas. 

Aqua Rosae Fortior. 



Of the above 5 are prepared by simple solution, 4 by passing gases through water, 3 
by distillation, and 6 by trituration of the medicament with precipitated calcium phos- 
phate, addition of water and filtration. 

All waters deteriorate when long kept, microscopic plants being propa- 
gated in them from spores derived from the atmosphere. They should 
be prepared only in such quantities as are needed for immediate use. 



Balnea, Baths (Unofficial). Baths are often medicated, and then 
become medicinal preparations. The ingredients only are ordered in a 
prescription, as per the following examples, each of which is intended for 
a bath of 20 to 30 gallons : — 



Balneum Acidi Nitrohyth-ochlorici. 

R . Acidi Nitrici, 

Acidi Hydrochlorici, . aa t ^j. 
M. Sig. — Use with 30 gallons of hot 
water, as a bath. 



M 



Balneum Sidphuris Compositum. 

Sulphuris Praecip., . . . % ij. 
Sodii Hyposulphitis, . . 5j. 
Acidi Sulphurici Dil., . gss. 

Aquae, Oj. 

. Sig. — For a 30-gallon bath. 



Capsulse, Capsules, (Unofficial). Gelatin Capsules of various sizes 
from o to 10 are to be obtained from the drug-stores. They are a conve- 
nient means of administering oils or nauseous solids, and when filled may 
be swallowed as easily as a large pill. By some of the manufacturers 
Soluble Elastic Capsules are prepared, each containing an ordinary dose 
of such medicines as Castor Oil, Cod-liver Oil, etc. The largest of these 
capsules makes a bolus which may be swallowed with a little effort, as it 
is quite compressible and changes its shape to suit the calibre of the pas- 



PHARMACEUTICAL PREPARATIONS. 567 

sage. The ordinary capsules are easily filled by the aid of a paper funnel, 
and the end of a pen-holder as a packer \ but simple devices (capsule- 
fillers) for facilitating the operation may be purchased. 



R . Pulv. Opii, gr. x. 

Pulv. Camphorae, . . . gr. xx. 
Sacch. Alb., q. s. 
Triturat, et riant capsular x. 
Sig. — One at bedtime for chordee 
peat in two hours if necessary. 



& . Copaibae, 3 iss. 

Oleoresinse Cubebse, . . 3 ss. 

M., et fiant capsular xij. 

Sig. — Two capsules to be taken three 
times daily, soon after meals, for gonor- 
rhea. 



Cataplasmata, Poultices, — are usually prepared at the residence of 
the patient, the ingredients only being ordered from the druggist. They 
are generally employed as a means of applying heat and moisture to a 
certain portion of the body, but are sometimes medicated with anodyne, 
counter-irritant or disinfectant agents. Poultices are not official in the 
U. S. Pharmacopoeia, but are in the British, the following list including 
all so recognized : — 

Cataplasma Carbonis, Charcoal Poultice, — Wood Charcoal I, Crumb of Bread 4, 
Linseed Meal 3, Boiling Water 20 parts. 

Cataplasma Conii, Hemlock Poultice, — Hemlock -juice I, evaporated to half its vol- 
ume, Linseed Meal 4, Boiling Water 10 parts. 

Cataplasma Fermenti, Yeast Poultice, — Beer Yeast 3, Wheaten Flour 7, Water at 
ioo° F, 3 parts. 

Cataplasma Lini, Linseed Poultice, — Linseed Meal 2, Boiling Water 5 parts, mixed 
with constant stirring. 

Cataplasma Sinapis, Mustard Poultice, — Mustard, Linseed Meal, Boiling Water and 
Water, of each a sufficiency. 

Cataplasma Sodae Chlorinatae, Chlorine Poultice, — Solution of Chlorinated Soda I, 
Linseed Meal 2, Boiling Water 4 parts. 

Cerata, Cerates, — are unctuous preparations similar to ointments, but 
of a much firmer consistence. They all contain Wax (Cera), and do not 
melt at temperatures below 104 F. They are intended for external use, 
and are generally spread on lint before being applied. There are 6 official 
Cerates, including Ceratum itself, which is made by fusing together 30 of 
White Wax and 70 of Lard. The composition of the others may be 
found in the section on Materia Medica under the appropriate titles, but 
the figures in parentheses below give the percentage of drug to basis in each. 

Ceratum. Ceratum Cetacei (10). 

Ceratum Camphorae (2). Ceratum Plumbi Subacetatis (5). 

Ceratum Cantharidis (32). Ceratum Resinse (35). 

Chartse, Papers, — consist of strips of paper medicated by impregna- 
tion of its fibers with medicinal substances or by being coated therewith. 
Of the 2 official Papers 1 is made with sized paper, and intended for 
external application as a vesicant or counter-irritant ; the other (Charta 
Potassii Nitratis) is Unsized paper impregnated with Nitre and intended 
for the inhalation of its fumes while burning. The official papers are — 

Charta Potassii Nitratis. Charta Sinapis. 



568 PHARMACEUTICAL PREPARATIONS. 

Collodia, Collodions, — are liquid preparations having for their base a 
solution of Pyroxylin in a mixture of Ether and Alcohol. They are in- 
tended for external use, being applied to the skin by means of a brush, 
producing a film on the surface after the evaporation of the menstruum. 
There are 4 official Collodions, viz.: — 

Collodium. Collodium Flexile. 

Collodium Cantharidatum. . Collodium Stypticum. 

The Flexible Collodion contains 5 per cent, of Canada Turpentine, and 3 per cent, of 
Castor Oil. Styptic Collodion contains 20 per cent, of Tannic Acid. 

Confectiones, Confections, — consist of medicinal substances formed 
into a mass with Sugar, Honey, Water, etc., with the object of rendering 
them palatable and preserving them from change. Electuaries are 
similar preparations, but this term is now obsolete. There are only two 
official Confections, viz.: — 

Confectio Rosae. Confectio Sennse. 

Confections and Electuaries are very seldom prescribed, and therefore 
can have but little place in extemporaneous pharmacy. A few old for- 
mulae for such preparations are given below as pharmaceutical curios. 
The first is a meritorious prescription, the second is said to have been 
purchased by Lord Anson for the sum of ^300. 



Electuary for 
R . Potassii Bitartratis, 
Potassii Nitratis, 
Pulv. Jalapae, . . . 
Confectionis Sennse 
Syrupi Zingiberis, q 


Piles. 

. . aa ^ ss. 
s. 
of a marble to 


be 


The Chelsea Pensioner . 

R . Sulphuris Loti, 

Potassii Bitart. , 

Pulv. Rhei, 

Guaiaci Resinae, 

Mellis Despum. , 

Myristicam Pulv., .... 


Ijj- 

%. 

j. 


Sig. — A piece the size 
taken thrice daily. 


M. Fiat electuarium. 
Sig. — A dessertspoonful twice 
a laxative in chronic rheumatism 


daily, as 



Confectio Damocratis. 
[An ingredient of Warburg's Tincture.] 
This preparation was official in the London Pharmacopoeia of 1745. It contained I 
grain of Opium in ^ss, and consisted of 45 ingredients, as follows, viz.: Cinnamon, 14 
parts; Myrrh, 11 parts; — White Agaric, Spikenard, Ginger, Spanish Saffron, Treacle, 
Mustard Seed, Frankincense and Chian Turpentine, of each 10 parts ; — Camel's Hay, 
Costus Arabacus, Zedoary, Indian leaf, Mace, French Lavender, Long Pepper, Seeds 
of Harwort, Juice of ripe Cistus, strained Storax, Opponex, strained Galbanum, Balsam 
of Gilead, Oil of Nutmeg, Russian Castor, of each 8 parts ; — Water Germunder, Balsam- 
tree Fruit, Cubeb, White Pepper, Seeds of Cretian Carrot, Poley Mont, strained Bdellium, 
of each 7 parts ; — Gentian-root, Celtic Hard, Leaves of Dittany of Crete, Red Rose, 
Seeds of Macedonium, Parsley, Sweet Fennel Seeds, Seeds of Lesser Cardamom, Gum 
Arabic, Opium, of each 5 parts ; — Sweet Flag, Wild Valerian, Anise-seed, Sagapenum, 
of each 3 parts ;— Spigrul, St. John's Wort, Juice of Acacia, Catechu, Dried Bellies of 
Skunk, of each 2^ parts ; — the roots finely powdered and the whole mixed thoroughly 
into a paste with Clarified Honey. 

Decocta, Decoctions, — are made by boiling vegetable substances with 
water. As very few drugs contain active ingredients which are not in- 



PHARMACEUTICAL PREPARATIONS. 569 

jured by heat, these preparations have never obtained favor with scientific 
physicians. There are only 2 official Decoctions, viz.: — 

Decoctum Cetrariae. Decoctum Sarsaparillae Compositum. 

The official general formula for Decoctions prescribes that when the strength is not 
directed by the physician, nor specified by the Pharmacopoeia, they shall be prepared in 
the proportion of 5 grammes of the substance with 100 cc. of water; but that the strength 
of decoctions of energetic or powerful substances should be specially prescribed by the 
physician. Decoctum Cetrarias has the aforesaid official strength, while Decoctum Sar- 
saparillae Compositum has the strength of 10 per cent, as regards its principal ingredient. 

Elixiria, Elixirs, — are sweetened, aromatic and spirituous prepara- 
tions, containing active medicinal substances in small quantities. There 
are but 2 official Elixirs, viz.: — 

Elixir Aromaticum. Elixir Phosphori. 

The first-named is intended to represent a type of the large class of 
unofficial elixirs employed in manufacturing and extemporaneous phar- 
macy. It is practically an alcoholized syrup, flavored with Orange, and 
is designed for use as an excipient for extracts, tinctures, salts, etc. The 
Elixir of Phosphorus has about % milligramme of Phosphorus to each cubic 
centimeter. The manufacturers have put on the market a great variety 
of elixirs, and most druggists keep a stock of them on hand prepared in the 
shop ; but they may be ordered by prescription just as any other mixture 
would be. The substances generally used in this form are as follows : — 

Arsenic. Guarana. 

Bismuth. Iron, Tincture of the Chloride. 

Ammonium Bromide. Iron, Phosphate. 

Lithium Bromide. Iron, Pyrophosphate. 

Potassium Bromide. Liquorice. 

Calisaya Bark. Pepsin. 

Chloral Hydrate. - Quinine. 

Coca. Strychnine. 

Gentian. Taraxacum. 
Ammonium Valerianate. 

Many of these agents may be combined with one another, as in the Elixir of Bismuth 
and Strychnine ; Elixir of Calisaya, Iron and Strychnine ; Elixir of Gentian with Tincture 
of Chloride of Iron ; Elixir of Iron, Quinine and Strychnine, etc., etc. 

Emplastra, Plasters, — are solid compounds, insoluble in water, of a 
tenacious but pliable consistence and intended for external application to 
limited areas of the body surface. They are prepared by incorporating 
medicinal substances with certain bases, which are usually Lead Plaster 
(Oleate of Lead), a Gum-resin, or Burgundy Pitch. The heat employed 
should be low so as to avoid decomposing the active agents, and should 
not be continued long enough to drive off any volatile constituents. The 
plaster mass is then spread evenly on chamois skin, kid skin or muslin. 



570 PHARMACEUTICAL PREPARATIONS. 

The constituents of the following named 13 official Plasters maybe found 
in the section on Materia Medica, under their appropriate headings. 

Emp. Ammoniaci cum Hydrargyro. Emplastrum Ichthyocollse. 

Emplastrum Arnicae. Emplastrum Opii. 

Emplastrum Belladonnse. Emp. Picis Burgundicae. 

Emplastrum Capsici. Emp. Picis Cantharidatum. 

Emplastrum Ferri Emplastrum Plumbi. 

Emplastrum Hydrargyri. Emplastrum Resinse. 

Emplastrum Saponis. 

Of the foregoing only two are directed to be spread, viz. — Emp. Capsici upon muslin, 
and Emp. Ichthyocollae upon taffeta, the others having no pharmacopceial prescription for 
the material to be used. Plasters after being spread should remain soft, pliable and ad- 
hesive, without melting at. the heat of the body. To soften the surface, if old, it should 
be brushed with a small quantity of Tincture of Camphor. 

Plasters are rarely prepared extemporaneously, the official and many 
others being produced on a large scale by the manufacturers, and are 
kept in stock by all druggists. As a consequence the compounding and 
spreading of a plaster by the pharmaceutist has become a lost art. The 
official plasters may be ordered by prescription in the manner illustrated 
below. Blisters may be produced by the application of any preparation 
of Cantharides sufficiently strong for the purpose. The official Cerate of 
Cantharides may be spread on Adhesive Plaster (Emplastrum Resin ae), 
making a blistering plaster, or Cantharidal Collodion may be painted 
over the surface. Plasters are usually ordered by the square inch, but a 
diagram of the shape and size may be drawn on paper, and the plaster 
be directed to conform thereto, as in the first following prescription. 



Emplastrum Vesicatorium. Counter-irritant and Anodyne 

R . Cerati Cantharidis, q. s. R . Chart ae Sinapis 

Extende supra Emplastrum Resinae hujus 
formae et magnitudinis. 

Sig. — Blistering Plaster, to be applied 
over the region of the heart. 



Emplas. Belladonnae, aa 3" x 6 // . 
Sig. — Apply the mustard paper first, to 
be followed by the plaster when the surface 
has been well reddened. 



Emulsa, Emulsions, — are aqueous, liquid preparations containing an 
insoluble medicinal substance (as an oil or a resin) in a state of minute 
subdivision and suspended by the aid of some viscid excipient, as gum, 
which may be contained in the medicinal ingredient itself (Ammoniac, 
Asafoetida), or may be added by the pharmaceutist. The official Emul- 
sions are 4 in number, all of which were classed as Mixtures in the phar- 
macopoeia of 1880, viz. — 

Emulsum Ammoniaci. Emulsum Asafcetidae. 

Emulsum Amygdalae. Emulsum Chloroformi. 

Natural Emulsions comprise two classes of substances, — (1) those emul- 
sions which exist ready formed in nature, as milk, yolk of egg, the milky 



PHARMACEUTICAL PREPARATIONS. 571 

juices of plants, etc., and (2) the mixtures formed by rubbing up gum- 
resins (as Ammoniacum, Myrrh, Asafcetida) with water. Each of these 
substances contains, together with its resin, enough gum to make a per- 
fect emulsion when triturated with water. The manufactured emulsions 
are simply imitations of the natural ones, sufficient gum being added in 
case of a resinous substance to cause its suspension in the aqueous diluent. 

Emulsification consists in the division of the oily or resinous substance 
into very minute globules, and the surrounding of each globule with a 
thin envelope of the excipient. If properly done the globules will remain 
mechanically suspended in the water, without any tendency towards re- 
combination. Milk is the best illustration of a natural emulsion, its butter 
existing in the aqueous portion as very minute globules, each surrounded 
by a thin film of casein. Yolk of Egg is a dense emulsion, consisting 
of oil suspended in water by means of albumin. 

The Excipients which may be used for emulsification are the following, 
arranged in the order of their most frequent employment, viz. — 

Mucilage of Acacia, — used for oils and resins. Powdered Acacia is even better, 
being made into a mucilage by the process of emulsification ; such a mucilage having the 
advantage of being perfectly fresh when incorporated with the other ingredients. To 
give good results the following proportions in parts by weight should be used, — 

Gum Acacia. Water. 

I part of Fixed Oil or Copaiba requires, ^ }( 

I " " Balsam of Peru " 2 1^ 

I " " Oil of Turpentine " I I 

Mucilage of Tragacanth, — may also be used for oils and resins, but it has not 
proved so satisfactory as the preceding. The same may be said of powdered Tragacanth. 

Vitellus, Yolk of Egg, — is an excellent agent for emulsifying oils, but mixtures 
made with it must be used within a few days, as they will not keep long. One yolk will 
emulsionize an ounce of fixed oil, and is about equal to half an ounce of Acacia. It is 
best suited to emulsions of cod-liver oil intended for immediate administration. The 
official Emulsum Chloroformi is an emulsion made with yolk of egg. Glyceritum Vitelli 
or Glyconin is an official preparation consisting of glycerin and yolk of egg. One ounce 
of it will emulsify three ounces of fixed oil. 

Liquor Potassae, — may be used for oils, the resulting compound being however a 
soap rather than an emulsion. Copaiba is usually emulsified by using both a gum and an 
alkali ; a similar process being employed for many of the fixed oils. 

Tincture of Senega, — will emulsify fats and oils very efficiently, even in very small 
quantities, TT\,x emulsifying an ounce of fixed oil. 

Tincture of Quillaja (Soap-bark), — is a good emulsifier of oils, and is much used 
in Europe for this purpose. 

Milk, — is used to emulsify Scammony in the Mistura Scammonii, which is official in 
the British Pharmacopoeia. 

Syrups, Confections and Extracts, — may be used in making emulsions, but are 
rarely so employed. 

Soap, — is occasionally used for emulsifying Oil of Turpentine. 

The method of preparing an emulsion which experience has shown to 
be the best is as follows : — Add the oil, resin, etc., to a proper quantity 



572 



PHARMACEUTICAL PREPARATIONS. 



of the excipient and mix both thoroughly in a mortar. Then add 
enough water to equal one-half the weight of the previous mixture, and 
triturate the whole rapidly and unceasingly until the emulsion is homo- 
geneous and of a whitish color. Next, add the remainder of the water 
slowly, with continual stirring; finally incorporating the other ingredients, 
if any. 

Emulsions are sometimes flavored and at the same time colored with 
such a preparation as the Compound Tincture of Cardamom, but they 
present a better appearance when perfectly white. Alcoholic preparations 
should not be added in large quantity to emulsions made with Acacia or 
Yolk of Egg, as alcohol will precipitate the emulsifying agent. Volatile 
Oils require admixture with a fixed oil before being made into an emul- 
sion. Soluble salts should never be prescribed with emulsions of oils. 
Acids are incompatible with mixtures which have been emulsified by an 
alkali. Mucilage used for emulsions should always be freshly prepared. 

The following examples of prescriptions for emulsions will represent 
those generally met with : — 



Cod- Liver Oil Emulsion. 

R • Olei Morrhuae, 

Vini Albi, 

Acidi Phosphorici Dil., . . 

Syrupi, 

Vitellum, 

Aq. Amygd. Amar , q. s. ad ^ viij 
Misce, et fiat emulsum. 

Sig. — Tablespoonful doses. 



3U- 

5 i ss - 

k»j. 

J- 



Alkaline Eviulsion of Copaiba. 
R . Copaibae, 

Liq. Potassae, aa^ij. 

Misce, et adde — 
Pulv. Acaciae, 

Pulv. Sacchari, aagij. 

Aq. Menth. Viridis, q. s. 

ad ^iv. 

Misce, et fiat emulsum. 

Sig. — Tablespoonful doses. 



Extracta, Extracts, — are solid or semi-solid preparations obtained by 
evaporating solutions of vegetable principles. The drug is first powdered, 
then percolated with the appropriate menstruum to exhaustion. The first 
third of the percolate is reserved, the remainder is evaporated at a tem- 
perature not above 122 F., until its weight is ten per cent, of that of the 
drug used, then mixed with the reserved portion, and both are evaporated 
to a pilular consistence. The above is the general rule, but in several 
instances maceration is directed for 1 to 4 days before percolation ; and 
in other cases, instead of reserving a portion of the percolate, the whole 
quantity is distilled until the alcohol is removed and the residue is evapo- 
rated to a pilular consistence. The menstrua used are, — in 6 cases Alco- 
hol, in 13 cases Diluted Alcohol of varying strength, in 7 Water, in 1 
Water with Aqua Ammonise, in 1 a diluted Acetic Acid, and in 2 Acetic 
Acid and Diluted Alcohol. One extract is an inspissated juice (Ext. 
Taraxaci) ; one is made by evaporating a fluid extract (Ext. Ergotse), one 
by mixing an extract with other ingredients (Ext. Colocynthidis Comp.), 
and one (Ext. Glycyrrhizae) is an ordinary commercial product. 



PHARMACEUTICAL PREPARATIONS. 



573 



The official Extracts number 33, and are named as follows, the letters 
in parentheses indicating the ingredients of the menstruum used in ex- 
traction in each case, viz. — 



Extractum Aconiti (A). 

Ext. Aloes (W). 

Ext. Arnicae Radicis (DA). 

Ext. Belladonnse Foliorum Alcohol- 

icum (A 2 W 1 ). 
Ext. Cannabis Indicae (A). 
Ext. Cimicifugae (A). 
Ext. Cinchonae (A3WJ. 
Ext. Colchici Radicis (WAc). 
Ext. Colocynthidis (DA). 
Ext. Colocynthidis Compositum. 
Ext. Conii (DA,Ac). 
Ext. Digitalis (A 2 W X ). 
Ext. Ergotae (DA,Ac). 
Ext. Euonymi (AjW^. 
Ext. Gentianae (W). 
Ext. Glycyrrhizae. 



Ext. Glycyrrhizae Purum (W). 
Ext. Haematoxyli (W). 
Ext. Hyoscyami (A 2 W 1 ). 
Ext. Iridis (A). 
Ext. Jalapae (A). 
Ext. Juglandis (DA). 
Ext. Krameriae (W). 
Ext. Leptandrae (A 3 W 1 ). 
Ext. Nucis Vomicae (AgWj). 
Ext. Opii (W). 



Ext. 
Ext. 



Physostigmatis (A). 
Podophylli (A 4 Wj). 



Ext. Quassiae (W). 

Ext. Rhei (A 4 W X ). 

Ext. Stramonii Seminis (DA). 

Ext. Taraxaci (W). 

Ext. Uvse Ursi (A 3 W 5 ). 



The Proximate Principles generally present in extracts, besides the 
peculiar principles of plants, are Sugar, Tannin, Extractive, Chlorophyll, 
Coloring-matter and Salts. When an alcoholic solvent is used there are 
also present Resins, Fats and often a Volatile Oil, and when the men- 
struum is not purely alcoholic there is more or less of gum and starch. One 
of these ingredients, named Extractive or Apotheme, is a deposit, soluble 
in water and alcohol, which has the singular property of passing into an 
insoluble substance under the influence of the atmospheric air with heat. 
It also has a tendency, when precipitated from solutions, to unite with 
other principles carrying them down with it. It is frequently present in 
extracts, hence its name. 

Extracta Fluida, Fluid Extracts, — are permanent and concentrated 
solutions of vegetable drugs, of uniformly definite strength if the crude 
drugs are so, a cubic centimeter {y\ 16.23) in each case representing the 
medicinal powers of one gramme (gr. 15.43) of the drug, or approxi- 
mately a minim of the finished preparation representing the active con- 
stituents of a grain of the drug. They are officially directed to be pre- 
pared by .percolation and partial evaporation, the menstrua employed 
being usually Alcohol, diluted Alcohol, or Alcohol and Water in various 
proportions, though a- few are percolated with water, the alcohol being 
afterward added. In several instances Glycerin in different proportions 
is added to the first menstruum ; and in the menstrua used for the fluid 
extracts of Conium, Ergot, Nux Vomica and Sanguinaria, Acetic Acid is 
an ingredient. In the preparation of the fluid extract of Prunus Virgin- 
iana, the extraction is preceded by maceration with water and glycerin, 
in order to permit of the formation of Hydrocyanic Acid by the reaction 



574 



PHARMACEUTICAL PREPARATIONS. 



of the amygdalin and emulsin of the bark upon each other, which takes 
place only in the presence of water. The glycerin aids to keep the dis- 
solved matters in perfect solution, and also to better retain the acid and 
volatile oil formed during the process. The fluid extract of Glycyrrhiza 
is prepared by maceration for 48 hours in a menstruum containing Am- 
monia-water, then by percolation, using a mixture of alcohol and water. 
The menstruum directed to be used in each case is intended to be that 
which will thoroughly extract all the active constituents of the drug and 
at the same time leave the inert soluble matters behind in the rejected 
portion, known as the marc. In manufacturing fluid extracts on a large 
scale modifications of the official processes are necessary, the methods 
used being generally percolation and maceration with hydraulic pressure, 
vacuum maceration followed by percolation, percolation with incomplete 
exhaustion, or repercolation. 

The official Fluid Extracts number 88, and are named in the following 
list; the letters and figures following in parentheses showing the ingre- 
dients of their respective menstrua, by the initials of Alcohol, Diluted 
Alcohol, Water, Glycerin and Ammonia-water. The interrogation sign 
(?) signifies that the several proportions cannot be represented by figures. 



Extractum Aconiti Fl. (A 3 W,). Ext. 

Ext. Apocyni Fl. (A 65 W 25 G 10 ). Ext. 

Ext. Arnicae Radicis Fl. (A 3 W\). Ext. 

Ext. Aromaticum Fluidum (A). Ext. 

Ext. Asclepiadis Fluidum (DA). Ext. 
Ext. Aspidospermatis Fl. (AgWgGj). Ext. 

Ext. Aurantii Amari Fl. (A 2 W X ). Ext. 
Ext. Belladonnae Radicis Fl. (A 4 Wj). Ext. 

Ext. Buchu Fluidum (A). Ext. 

Ext. Calami Fluidum (A). Ext. 

Ext. Calumbae Fluidum (A 3 W X ). Ext. 

Ext. Cannabis Indicae Fl. (A). Ext. 

Ext. Capsici Fl. (A). Ext. 

Ext. Castaneae Fl. (A 4 W 5 G X ). Ext. 

Ext. Chimaphilae Fl. (DA). Ext. 

Ext. Chiratae Fl. (AjW^. Ext. 

Ext. Cimicifugae Fl. (A). Ext. 

Ext. Cinchonae Fl. (AWG?). Ext. 

Ext. Cocae Fluidum (DA). Ext. 

Ext. Colchici Radicis Fl. (A 2 W,). Ext. 

Ext. Colchici Seminis Fl. (A.^). Ext. 

Ext. Conii Fl. (DA). Ext. 

Ext. Convallariae Fl. (DA). Ext. 

Ext. Cubebae Fluidum (A). Ext. 

Ext. Cusso Fluidum (A). Ext. 

Ext. Cypripedii Fluidum (DA). Ext. 

Ext. Digitalis Fluidum (A./^). Ext. 

Ext. Dulcamara; Fluidum (DA). Ext. 

Ext. Ergotae Fluidum (DA). Ext. 

Ext. Eriodictyi Fluidum (A 4 W X ). Ext. 

Ext. Eucalypti Fluidum (A 3 W 1 ). Ext. 

Ext. Eupatorii Fluidum (DA). Ext. 

Ext. Franguloe Fluidum (A 5 W 8 ). Ext. 



Gelsemii Fluidum (A). 
Gentianae Fluidum (DA). 
Geranii Fluidum (DA 9 Gj). 
Glycyrrhizae Fl. (A 30 W 65 Am 5 ). 
Gossypii Radicis Fl. (A 3 Gj). 
Grindeliae Fluidum (A). 
Guaranae Fluidum (A 3 Wj). 
Hamamelidis Fl. (AgWgGj). 
Hydrastis Fluidum (A 6 W 3 G X ). 
Hyoscyami Fluidum (AjW^. 
Ipecacuanhas Fluidum (AgWj). 
Tridis Fluidum (A). 
Kramerise Fluidum (DA 9 G X ). 
Lappae Fluidum (DA). 
Leptandrae Fluidum (AgWj). 
Lobeliae Fluidum (DA). 
Lupulini Fluidum (A). 
Matico Fluidum (AgW^. 
Menispermi Fluidum (A^Wj). 
Mezerei Fluidum (A). 
Nucis Vomicae Fluidum (AgWJ. 
Pareirae Fluidum (AWG?). 
Phytolacca Radicis Fl. (A 2 W X ). 
Pilocarpi Fluidum (DA). 
Podophylli Fluidum (A 4 W a ). 
Pruni Virginianae Fl. (AWG?). 
Quassiae Fluidum (A X W 2 ). 
Rhamni Purshianae Fluidum (DA). 
Rhei Fluidum (A 4 W X ). 
Rhois Glabrae Fluidum (DA^). 
Rosae Fluidum (DAgGj). 
Rubi Fluidum (A^Y^). 
Rumicis Fluidum (DA). 



PHARMACEUTICAL PREPARATIONS. 575 

Ext. Sabinse Fluidum (A). Ext. Stillingiae Fluidum (DA). 

Ext. Sanguinariae Fluidum (A 3 Wj). Ext. Stramonii Seminis Fl. (A 3 W 1 ). 

Ext. Sarsaparillae Fluidum (A^wJ). Ext. Taraxaci Fluidum (DA). 

Ext. Sarsaparillre Fl. Co. (AgWpGJ. Ext. Tritici Fluidum (A^). 

Ext. Scillse Fluidum (A 3 W X ). Ext. Uvae Ursi Fluidum (A 2 W 5 G 3 ). 

Ext. Scoparii Fluidum (DA). Ext. Valerianae Fluidum (A 3 Wj). 

Ext. Scutellariae Fluidum (DA). Ext. Veratri Viridis Fluidum (A). 

Ext. Senegae Fluidum (A 75 W 20 Am 5 ). Ext. Viburni Opuli Fluidum (AgWj). 

Ext. Sennse Fluidum (DA). " Ext. Viburni Prunifolii Fl. (AgW^. 

Ext. Serpentariae Fluidum (A 4 Wj). Ext. Xanthoxyli Fluidum (A). 

Ext. Spigeliae Fluidum (DA). Ext. Zingiberis Fluidum (A). 

In 14 instances only does the Pharmacopoeia direct the making of 
other preparations from corresponding fluid extracts, these being the 
Syrups of Ipecac, Krameria, Rhubarb, Rose, Rubus, Senega and Ginger, 
the Compound Syrups of Sarsaparilla and Squill, the Tincture of Ipecac 
and Opium, the Wine of Ipecac, the Extract of Ergot, the Liniment of 
Belladonna and the Mixture of Rhubarb and Soda. Notwithstanding 
this fact it is a common practice for dispensing pharmaceutists to make 
tinctures, syrups, infusions, etc., from fluid extracts; and some manufac- 
turers put labels on the bottles containing their fluid extracts, giving the 
formulae for so preparing other preparations. This practice is illegitimate 
and tends still further to degrade the profession of pharmacy into a mere 
trade, so far as dispensing is concerned. 

A large number of unofficial fluid extracts are manufactured and for sale, one firm 
alone carrying over 400 such on its catalogue. Normal Liquids are a class of superior 
fluid extracts introduced by Parke, Davis & Co., which are claimed to be adjusted to a 
maximum strength by accurate assays for alkaloidal strength made at each stage of their 
manipulation, irrespective of the amount of material requited, which in the case of official 
fluid extracts is prescribed by the Pharmacopoeia, regardless of the varying quality of drugs 
in the market. This firm prepares Normal Liquids of Aconite, Veratrum Viride, Bella- 
donna (root or leaves), Cannabis Indica, Cinchona, Calisaya, Cinchona Rubra, Colchicum 
(root or seed), Conium, Ergot, Digitalis, Gelsemium, Hyoscyamus, Ipecacuanha, Podo- 
phyllum, Nux Vomica, Rhubarb, and Stramonium (seed or leaves). Of these prepara- 
tions one cubic centimeter is equivalent to one gramme of the corresponding drug of 
standard alkaloidal strength. A fluid extract of Belladonna leaves may contain 0.25 or 
0.45 per cent, of Atropine, according to the quality of the drug employed ; a Normal 
Liquid will contain invariably 0.4 per cent, of the alkaloid, so that in a given dose it may 
be relied upon to produce a certain effect. 



Gargarisma, A Gargle (Unofficial), — is a mixture or solution for 
application to the pharynx or to the mouth (mouth-wash). It should not 
contain any very active drug, which would produce dangerous symptoms 
if swallowed, or any agent which would injure the teeth or the mucous 
membrane. Gargles are ordered and compounded in the same manner 
as mixtures. They usually contain astringent or disinfecting salts (Alum, 
Borax, Potassium Chlorate, Zinc Sulphate), with a vegetable astringent 
and often honey. The following formulae will illustrate prescriptions of 
this class : — 



5?6 PHARMACEUTICAL PREPARATIONS. 



R . Tr. Guaiaci Ammoniatae, 

Tr. Cinchonse Comp., aa^ss. 

Mellis Despumat. ,. . . ^jss. 
Bene simul agita, et adde — 

Potassii Chloratis, . . . ^ijss. 

Aquae, q. s., ad . . . . ^viij. 
Fiat gargarisma. Sig. — Gargle. 



1£ . Aluminis, £ij. 

Granati Corticis, . . . 3 iv 

Petal. Rosae Rubr. , . . zj. 

Mellis Despumat., . . Jj. 

Aquae Bullientis, . . . 5jvj 
M. Sig. — Gargle. 



( Goddard. 



Glycerita, Glycerites, — are mixtures of medicinal substances with 
Glycerin, in which some of them are dissolved. They are very useful 
preparations for dispensing purposes, as they can be readily diluted with 
water or alcohol without precipitation. There are 6 official Glycerites, 
the figures following their names in the list below indicating the percent- 
age of drug in each. The Glycerite of Starch contains 10 per cent, of 
water, and that of Hydrastis has for its menstruum a mixture of glycerin, 
alcohol and water. 

Glyceritum Acidi Carbolici, 20. Glyceritum Boroglycerini, 31. 

Glyceritum Acidi Tannici, 20. Glyceritum Hydrastis, 100. 

Glyceritum Amyli, 10. Glyceritum Vitelli, 45. 

Haustus, A Draught (Unofficial), — is an extemporaneous mixture 
consisting of a single dose, and usually ordered in a vial containing from 
one to two fluidounces. 

Effervescing Draught is one of the best known. It is prepared by neutralizing a 
watery solution of Potassium Bicarbonate with Lemon-juice or Citric Acid, and may be 
drank during effervescence. When the C0 2 has escaped it is a solution of Potassium 
Citrate in water, and corresponds to the official Liquor Potassii Citratis. 

Black Draught is another well-known preparation of this class. It is official as 
Infusum Sennae Compositum. 

Infusa, Infusions, — are prepared by treating vegetable substances with 
hot or cold water without boiling. Cold water is preferred when the 
drug contains a desirable volatile principle, or when its active ingredient 
is injured by heat. The drug should be coarsely comminuted, sliced or 
bruised, and treated by maceration or percolation with the proper quan- 
tity of water, which in the absence of specific directions to the contrary 
should be 5 parts by weight of the drug to 100 of water, or 5 grammes in 
100 cc. Infusions should be freshly made as required for they are very 
prone to decomposition. Those official number 4 and are named in the 
following list, the figure after each representing the percentage of drug 
to menstruum, viz. — 

Infusum Cinchonae, 6. Infusum Pruni Virginianae, 4. 

Infusum Digitalis, 1^. Infusum Sennae Compositum, 6. 

The last-named infusion contains also 12 per cent, each of Manna and Magnesium 
Sulphate and 2 of Fennel. The infusion of Cinchona has of Aromatic Sulphuric Acid 
I per cent. Alcohol, in the proportion of 10 per cent, is an ingredient of the Infusion 
of Digitalis to prevent decomposition. 



PHARMACEUTICAL PREPARATIONS. 



577 



Many dispensing pharmaceutists are in the habit of making infusions 
from concentrated alcoholic tinctures or from fluid extracts. It is a very 
reprehensible practice, especially in those cases where the active ingre- 
dients are of a resinous nature and therefore precipitate when the alco- 
holic solution is added to water. 

Inhalationes, Inhalations, and Vapores, Vapors (both Unofficial), 
are medicines in the form of a vapor, a gas or an atomized spray, to be 
inhaled by the patient for their local action on the respiratory tract. 
The well-known steam atomizer is the agent by which most of these 
preparations are administered, though many substances may be inhaled 
from the surface of hot water, from a sponge in a bottle surrounded by a 
hot cloth, or from a heated shovel. They are prescribed in the usual 
manner, as follows : — 



Stimulant Inhalation. 



R. 



Olei Cubebae, gij. 

Magnesii Cabonat. , . . ^j. 

Aquse, 3HJ. 

M. Sig. — A teaspoonful in a pint of 
water at 150 F., for each inhalation. 

Oil of Pine. 

R. 01. Pini Sylvestris, . . g-ij. 
Magnesii Carb., .... gj. 

A qu«, I"j- 

M. Sig. — A teaspoonful on a pint of 
hot water for each inhalation. 



Carbolized Inhalation. 



R 



Acidi Carbolici TT^xlviij. 

Aquas, q. s. ad .... Sjij. 
M. Sig. — Use one-half in the cup of 
steam-atomizer for each inhalation. 



Tar and Turpentine. 



R 



01. Picis Liquidae, 

01. Terebinth., . . . aa^ij. 
M. Sig. — Pour slowly on a hot shovel 
in the sick-room, keeping the vapor con- 
fined therein. 



The official Charta Potassii Nitratis (Nitre-paper), is a preparation intended for use as 
an inhalation, its vapors while burning being taken into the lungs. 



Injectiones, Injections (Unofficial), — are liquid preparations in- 
tended for introduction into the cavities of the body by means of a 
syringe. When thrown into the rectum they are termed Enemata (Ene- 
mas or Clysters), and are usually prepared at the bedside. Enemata 
may be demulcent, laxative, nutritive, stimulant or vermifuge in charac- 
ter; and always have warm or tepid water as their diluent, with which 
are incorporated such medicaments as may be desired. They may con- 
sist simply of water to act as a wash for the cleansing of the bowel. In- 
jections are termed vaginal, urethral, vesical, nasal, hypodermic, etc., 
according to the locality in which they are employed. A special form 
of syringe is employed in each case, the discussion of which belongs rather 
to the domain of surgery than to that of medicine. Those used for the 
nasal cavities are often arranged with small holes or an atomizing attach- 
ment, so as to deliver the injection in the form of a fine spray. A Col- 
lunarium is a nasal douche or wash. In the Appendix will be found a 
37 



578 



PHARMACEUTICAL PREPARATIONS. 



list of formulae for hypodermic injections 
forms are appended below. 



a few prescriptions for other 



Enema for Stricture of the Rectum. 
R. Bismuthi Subcarb., . . £j. 

Extracti Opii, gr. ij . 

Glycerini, Aquae, . . aa^ij. 
M. Fiat enema. Sig. — Two table- 
spoonfuls to be injected thrice weekly. 



Demulcent Enema. 



Tincturae Opii, 
Decocti Amyli, 
M. Fiat enema. 



n\xx: 

giv-vj. 



K 



Vermifuge Enema. 
Extr. Quassias Fl., . . 3Jss. 

Aquae, ^ ijss. 

M. Sig. — A tablespoonful with an equal 
quantity of warm water, as an enema, to 
be retained as long as possible. 



Nasal Injection (Dooell's). 
R . Acidi Carbolici, .... gjss. 
Sodii Bicarb., 
Sodii Boratis, . . . aagiv. 

Glycerini, pjxivss. 

Aquae q. s. ad .... ^viij. 
M. Sig. — A tablespoonful diluted with 
an equal quantity of tepid water to be used 
thrice daily with a nasal sprayer. 



Injection for Gonorrhea 
(Injection Brou.) 
R . Zinci Sulphatis, . . 
Plumbi Acetatis, 
Tincturae Opii, . . 
Tinct. Catechu, . . 
Aquae Rosae, q. s. ad 
M. Fiat injectio. Si£ 
urethral syringe. 



gr. viij. 
gr. xv. 

Use with 



Injection for Chronic Urethritis. 
R . Hydrarg. Chi. Corrosivi, gr. j£. 
Zinci Chloridi, . . . . gr. ss. 
Aquae Destillatae, . . . ^ viij. 
M. Sig. — A tablespoonful to be injected 
well down into the urethra thrice daily, 
through a gum catheter. 



Vaginal Injections for Leucorrhea. 

R . Aluminis, 55 j. 

Zinci Sulphatis, . . . . gss. 

Sodii Boratis, gr. iv. 

M. Sig. — Dissolve in half-a-pint of 
warm water, and use with a vaginal sy- 
ringe. 
fjt. Acidi Tannici, .... ^j. 

Glycerini, S^ Y - 

M. Sig. — One-half with an equal 
quantity of water to be injected twice 
daily. 



Linimenta, Liniments. — are very thin ointments for external applica- 
tion, intended to be applied with friction to the skin. They are solutions 
of various substances in oily liquids or in alcoholic liquids containing 
fatty oils. Of the following 9 official Liniments 2 have as their basis 
Cotton-seed Oil, 1 Linseed Oil, 1 Oil of Turpentine, 1 Alcohol, and 
3 Alcohol and Water. 



Linimentum Ammoniae. 
Linimentum Belladonnas. 
Linimentum Calcis. 
Linimentum Camphorae. 



Linimentum Chloroformi. 
Linimentum Saponis. 
Linimentum Saponis Mollis. 
Linimentum Sinapis Compositum. 



Linimentum Terebinthinae. 

Besides the above, (except Lin. Saponis Mollis), the Br. Phar. contains Lin. Aconiti, 
Lin. Camphorae Comp., Lin. Crotonis, Lin. Hydrargyri, Lin. Iodi, Lin. Opii, Lin. 
Potassii Iodidi cum Sapone, and Lin. Terebinthinae Aceticum. 

Extemporaneous Liniments may correspond to the official ones or they 
may be simple mixtures of fluids without either fat or soap. A prescrip- 
tion for each kind is appended. The official Linimentum Saponis (Soap 
Liniment) is a good basis for extemporaneous preparations of this class. 



PHARMACEUTICAL PREPARATIONS. 



5/9 



Compound Chloroform Liniment. 

R. Ext. Belladon. Rad. FL, . ^ss. 
Ext. Aconiti FL, 
Chloroforrni Venalis, . . aagij. 
Spiritus Camphorae, . . . ^j. 
Alcoholis Diluti, q. s. ad . ^viij. 
M. Fiat linimentum. 
Sig. — Poison. To be rubbed on the 
painful part. 



Anodyne Liniment. 



R. Tinct. Aconiti, ^ij. 



M 



Tinct. Opii, 
Tinct. Arnicas, . . 
Chloroforrni, . . . 
Linim. Saponis, q. s. 
Fiat linimentum . 



3 iv. 



Sig. — Poison. Liniment. 



Stokes' Liniment, 

R . Olei Terebinthinas, 
Acidi Acetici, 
Olei Limonis, . , 
Vitellum, .... 
Aquae Rosas, . . . 

M. Fiat linimentum. 

Sig. — Liniment. 



!§ss. 



Siij- 



R 



Army Medical Wagon Liniment. 

. Liq. Ammonias, 

01. Terebinthinae, 

01. Olivae, 

aa, partes aequales. 
M. Fiat linimentum. 
Sig. — Liniment. 



An Embrocation is a similar preparation, but of thinner consistence, 
almost obsolete. 



The term is 



Liquores, Solutions, — comprise all aqueous solutions of non-volatile 
substances, except the syrups, infusions and decoctions, which naturally 
form distinctive classes. There are 24 official solutions, 7 of which are 
simple aqueous solutions of the medicament, the rest being chemical 
aqueous solutions, in which the dissolved substances are altered by 
chemical action and new ones formed. They are named as follows, — 



Liquor Acidi Arsenosi. 


Liquor Iodi Compositus. 


Liquor Ammonii Acetatis. 


Liquor Magnesii Citratis. 


Liquor Arseni et Ffydrargyri Iodidi. 


Liquor Plumbi Subacetatis. 


Liquor Calcis. 


Liquor Plumbi Subacetatis Dilutus 


Liquor Ferri Acetatis. 


Liquor Potassae. 


Liquor Ferri Chloridi. 


Liquor Potassii Arsenitis. 


Liquor Ferri Citratis. 


Liquor Potassii Citratis. 


Liquor Ferri et Ammonii Acetatis. 


Liquor Sodas. 


Liquor Ferri Nitratis. 


Liquor Sodas Chloratae. 


Liquor Ferri Subsulphatis. 


Liquor Sodii Arsenatis. 


Liquor Ferri Tersulphatis. 


Liquor Sodii Silicatis. 


Liquor Hydrargyri Nitratis. 


Liquor Zinci Chloridi. 



Lotio, A Lotion or Wash (Unofficial), — is a solution or mixture of 
medicinal agents, intended for external application ; usually consisting 
of some soluble, astringent salt, dissolved in water, with perhaps some 
glycerin or alcohol. A Fomentation {Fotus) is a similar preparation 
used hot. A Colly?'ium is an eye-wash, and generally contains a soluble 
astringent salt dissolved in rose-water or distilled water, in the proportion 
of gr. j-iv to the 3. The only official preparation suitable for a lotion is 
the Liquor Plumbi Subacetatis Dilutus (Lead-water). A well-known 
anodyne, refrigerant and astringent lotion is that represented by the 
upper two of the following prescriptions. 



580 



PHARMACEUTICAL PREPARATIONS. 



Lead-water and Laudanum. 

. Liq. Plumbi Subacetatis, . ^j. 

Tinct. Opii, ...... ,^j. 

Aquae, q. s. ad . . . . ^viij. 

M. Fiat lotio. Sig. — Lotion. 

( Gross. ) 



3iJ 



Collyrium. 

R . Sodii Boratis, . . . 

Aquae Camphorae, . . 

Mucil. Cydonii, 

Aquae Destil., . . . aa ^ ss. 
M. Fiat collyrium. Sig. — Eye-water; 
a few drops to be put into the eye three or 
four times daily. 



Lead and Opium Wash. 
R . Liq. Plumbi Subacetatis, 

Tinct. Opii, . . . . aa |; j. 

Aquae, q. s. ad ^ v iij- 

M. Fiat lotio. Sig. — Lotion. 

{Slurgis.) 

Collyrium of Four Sulphates. 
r£ . Zinci Sulphatis, 
Ferri Sulphatis, 
Cupri Sulphatis, 

Aluminis, aagr. j. 

Aquae Destillatae, .... ^j. 
M. Fiat collyrium. Sig. — For use with 
brush to palpebral conjunctivae, and to be 
washed off with clean water. 



Massse, Masses, — are Pill-masses prepared as described under the 
subtitle PilultE. The official Masses number 3, viz. — 



Massa Copaibae. 



Massa Ferri Carbonatis. 



Massa Hydrargyri. 



Mellita, Honeys, — differ from syrups merely in their being prepared 
with honey as a base. The Oxymel and Oxymel Scilloz of the B. P. are 
similar preparations, containing also Acetic Acid. There are 3 official 
Honeys, including two forms of honey itself, viz. — 



Mel. 



Mel Despumatum. 



Mel Rosas. 



Misturse, Mixtures, — in official pharmacy are aqueous preparations 
of insoluble substances held in suspension by a suitable vehicle. In ex- 
temporaneous pharmacy the term mixture has a wider signification, as 
explained below. Mixtures are generally prepared extemporaneously 
upon prescriptions, as few of them are of the stability necessary to insure 
their preservation beyond a few days. The official mixtures are 4 in 
number, and are named as follows, — 



Mistura Cretae. 

Mistura Ferri Composita. 



Mistura Glycyrrhizae Composita. 
Mistura Rhei et Sodae. 



In extemporaneous pharmacy the term Mixture is applied to every fluid 
compound intended for internal use, except a few which bear distinctive 
titles, such as Emulsions, Draughts, Enemas, Elixirs and Drinks. The 
simplest form of mixture in this extended sense is that in which two or 
more liquids are mixed together ; but a great variety of substances may 
be prescribed in this form, chief among which are most of the soluble 
salts, light insoluble powders, salts which may be diffused by agitation, 
extracts, gum-resins, and the fixed essential oils. They are generally 
ordered in 2, 3, 4, 6, 8, 10 and 12-ounce vials. 

Substances suitable to the mixture-form, properly so called, are those 
which, though more or less insoluble in water, will mix therewith by 



PHARMACEUTICAL PREPARATIONS. 



58i 



means of agitation, trituration, etc. 
as follows : — 

Diffused by Agitation : — 

Calcii Phosphas Prascipitatus. 
Cinchona (powdered). 
Ipecacuanha (powdered). 
Magnesia. 
Quininae Sulphas. 
Sulphur Prascipitatum. 

Suspended by Viscid Excipients : — 
Essential Oils. 
Oleum Amygdalae. 
Oleum Morrhuae. 
Oleum Olivae. 
Oleum Ricini. 
Copaiba. 
Ferri Carbonas Saccharatus. 



Those most frequently ordered are 



Miscible only by Trituration ; — 
Ammoniacum. 
Asafcetida. 
Confectio Rosas. 
Confectio Sennae. 
Extractum Aconiti. 
Ext. Belladonnas Fol. Alcohol. 
Ext. Conii. 
Ext. Hyoscyami. 
Ext. Stramonii. 
Ext. Glycyrrhizas. 
Ext. Kramerias. 
Ext. Taraxaci. 
Guaiacum. 
Scammonium. 
Myrrha. 

Best Suspended by the aid of a Fixed Oil or Yolk of Egg : — 

Ext. Cannabis Indicae. Oleum Terebinthinae. 

Camphora. Chloroformum. 

Solutions intended for internal administration are classed as Mixtures 
in extemporaneous pharmacy, for the reason already stated. The follow- 
ing list of acids and salts comprises most of the solids which are best 
adapted for use in liquid form, by reason of their solubility in water. 



Acidum Citricum. 
Acidum Tannicum. 
Acidum Tartaricum. 
Alumen. 

Ammonii Chloridum. 
Antim. et Potass. Tartras. 
Barii Chloridum. 
Calcii Chloridum. 
Calcii Hypophosphis. 
Ferri Pyro phosphas. 
Ferri Sulphas. 
Ferri et Ammonii Citras. 



Ferri et Potassii Tartras. 
Ferri et Quininas Citras. 
Magnesii Sulphas. 
Mangani Sulphas. 
Potassii Acetas. 
Potassii Bicarbonas. 
Potassii Bromidum. 
Potassii Carbonas. 
Potassii Citras. 
Potassii Chloras. 
Potassii Hypophosphis. 
Potassii Iodidum. 



Potassii Tartras. 
Potassii et Sodii Tartras. 
Morphinas Acetas. 
Morphinas Hydrochloras. 
Morphinas Sulphas. 
Sodii Bicarbonas. 
Sodii Boras. 
Sodii Carbonas. 
Sodii Chloridum. 
Sodii Hypophosphis. 
Sodii Phosphas. 
Sodii Sulphas. 



A few require the use of viscid substances as vehicles or correctives. 
They are as follows : — 



Ammonii Carbonas. 
Plumbi Acetas. 



Potassa. 

Potassii Cyanidum. 



Hydrargyri Chloridum Corrosivum. 

Certain salts are best ordered by prescribing such agents as will when 
in solution together react upon each other and produce the desired salt. 
Instances of this may be found in the pharmacopoeial processes for most 
of the official Liquores, some salts so produced being the following : — 



Ammonii Acetas. 
Magnesii Citras. 
Potassii Citras. 
Ferri Citras. 



Ferri Acetas. 
Ferri Chloridum. 
Ferri Nitras. 
Hydrargyri Nitras. 



Potassii Arsenis. 
Potassii Hydras. 
Sodii Hydras. 
Zinci Chloridum. 



582 PHARMACEUTICAL PREPARATIONS. 

Certain other substances require the addition of other agents in order 
to form eligible solutions. Such are the following : — 

Quininse Sulphas, — requires acidulated water for its solution, the acid used being 
generally Diluted Sulphuric, or the Aromatic Sulphuric. This method of prescribing 
the salt develops its bitter taste to the utmost, and is often avoided by ordering the drug 
to be suspended in a viscid liquid, such as Pulv. Acaciae in Syrup of Ginger. In such a 
case an officious dispenser anxious to show his smartness by adding some dilute Sul- 
phuric Acid to dissolve the Quinine would thereby defeat the object of the prescriber. 

Quinine Sulphate may be prescribed with Aromatic Spirit of Ammonia, Spirit of 
Nitrous Ether, Tinctures or other alcoholic preparations together with Glycerin or Syrup 
and Water. In such cases the salt should be first dissolved in the alcoholic portion of 
the prescription, then the glycerin or syrup and finally the aqueous portions should be 
added gradually. It may also be ordered with Diluted Sulphuric Acid and some vege- 
table infusion containing Tannin, in which case a precipitate of Quinine Tannate will be 
produced. This of course should not be filtered, but should be dispensed with a 
" Shake-label." 

For the use of Velatine as a vehicle for the administration of Quinine Salts, see under 
the title Cinchona, in Part I. 

Chinoidin, Cinchonine Sulphate and Quinidine Sulphate, — also require the 
addition of a dilute mineral acid for their solution in aqueous mixtures. 

Iodine, — requires the addition of Potassium Iodide for its solution in a convenient 
quantity of water, as in the case of the official Liquor Iodi Compositus. 

Hydrargyri Iodidum Rubrum, Red Mercuric Iodide, — requires the addition of 
Potassium Iodide or Mercuric Chloride for its aqueous solution. 

Potassii Bitartras, Cream of Tartar, — requires the addition of Borax or Boric Acid 
for its solution in water. 

Benzoic Acid, — requires the addition of Borax to aid its solubility in water, an equal 
part of the latter making it 5 times more soluble than when alone. 

Lime, — is more soluble in sweetened water than in plain water, the sugar aiding its 
solution. 

Excipients are substances which give form and consistence to prescrip- 
tions, and serve as vehicles for the exhibition of the other ingredients. 
S jme of the excipients are Diluents, or agents which effect the dilution or 
division of the active ingredients ; while others act in the double capacity 
of diluents and Flavoring agents . The Excipients most generally used in 
mixtures may be tabulated as follows, — 

Diluents. True Excipients. 

Water (Aqua).' Acacia (in powder or mucilage). . 

Medicated Waters (Aquae). Tragacanth (in powder or mucilage). 

Syrups. Confections. Sugars. 

Mel Rosae. Some Extracts. 

Elixir Aromaticum. Yolk of Egg (Vitellus). 

Flavoring Agents. 

Oleum Amygd. Amarae. Tinct. Cardamomi Comp. Spiritus Limonis. 

Oleum Cari. Tinct. Cinnamomi. Spiritus Myristicae. 

Oleum Caryophylli. Tinct. Gentianae Comp. Spiritus Menthae Piperitae. 

Oleum Cinnamomi. Tinct. Tolutana. Spiritus Menthae Viridis. 

Oleum Gaultheriae. Tinct. Vanillae. Syrupus Limonis. 

Oleum Sassafras. Tinct. Zingiberis. Syrupus Tolutanus. 

Tinct. Aurantii Dulcis. Spiritus Anisi. Syrupus Zingiberis. 

Tinct. Cardamomi. Spiritus Lavandulae. 



PHARMACEUTICAL PREPARATIONS. 583 

Compounding the Mixture is a matter of no slight importance, and one 
which is best learned at the dispensing counter, though a few directions 
may not be out of place. In «the case of the simplest form of mixture, 
where two or more fluid preparations are prescribed together, the only 
operations required are the measuring of the several ingredients and 
pouring them into the designed vial. In doing this the compounder 
should pursue a regular and definite order of procedure. Taking in 
his left hand a graduate of sufficient capacity to hold the whole quantity 
prescribed, he should walk alongside the shelves, and with the right hand 
pour from the stock-bottles the requisite quantity of each ingredient in 
the order in which they are entered on the prescription. A skillful 
druggist will hold the graduate between the thumb and first finger, the 
prescription between the second and third fingers, and the stopper of the 
stock-bottle between the little finger and the hand, leaving his right hand 
free for the manipulation of the bottles containing the ingredients. 

When an actively poisonous agent is ordered it should always be the 
last thing put into the mixture. Attention to this rule will prevent the 
danger of the toxic substance being put in twice. 

The order in which the ingredients are put together is not of so much 
importance in compounding a simple mixture as in the case of an emul- 
sion, and the order of the prescription can usually be followed, with the 
exception noted in the preceding paragraph. Still, when several alcoholic 
preparations, syrups and waters are ordered together, it is good practice 
first to mix the alcoholic fluids, then to add the syrups and finally the 
water, so as to avoid the precipitation of resinous principles which would 
occur if the alcoholic solutions were added to the water. Distilled water 
should always be used, in order to insure uniformity in taste and appear- 
ance, and also as a matter of purity and cleanliness. All mixtures should 
be well shaken before being labelled. 

Solids which are comparatively insoluble or only slowly soluble require 
to be rubbed up in a mortar with one or more of the fluid ingredients. 
Glass mortars are much employed for this purpose, and many compound- 
ers mix all the ingredients in such a mortar before transferring them to 
the vial. Vegetable powders (as Rhubarb, Ipecac, etc.), or finely pul- 
verized inorganic substances, are often ordered in intimate mixture with 
water, thickened with mucilage or syrup. In such cases the mixture 
should be made in a porcelain or wedgewood mortar, enough mucilage or 
syrup being added at first to make a thick paste, and after this is rubbed 
smooth the water may be gradually added during the continued process 
of mixing. This process will answer for all inorganic substances in 
powder, except Magnesia, which is best mixed by being thrown on the 
surface of the water ; after it has sunk to the bottom as a uniform sedi- 
ment the other ingredients may be added and the whole well shaken. 



5 8 4 



PHARMACEUTICAL PREPARATIONS. 



Froth upon the surface of the liquid, which often arises after agitation 
and may prevent the corking of the bottle, will quickly subside on the 
addition of a few drops of alcohol. • 

The following are specimens of prescriptions for medicines to be admin- 
istered in mixture form : — 



Bismuth Mixture for Children. 

$. Bismuthi Subcarbonatis, . . 5pj. 

Syrupi Acacias, 

Aquae Cinnamomi, . . . . aa^ij. 
Misce. Signa. — A teaspoonful every 
hour in choleraic diarrhea. 



Quinine Mixture for Children. 

R . Quininse Sulphatis (pulv.), . £ss. 

Acacise (pulv.), ...... 5Jss. 

Syrupi Zingiberis, ^ iv. 

Fiat mistura. Signa. — A teaspoonful 
thrice daily. 



Mucilagines, Mucilages, — are thick, viscid liquids prepared by dis- 
solving gum in water, or by extracting with water the mucilaginous prin- 
ciples from certain plants. They are easily spoiled and should be kept 
only in small quantities The official Mucilages number 4, as follows, the 
first two being prepared without heat, the last two with heat, — 



Mucilago Acaciae. 

Mucilago Sassafras Medullae. 



Mucilago Tragacanthae. 
Mucilago Ulmi. 



Oleata, Oleates, — are liquid solutions of metallic salts or alkaloids in 
Oleic Acid, intended for external administration. They are not definite 
chemical compounds, though the term is also employed in trade to desig- 
nate certain solid preparations which are claimed to be chemical com- 
pounds of the same acid with various bases. [See under Acidum Olei- 
cum, ante, page 103.] There are three official Oleates, as follows, — 

Oleatum Hydrargyri (20 per cent.). Oleatum Veratrinae (2 per cent.). 

Oleatum Zinci (5 per cent.). 

Oleoresinse, Oleoresins, — are liquid preparations consisting principally 
of natural oils and resins extracted from vegetable substances by percola- 
tion with Ether. They differ from fluid extracts in not bearing any uni- 
form relation of cc. to the gramme of drug, in containing principles 
which though soluble in ether are not so in alcohol, and in some instances 
being devoid of principles which are insoluble in ether but soluble in 
alcohol. They are the most concentrated liquid preparations of drugs 
which can be produced, and are prepared by percolating the powdered 
drug with Ether until exhausted, recovering the greater part of the ether 
by distillation, and exposing the residue in a capsule to spontaneous 
evaporation until the remaining ether has evaporated. There are 6 official 
Oleoresins, viz. — 



Oleoresina Aspidii (10-15). 
Oleoresina Capsici (5). 
Oleoresina Cubebae (18-25). 

The figures in parentheses show the percentage of oleoresin yielded by each drug. 



Oleoresina Lupulini (50). 
Oleoresina Piperis (5). 
Oleoresina Zingiberis (6— J 



PHARMACEUTICAL PREPARATIONS. 



585 



Pigmenta, Paints, (Unofficial), — are preparations for external use, 
which cannot be classed with the preceding. They are generally pre- 
scribed in skin diseases, for use over inflamed joints, or for application to 
the throat with a camel's-hair brush. 



R . Tinct. Iodi, |j. 

^Etheris, ^iij. 

Tinct. Aconiti, 3 ss. 

Ext. Belladon. Rad. Fl., . giv. 

Morphinge Sulph., .... gr. ij. 

Iodi, 3J SS - 

Sig. — Paint 4 or 5 coats freely over the 
inflamed and painful parts. 



R . Alcoholis, Saponis Viridis, 

Olei Cadini, & a ^j- 

Sig. — Paint over the part. 

R. Olei Tiglii, gj. 

^Etheris, £ij. 

Tinct. Iodi, 3 v. 

M. Sig. — Paint on once in 3 days. 



Pilulae, Pills, — are spherical masses composed of medicinal agents 
and intended to be swallowed whole. The Mass consists of the active 
ingredients and the Excipient, the latter being the substance which gives 
to the mass its adhesive and plastic qualities. In official pharmacy the 
excipients are specified both as to composition and quantity in each case, 
and those directed to be used in the preparation of the 3 official Masses 
and the 15 official Pills are as follows, — 

5 are made with Soap and Water, — Pil. Aloes, Pil. Aloes et Asafoetidae, Pil. Asafoe- 
tidae, Pil. Opii, Pil. Rhei. 

4 are made with Water alone, — Pil. Aloes et Mastiches, Pil. Catharticae Comp., Pil. 
Catharticae Vegetabiles, Pil. Rhei Comp. 

I with Syrup, — Pil. Aloes et Myrrhae. 

I with Mucilage of Tragac a nth, — Pil. Antimonii Comp. 

1 with Acacia and Water, — Pil. Ferri Iodidi. 

2 with Glycerin and Water, — Pilulae Phosphori, Pil. Ferri Carbonatis. 
I with Confection of Rose, — Pilulae Aloes et Ferri. 

I with Honey, Syrup and Water, — Massa Ferri Carbonatis. 

I with Glycerin and Honey of Rose, — Massa Hydrargyri. 

1 has no excipient, — Massa Copaibae, being a resin left after distillation. 

The pharmacopoeial directions for the formation of the pill-mass vary 
in each case, but in general they prescribe that the ingredients shall be 
mixed intimately, then beaten with the excipient to form a mass and 
divided into a certain number of pills. Two of the official pills are 
directed to be coated with an ethereal solution of the Balsam of Tolu, 
— Pilulae Ferri Iodidi and Pilulae Phosphori. Full descriptions of the 
various details of pill-making are given on the next page. 

The number of official pills is 15, for the composition of which the 
student is referred to their several titles in the section on Materia Medica. 
They are named as follows, — 



Pilulae Aloes. 

Pilulae Aloes et Asafoetidae. 
Pilulae Aloes et Ferri. 
Pilulae Aloes et Mastiches. 
Pilulae Aloes et Myrrhae. 
Pilulae Antimonii Compositae. 
Pilulae Asafoetidae. 



Pilulae Catharticae Compositae. 
Pilulae Catharticae Vegetabiles. 
Pilulae Ferri Carbonatis. 
Pilulae Ferri Iodidi. 
Pilulae Opii. 
Pilulae Phosphori. 
Pilulae Rhei. 



Pilulae Rhei Compositae. 



586 PHARMACEUTICAL PREPARATIONS. 

Pills constitute a form of medicine very much used in extemporaneous 
pharmacy, and one with the preparation of which the compounder should 
be perfectly familiar, for it will constitute fully one-third of his work at 
the dispensing counter. Pills should not exceed 5 grains in weight, 
unless the ingredients are very heavy, as Bismuth, Calomel, Hydrargyrum 
cum Creta, etc., of which 6, 8, or 10 grains may be made into a pill 
which may be readily swallowed. A Bolus is a similar mass, but larger 
than a pill, while the names Granule and Parvule are given to masses 
smaller than the average pill. 

The Process of Pill : making. 
The Process of Pill-making is briefly as follows : The ingredients 
ordered in the prescription are separately weighed out in the order of 
their bulk, commencing with that one of which the smallest quantity is 
to be used. If any require pulverization they should be placed first in 
the mortar and reduced to powder, the other dry ingredients added, next 
the soft extracts and the excipient selected ; the whole being worked up 
into a mass, the Pill-mass, by the aid of the mortar and pestle. The 
perfect pill-mass should be uniform throughout, should not show any 
particles of any one ingredient, should have such a consistence that the 
pills made from it will retain their shape, should not be too hard, nor too 
dry, nor should it stick to the fingers. The mortar should be large and 
shallow, of unpolished wedgewood ware ; having a thick, smooth and 
well-formed bottom and a pestle which fits it. The operation of working 
up the mass is one of kneading it between the end of the pestle and the 
side of the mortar, and if proper ingredients and excipient are used and 
the work is well done, the mass will eventually loosen itself from both 
mortar and pestle. If it does not do so it should be removed with a 
spatula when sufficiently worked, and may be kneaded for a few minutes 
between the fingers. It should then be placed upon the tile or slab pre- 
viously dusted with a little Lycopodium or Starch in fine powder, and 
rolled into a long cylinder by the aid of a broad-bladed spatula, until the 
mass is of a length corresponding to the divisions on the tile-scale which 
represent the number of pills to be made. The mass should then be 
placed along the scale, and a cut made through it with the spatula at each 
division, the pieces being at once rounded separately into pills by the 
thumb and two fingers of each hand. A pill-machine is often employed, 
consisting of two metal plates having semi-cylindrical grooves on one 
side, set into wooden boards, the whole forming a convenient apparatus 
for rolling the mass and then cutting it into the required number of pills 
by one movement. The pills are then left to dry upon the slab while the 
label is being written, after which they are placed in a pill-box, or in a 
wide-mouthed bottle if they contain volatile ingredients, and surrounded 



PHARMACEUTICAL PREPARATIONS. 587 

by a Conspergative powder (Lycopodium, powdered Chalk, dusted Talc), 
to prevent their adhering together or losing their shape. 

Excipients used in pill-making are seldom mentioned in the prescrip- 
tion, but are usually left to the choice of the compounder. Some sub- 
stances need no excipient, but may be made at once into pills ; such 
being the softer Extracts and some Gum-resins, the former if too hard 
only needing a little water, and the latter a few drops of spirit to soften 
them to the required degree of plasticity. Every druggist has his favorite 
pill-excipient, many using a paste made of powdered Tragacanth 1, Gly- 
cerin 2,% and Water 1 part, while others use Extract of Malt or a mixture 
of Syrup and powdered Acacia for general use. Powdered Tragacanth to 
give tenacity, Glycerin to keep the mass soft, and Water to develop the 
adhesive qualities of many ingredients, will answer for fully nine-tenths 
of all the cases which occur in practice. These three excipients should 
stand on the dispensing counter ready for use, and all ready-made pastes 
or mixtures should be discarded, as being slovenly, dirty and liable to 
change. The excipients described below are those in general use and 
are arranged in the order of their comparative importance. 

Liquid Excipients. 

Glycerin, — is a very valuable excipient, as it continually attracts moisture from the 
atmosphere, and pills made from it do not get hard. It should always be used for 
Quinine pills. Glycerites of Starch or Tragacanth are generally useful excipients. The 
former is official, the latter is made in the proportion of gss to the ^ . 

Glucose, — is a good excipient, being colorless, adhesive, and not readily volatilized 
at ordinary temperatures. Since its introduction by Mr. Lascheid for this purpose it has 
steadily grown in favor. 

Honey, — may be used for dark-colored substances. It should be evaporated to one- 
half its bulk, and then if mixed with a little Tragacanth it makes an excellent excipient 
for insoluble powders. 

Extract of Malt, — is a pretty fair excipient, but has the disadvantage of its dark color. 

Syrup, — is a fair excipient for powders, but it should not be used for metallic salts, 
especially Calomel, which it reduces in a short time. Syrup of Acacia is good where 
there is little room left for the excipient, but pills made with it become very hard and 
insoluble if they are kept long. 

Mucilage of Acacia, — is very adhesive, but not a good excipient for the same reason 
as given for the syrup. 

Water, — is only used alone as an excipient when the ingredients possess sufficient ad- 
hesiveness to be developed by the water. Such are the following powders : Aloes, Rhu- 
barb, Kino, Tannic Acid, Opium, Squill, Asafcetida, — also Ferric Citrate, Berberine Sul- 
phate, and some other salts. 

Alcohol, — is used to soften Camphor, Compound Extract of Colocynth, Guaiac, res- 
inous extracts, gums, etc. 

Solid Excipients. 

Tragacanth, — is an excellent excipient, especially for substances which are too soft, 
giving them body and elasticity. 

Acacia, — is added to give more adhesiveness than can be obtained from viscid liquids 
alone. Pills made with it are generally very hard. It is used for Silver Nitrate, which 
may explode if mixed with vegetable extracts or glucose. 



588 PHARMACEUTICAL PREPARATIONS. 

Soap, — is the best for resinous and fatty substances, increasing the solubility of the 
former. It is oftener employed in the official pills than any other excipient, but should 
not be used for substances which are decomposed by an alkali, nor for Tartar Emetic. 

Bread-crumb {Mica Pa?iis), — is an excellent excipient for Croton Oil, or other 
powerful liquid substances, as volatile oils. 

Confection of Rose, — is too bulky for general use, but is a good excipient for very 
active agents like Strychnine, which are used in small quantity. 

Althaea, — is good for absorbing and adhesive purposes, but is too bulky for general use. 

Petrolatum, Cacao Butter, and Resin Cerate, — are used for oxidizable substances, 
as Potassium Permanganate. 

Kaolin, — is well adapted as an excipient for Silver Nitrate and other substances which 
are easily decomposed. 

Liquorice, — is an old excipient, but not much employed now. In powder it may 
be used for oils. 

Conspergatives are absorbent powders which are dusted upon the 
finished pills and put around them in the box or vial in which they are 
dispensed, to keep them from sticking together and losing their shape. 
Powdered Liquorice was formerly much used for this purpose, but the best 
conspergatives are Lycopodium, Talc, Althaea and Rice Flour, the latter 
especially for white pills. 

Substances suitable for the pilular form of medicine are — 
Those acting in small doses. Heavy, insoluble substances. 

Those intended to act slowly. Fetid substances. 

Those to act on the lower bowel. Vegetable extracts. 
Gums-resins, Balsams, Turpentine. 

When the basis is an unadhesive substance, one of the other ingredients 
should be an extract or a vegetable powder which will form a mass by 
moisture alone. Attention to this rule in prescribing pills will often pre- 
vent the increase of their size by the use of inert excipients. 

Substances difficult to combine, except by peculiar treatment, are 
met with frequently. The following notes will cover most such cases : — 

Aloes, — is best treated on a heated slab with alcohol in very small quantity. Soap is 
the excipient in the official Pilulse Aloes. 

Butyl Chloral Hydrate, — should be treated with a little Confection of Rose and 
thick mucilage. 

Calcium Sulphide, — should be well triturated with an equal quantity of Sugar of 
Milk, and then worked up with a little powdered Liquorice-root and Tragacanth 
Mucilage. 

Camphor, — should be powdered with a little alcohol, and may be worked into a pill- 
mass with Glycerite of Tragacanth after the evaporation of the alcohol. 

Carbolic Acid,— requires nearly an equal part of wheaten flour or bread-crumb, with 
a very minute quantity of Glycerite of Tragacanth. Creosote may be made into a mass 
by the addition of Powdered Liquorice with a very little bees' wax. If made into a pill 
with Silver Oxide it will explode unless the silver salt be first diluted by trituration with 
Liquorice, Gentian, or some other inert powder. 

Iron and Quinine Citrate, — is very deliquescent with most excipients. Canada 
Balsam is the best for it. 



PHARMACEUTICAL PREPARATIONS. 



589 



Copaiba, — may be made into a pill-mass by the addition of a little Magnesium Car- 
bonate or Wax. 

Croton Oil, — is best worked up with bread-crumb, though powdered Liquorice and 
mucilage of Acacia may be used. 

Ferrous Iodide, — in pill form requires special manipulation and protection to remain 
unoxidized. The official Pil. Ferri Iodidi is prepared with Iodine and Reduced Iron, 
has Liquorice, Sugar, and Acacia as excipients, and is protected by a coating of Balsam 
of Tolu. In other formulae, Acacia, Althaea, Cacao-butter, Elm bark, and Liquorice are 
used as excipients. 

Ferrous Sulphate, — is used in Blaud's Pill and in the official Pil. Ferri Compositae, 
with Potassium Carbonate, to form by mutual decomposition Ferrous Carbonate, which 
quickly passes into the ferric salt by exposure. Myrrh in powder and syrup is the ex- 
cipient used for the official pill. 

Gallic Acid, — makes a good pill with a very small quantity of Glycerin. Tannic 
Acid requires about one-fifth its weight of Glycerin and one-tenth of Mucilage. 

Phosphorus, — presents the problem of combining it in pill without letting it oxidize. 
This is believed to be accomplished by the pharmacopoeial directions for the Pil. Phos- 
phori, according to which the Phosphorus is dissolved in Chloroform in a test-tube, then 
quickly worked into a mass with Althaea, Acacia, Glycerin and Water, and finally the 
pills are coated by shaking with an Ethereal solution of Balsam of Tolu. Carbon Bisul- 
phide is a better solvent, but when it is used the pill-mass retains its disgusting odor. 

Potassium Acetate, — requires Canada Balsam to secure its stability in pill form. 
Potassium Iodide is best manipulated by rubbing it into a smooth paste with a very 
little water, then adding a small quantity of Liquorice powder. Potassium Perman- 
ganate should be worked up with Kaolin and a very little water. Resin Cerate, Soft 
and Hard Paraffin and Cacao-butter are also used as excipients. 

Quinine, — requires very clean hands and tools, and a colorless excipient, as Glycerin 
or Glucose, to make a nice-looking pill. If one part of Tartaric Acid is added to four of 
the Quinine salt, the mass will be less likely to crumble and will be of less bulk. Qui- 
nine Sulphate may be made into small and soluble pills by simply triturating it with 
Aromatic Sulphuric Acid n\iij to each 5 grains of the salt. The moulding into pills 
should be done at the moment when the mass has begun to dry. A drop of syrup or 
honey, added at this time, will prevent the too rapid hardening of the mass. 

Rhubarb, — in powder makes a good mass with one-fifth of its weight of Glycerin ; 
but Soap is the excipient ordered for the official Pilulae Rhei. 

Substances unsuited to the pilular form are — 
Those requiring large doses, and those which are volatile. 
Emetics, and other agents administered for immediate effect. 
Essential Oils in quantity exceeding half a drop to each pill. 
Oils and other bodies which require much solid matter to make a mass ; 

except those prescribed in very small dose, as Croton Oil. 
Deliquescent Salts, unless intended to be used immediately. 
Efflorescent Salts, unless deprived of their water of crystallization. 



Deliquescent Salts. 

Ammonii Iodidum. 

Nitras. 

Valerianas. 

Auri Chloridum. 
Calcii Chloridum. 

Chinolin Salts, except the Tartrate, which 

is stable. 
Lithii Citras. 
Bromidum. 

Salicylas. 



Efflorescent Salts. 

Alumen (slightly). 
Ammonii Carbonas. 

Phosphas. 

Antim. et Potassii Tartras (slightly). 
Cupri Acetas. 

Sulphas. 

Magnesii Sulphas (slightly). 
Potassii et Sodii Tartras (slightly). 

Ferrocyanidum (slightly). 

Quininae Bisulphas. 



590 



PHARMACEUTICAL PREPARATIONS. 



Deliquescent Salts. 
Magnesii Citras. 
Potassa. 

cum Calce. 

Potassii Acetas. 

Carbonas. 

Citras. 

Cyanidum. 

Hypophosphis. 

Sulphis. 

Tartras. 

Sodii Hypophosphis. 

Iodidum. 

Zinci Bromidum. 

Chloridum. 

Iodidum. 



Efflorescent Salts. 
Quininse Sulphas (after a time). 
Soda. 
Sodii Acetas. 

Arsenas (slightly). 

Benzoas. 

Boras (slightly). 

Carbonas. 

Hyposulphis. 

Phosphas. 

Santoninas (slightly). 

Sulphas. 

Sulphis. 

Strychnine Sulphas. 
Zinci Acetas. 

Sulphas. 



Coated Pills are manufactured upon a large scale by the great drug 
houses, extensive machinery being employed for the purpose. The coat- 
ing material used is either Sugar or Gelatin. The U. S. Pharmacopoeia 
directs that two of the official pills shall be coated by being shaken with 
a solution of Balsam of Tolu in Ether, — Pil. Ferri Iodidi and Pil. Phos- 
phori. In extemporaneous pharmacy it is rarely practicable to coat pills 
with anything except gold or silver leaf, and this is sometimes directed 
by the prescriber, the word " Deaur enter — let them be gilded" being 
used in the subscription. To do this neatly the pills should have no trace 
of powder on them, but should be first coated with a trifle of fresh muci- 
lage by rolling between the mucilage-moistened fingers, each pill being 
then dropped directly on to a sheet of gold or silver leaf, until a dozen or 
more are so deposited. The leaf and its pills are then allowed to slide into 
a globular boxwood shaker, or the leaf may be first placed in the shaker 
^and the pills dropped on it there. A cautious circular movement being 
given to the shaker the pills are caused to travel around its walls, and 
when the cover is removed they will be found to have each received an 
even coating of the metal used. Gold leaf should always be employed 
for pills of Blue Mass or Asafoetida, as silver is amalgamated with the 
former and turned black by the latter. 

Albumin may be used for coating small numbers of pills, which should be of very firm 
consistence before the coating is applied. Each pill is rolled between two fingers with a 
little white of egg, and then revolved in a warm pan. Another method of finishing them 
is, after coating with albumin, to rotate them in a tray with powdered French chalk until 
their surfaces become smooth and shiny. This process gives a very nice finish. 

The following prescriptions represent the composition of a few unoffi- 
cial pills in general use. A complete pill formulary is easily obtained, 
being published annually by the principal manufacturers. 



Anaphrodisiac and Sedative. 

R . Camphorae, gr. xxx. 

Lupulini, gr. xx. 

Fiat massa et div. in pil. xx. 
Sig. — One thrice daily. 



Astringent Pill. 
rjc . Argenti Nitratis, . . . gr. xx. 
Pulv. Cretse (Gallicse), . gr. lxxx. 
Petrol ati, q. s. 
Fiat massa et div. in pil. xl. 



PHARMACEUTICAL PREPARATIONS. 



591 



R 



Pills of Iron 
. Ferri Reducti, . . . 

Mannas, 

Glucosi, q. s. 
Fiat massa et div. in pil. xxv 
Sig. — One after each meal. 



gr.l. 
gr. xv. 



Emmenagogue Pill (Olio). 
. Ferri Sulph. Exsic, . . gr. xlviij. 

Pulv. Aloes, gr. xij. 

Terebinthinae^ . . . . gr. xxvij. 

01. Terebinth., .... rr^x. 
Fiat massa et div. in pil. xxx. 
Sig. — Two, three times a day. 



Hooper's Fe?nale Pills. 
R. Pulv. Aloes Socot., . . gr. xlviij. 
Ferri Sulph. Exsic., . . gr. xxiv. 
Ext. Hellebori Nig., 
Pulv. Myrrhae, 

Saponis, aa gr. xij. 

Pulv. Canelbe Alb., 
Pulv. Zingiberis, . . aa gr. vj. 
Aquas vel Syrupi, q. s. 
Fiat massa et div. in pil. , quisque pondo 
gr. ijss. 

Sig. — One to three at a dose. 



R 



Astringent Pill 
. Plumbi Acetatis, . . , 
Pulv. Camphoras, . . , 
Pulv. Opii, . . ... 
Bismuthi Subcarb., . . g 
Ext. Gentianae, q. s. 
Fiat massa et div. in pil. xij. 
Sig. — One thrice daily. 



gr. xvj. 
gr. xij. 
gr. iij. 
gr. xij. 



Cholagogne Pills [Squibb). 
R. Resinas Podophylli, . . gr. vj. 
Ext. Belladon. Alcohol., gr. iij. 
Pulv. Capsici, 

Pulv. Sacch. Lactis, . aa gr. xxiv. 
Pulv. Acacias, . . . . gr. vj. 
Glycerini, Syrupi, aa, q. s. 
Fiat massa et div. in pil. xxiv. 
Sig. — One or two as required. 



Aperient Pills. 
R . Pul. Aloes Socot., . . . gr. xxiv. 
Pulv. Rhei, ..... gr. xlviij. 
Hydrarg. Chlor. Mitis, . gr. iv. 
Antim. et Potas. Tart., . gr. ij. 
Fiat massa et div. in pil. xxiv. 
Sig. — One or two as needed. 

Tonic Pill for Women. 
R . Strychninas Sulph., 
Acidi Arsenosi, . 
Ext. Belladonnas, 
Quininae Sulph., 
Massae Ferri Carb 
Fiat massa et div. in pil. xxxv 
Sig. — One three times daily 



aagr. j. 
■ gr. v. 
. gr. xxxv. 
. gr. xc. 



R 



Anti- Bilious Pills. 
Pulv. Scammonii, 
Pulv. Aloes Socot., 
Pulv. Gambogiae, 
Hydrarg. Chlor. Mitis, 
Potassii Bitart., . . . aa 
Ext. Taraxaci, q. s. 
Fiat massa et div. in pil. xx. 



Potus, A Drink (Unofficial), — is a solution or a mixture intended to 
be used ad libitum, and generally consists of a Potassium or Sodium salt 
or a mineral acid, in dilute solution, sweetened and flavored. 

tt\v ; Aquae 



The Imperial Drink. R . Potassii Bitartratis, 3 ij 
Bullientis, q. s. ad 25 xx. M. Fiat potus. Sig. — Use as 



Olei Limonis, 
drink. 



Pulveres, Powders, — are usually prepared extemporaneously, but a 
few compound ones have been made official, the ingredients being 
directed to be rubbed together until reduced to a fine powder and thor- 
oughly mixed. Special directions are given for the preparation of two 
— the Compound Effervescing Powder and the Compound Powder of 
Morphine. There are 9 official powders, named as follows, — 

Pulvis Antimonialis. Pulvis Glycyrrhizae Compositus. 

Pulvis Aromaticus. Pulvis Ipecacuanhas et Opii. 

Pulvis Cretas Compositus. Pulvis Jalapae Compositus. 

Pulvis Effervescens Compositus. Pulvis Morphinas Compositus. 

Pulvis Rhei Compositus. 



59 2 PHARMACEUTICAL PREPARATIONS. 

The composition of each of these preparations will be found in the section on Materia 
Medicaand under the title from which its name is derived, except that of the Compound 
Effervescing Powder, which is placed under the title Potassium. Pulvis Ipecacuanhse 
et Opii is really a trituration, its ingredients being rubbed together with sugar of milk 
into a very fine powder. 

As prepared extemporaneously Powders are generally compound and 
may be mixed on a slab with a spatula, but a much better method of 
mixing them is by trituration in a mortar. The latter should always be 
employed except in the case of substances which may explode if so 
treated, as Potassium Chlorate with oxidizable substances. (See ante, 
page 550.) The diluent best employed in powders is Sugar of Milk, on 
account of its hardness, its density and its comparative insolubility. A 
coloring agent, as Carmine in minute quantity, is a useful ingredient, 
enabling the eye to judge of the degree of mixing and subdivision ob- 
tained. Powders containing soluble salts, extracts, volatile oils, camphor, 
or any other hygroscopic or volatile substances, should be dispensed in 
waxed paper. For ordinary powders the plain white paper of the drug- 
stores will answer, but a better paper for small powders is a very thin 
one having a high surface finish, as the white glazed French demy. 
Powders are often ordered in Wafers {Cachets'), to be swallowed without 
unfolding. The division of powders into the number of Papers (C/tar- 
tulce) ordered and folding them neatly, require a considerable amount 
of practice. A small machine is used, over which the ends of the papers 
are bent, in order to have them of the proper size for the box in which 
they are dispensed. If they are to be put into an envelope, less exact- 
ness of folding is required, and the mechanical contrivance may be dis- 
pensed with. 

Substances suitable to administration in the form of powders are those 
which are insoluble, those which would be chemically incompatible in 
fluid form, and certain pulverizable extracts. Those which are unsuited 
to this form are such as have a very nauseous taste or odor, substances of 
which the dose is large, those which are deliquescent, efflorescent or 
very volatile, and those which liquefy on mixing. A list of deliquescent 
and efflorescent salts is found on page 589, while the following-named, 
though dry alone, become moist when triturated together, viz. — 

Sodium Sulphate and Potassium Carbonate. 
Zinc Sulphate and Lead Acetate. 
Camphor and Chloral Hydrate. 

Many substances cannot be powdered without the intervention of 
another body : thus Opium requires a hard substance like sugar of milk 
or potassium sulphate, Camphor requires a minute quantity of alcohol, 
Myrrh needs sugar or gum, etc. Substances, as the alkaloids and their 
salts, which are very active and are used in very small doses, require some 
inert substance to give them bulk enough for division and handling. 



PHARMACEUTICAL PREPARATIONS. 



593 



Sugar of Milk will be found the best agent for this purpose. Prescrip- 
tions may order the ingredients for a single powder, with directions to 
dispense a certain number of the same composition ; or they may give 
the quantities for the whole number of powders ordered, with instructions 
to divide into a certain number. The dispenser should carefully scan the 
prescription in order to avoid the multiplication of quantities where divi- 
sion is intended. The official powders are named on p. 591, and the 
following formulas will serve to illustrate those generally prescribed : — 



Astringent Powder for Infants. 

B . Plumbi Acetatis, . . . . gr. ij. 

Pulveris Opii, gr. ss. 

Camphorae, gr. j. 

Sacchari Lactis, . . . . gr. iij. 
Trit. et div. in chartulas xij. 
Sig. — One every 2 or 3 hours in diar- 
rhea of infants. For an adult the above 
represents one dose. 



Gastric Sedative. 



B 



. Bismuthi Subnitratis, . . ^j. 

Pulveris Rhei, 

Pulveris Aromat., . . aasjss. 
M. et div. in chartulas vj. 
Sig. — One before each meal. 



Laxative Powder. 



B . Hydrarg. Chlor. Mitis, . gr. 
Sacchari Lactis, . . . . gr. 
M. et fiant pulv. x. 
Sig. — One powder twice daily. 



Bisi?iuth and Soda. 

Bismuthi Subnitratis, 

Sodii Bicarb., . . . . aagij. 

Pulv. Zingiberis, . . . . gr. xl. 
M. et div. in chartulas xij. 
Sig. — One after each meal. 
Corrective in dyspepsia, acne and eczema. 



Antipruritic Powder. 



B 



Pulveris Camphorae, . 

Zinci Oxidi, .... 

Pulv. Amyli, ^j. 

M. et fiat pulvis. 

Sig. — Use locally as a dusting powder to 
relieve itchingf. 



32- 



Catarrh Powder 



R 



M. 



Bismuthi Subnitratis, . . 5 iij. 

Pulv. Acaciae, gj. 

Pulv. Talci, gij. 

Morphinae Hydrochlor., . gr. j. 
Sig. — Use by insufflation. 



Compressed tablets are really powders which have been compressed into 
tablet shape by machinery. A little pressure from the blade of a spatula 
will restore them to the powder form. 



Resinae, Resins. — Pharmaceutical resins are solid preparations ob- 
tained by precipitating the resinous principles of plants from their alcoholic 
solution by the agency of water. They differ from alcoholic extracts in 
containing only those principles which are soluble in alcohol and insoluble 
in water, while the extracts contain all principles which are soluble in 
alcohol. Besides Resina itself, which is the residue left after distilling 
off the volatile oil from Turpentine, there are 4 official Resins, three of 
which correspond to the above description, and one (Resin of Copaiba) 
is the residue left after distilling off the volatile oil from Copaiba. They 
are named : — 



Resina Copaibae. 
Resina Jalapae. 
True Resins are defined on page 25. 
33 



Resina Podophylli. 
Resina Scammonii. 



594 PHARMACEUTICAL PREPARATIONS. 

Spiritus, Spirits, — are alcoholic solutions of volatile substances, which 
may be solids, liquids or gases. They are officially prepared either by 
simple solution, by solution with maceration, by gaseous solution, by 
chemical reaction or by distillation. The menstruum is Alcohol or 
Deodorized Alcohol in nearly all instances, 4 having Water in addition, 
and 2 being alcoholic liquids of a specified alcoholic strength (Whiskey, 
Brandy). The official Spirits are 25 in number, as follows, — 

Spiritus Athens, 32^. Spiritus Frumenti, 44-50. 

Spiritus JEtheris Compositus, 2> 2 Yz- Spiritus Gaultheriae, 5. 

Spiritus ^Etheris Nitrosi, 4. Spiritus Glonoini, I. 

Spiritus Ainmonige^ 10. Spiritus Juniperi, 5. 

Spiritus Ammonk Aromaticus, 9. Spiritus Juniperi Compositus, 63^. 

Spiritus Amygdalae Amarae, I. Spiritus Lavandulae, 5. 

Spiritus Anisi, 10. Spiritus Limonis, 5. 

Spiritus Aurantii, 5. Spiritus Menthae Piperitae, 10. 

Spiritus Aurantii Compositus, 20. Spiritus Menthae Viridis, 10. 

Spiritus Camphorae, 10. Spiritus Myrciae, 55. 

Spiritus Chloroformi, 6. Spiritus Myristicae, 5. 

Spiritus Cinnamomi, 10. Spiritus Pkosphori, o. 12. 
Spiritus Vini Gallici, 39-47. 

The figures placed after Spiritus Frumenti, Spiritus Juniperi Comp. , Spiritus Myrciae 
and Spiritus Vini Gallici, represent the percentage of absolute Alcohol by weight in 
each ; those placed after the others indicate the quantity of the principal ingredient in 
grammes to each 100 cubic centimeters of the preparation. Absolute Alcohol is the 
menstruum directed for Spiritus Phosphori. 

Suppositoria, Suppositories, — are solid bodies containing medicinal 
substances, and intended for introduction into the vagina, rectum or 
urethra. The Pharmacopoeia prescribes a general formula for their prepa- 
ration, according to which the medicinal portion should be incorporated 
with Oil of Theobroma by rubbing together at a temperature of 95 F. 
The mixture should be poured into suitable moulds and cooled on ice or 
in ice-cold water. Unless otherwise specified they should have the fol- 
lowing shapes and weights, corresponding to their several uses: — 

Rectal Suppositories, — cone-shaped, about I gramme (15 grains) each. 
Urethral Suppositories, — pencil-shaped, about 1 gramme (15 grains) each. 
Vaginal Suppositories, — globular, about 3 grammes (45 grains) each. 

The only official Suppositories are those of Glycerin, (Suppositoria 
Glycerini), in which Stearic Acid is employed to give the requisite con- 
sistence. 

In extemporaneous pharmacy Suppositories are usually prepared with 
Cacao-butter as a basis, but for those intended for the uterus or urethra a 
mixture of Gelatin and Glycerin is considered the best excipient, being 
firmer and more plastic than cacao-butter, and more easily handled. 
Hollow cones of cacao-butter, or some composition resembling it, are 
kept in the shops, and will be used by the average druggist in filling pre- 
scriptions for rectal suppositories unless prohibited, as they save him con- 



PHARMACEUTICAL PREPARATIONS. 



595 



siderable labor ; the active drug being simply placed in the centre of the 
cone, which is then sealed by a plug fitting into its base. These contriv- 
ances are by no means so efficient as the regular suppository, in which 
the medicinal agent is thoroughly incorporated with the excipient, for the 
former smear the rectum with a quantity of melted grease before the active 
ingredient is permitted to come into contact with its walls. The agents 
used in suppositories are chiefly extracts and alkaloids, some few powders 
and a few metallic salts are occasionally employed. Those for the adult 
rectum should contain about 15 grains of the excipient, for the vagina a 
drachm of cacao-butter is the average quantity. Those for the uterus and 
urethra are made of cylindrical instead of conical form, and about the 
diameter of a no. 9 catheter. 

The methods of compounding suppositories are two — that by the use of 
moulds (the official method), and that by hand. The former process is 
described above, but many prefer the hand method which is as follows : 
The medicament is mixed with finely shaved Cacao-butter by the aid of a 
spatula, on a board or tile lightly dusted with Lycopodium or Starch. 
After a smooth and uniform mixture is thus obtained, the mass may be 
rolled into cylindrical form, cut into the required sizes and with the 
spatula given the required shape. When dispensed, they should be placed 
in a powder-box between layers of cotton. 

Bougies or Pencils, as urethral and uterine suppositories are often 
termed, may be prepared by melting together White Gelatin 3, Glycerin 
1, and Distilled Water 1 part by weight, then adding the medicament 
and drawing the mass into a glass tube previously oiled inside. When 
cold the bougie may be pushed out and cut into suitable lengths. 

Suppositories and bougies may be prescribed in the manner illustrated 
by the following formulae : — 



Anodyne Suppository. 






R. Ext. Opii, .... 




gr- 


v j- 


Ext. Belladonnas Fol. 


Al 






coholici, 




g r - 


ss. 


Ext. Hyoscyami, . . . 




gr- 


ij- 


Olei Theobromae, q s. 








M. Fiant suppositoria vj . 








Sig. — One into the rectum 


mornin. 


y and 


night. 








Anthelmintic. 




R . Santonini, 


gr- 


xij 




Olei Theobromae, . . 


3) 






M. Fiant suppositoria vj. 








Sig. — One into the rectum 


as directed. 



Quinine Suppository. 
&. Quininae Sulphatis, . . gr. v. 
Olei Theobromae, . . . gr. x. 
Fiat suppositorium unum, mitte tales sex. 



B 



Wade'' s Bougies. 
. Iodoformi, 

Bismuthi Subnitrat. , . . aa^j. 

Chloralis Hydratis, . . . . gr. viij. 

Morphinas Sulphat., . . . gr. iij. 

01. Rosas, TT\x. 

Gelatini et Glycerini, q. s. 
M. Fiant bougia xij. 
Sig. — One into urethra thrice daily. 



• gr- vj. 

• gr. xij. 



Botigie for Gleet. 
& . Zinci Sulphatis, . 
Ac. Carbolici, 
Pulv. Hydrastis, 
Ext. Belladonnas Fol. Al- 

coholici, .... 
Gelatini et Glycerini, 
M. Fiant bougia xij. 
Sig. — One into the urethra night and 
morning. 



gr. xij. 



q. s. 



596 PHARMACEUTICAL PREPARATIONS. 

In the British Pharmacopoeia the following 7 suppositories are official, viz. — 

Suppositoria Acidi Carbolici, Phenol Suppositories, — Phenol, 12 grains ; White 
Beeswax, 24 grains ; Oil of Theobroma, q. s. for 12 suppositories, each containing I 
grain of Phenol. 

Suppositoria Acidi Tannici, Tannic Acid Suppositories, — Tannic Acid, 36 grains ; 
Oil of Theobroma, q. s. for 1 2 suppositories, each containing 3 grains of Tannic Acid. 

Suppositoria Belladonnae, Belladonna Suppositories, — Alcoholic Extract of Bella- 
donna, 18 grains; Oil of Theobroma, q. s. for 12 suppositories, each containing Ij4. 
grain of the extract or approximately -J^ grain of the alkaloids of belladonna root. 

Suppositoria Glycerini, Glycerin Suppositories, — Gelatin, cut small, ^ ; Glycerin, 
by weight, 2.y z ; Distilled Water, a sufficiency to make as many suppositories as desired, 
according to size, each containing 70 per cent, by weight of Glycerin. 

Suppositoria Iodoformi, Jodofor/n Suppositories, — Iodoform, 36 grains; Oil of 
Theobroma, q. s. for 12 suppositories, each containing 3 grains of Iodoform. 

Suppositoria Morphinae, Morphine Suppositories, — Morphine Hydrochloride, 3 
grains; Oil of Theobroma, q. s. for 12 suppositories, each containing % grain of the 
Morphine salt. 

Suppositoria Plumbi Composita, Compound Lead Suppositories, — Acetate of 
Lead, 36 grains; Opium, in powder, 12 grains; Oil of Theobroma, q. s. for 12 suppos- 
itories, each containing 3 grains of Lead Acetate and I grain of Opium. 

Syrupi, Syrups, — are concentrated solutions of Sugar in water or in 
aqueous liquids. They sometimes contain Acetic Acid, and occasionally 
Alcohol ; and are termed simple, medicated ox flavored, according as they 
are simple solutions of sugar in water alone, or contain soluble medicinal 
substances or flavoring ingredients. The sugar used should be very dry, 
and its official description corresponds with the granulated sugar of com- 
merce. The permanency of these preparations chiefly depends on their 
possessing the proper relative proportions of sugar and water. They are 
prepared either by solution with heat, by agitation without heat, by add- 
ing a medicated liquid to simple syrup, by digestion or maceration, or by 
cold percolation ; these processes being all officially directed except the 
last. They are best preserved by being poured while hot into pint bottles, 
which should be corked securely while full, and the tops dipped into 
melted sealing-wax. Fermented syrups are useless for dispensing pur- 
poses. The number of official syrups is 32, as follows, — 

Syrupus. Syrupus Ipecacuanhas. 

Syrupus Acacias. ' Syrupus Kramerias. 

Syrupus Acidi Citrici. Syrupus Lactucarii. 

Syrupus Acidi Hydriodici. Syrupus Picis Liquidas. 

Syrupus Allii. Syrupus Pruni Virginianae. 

Syrupus Althaeae. Syrupus Rhei. 

Syrupus Amygdalae. Syrupus Rhei Aromaticus. 

Syrupus Aurantii. Syrupus Rosas. 

Syrupus Aurantii Florum. Syrupus Rubi. 

Syrupus Calcii Lactophosphatis. Syrupus Rubi Idaei. 

Syrupus Calcis. Syrupus Sarsaparillae Compositus. 

Syrupus Ferri Iodidi. Syrupus Scillae. 

Syrupus Ferri, Quininae et Strychninae Syrupus Scillae Compositus. 

Phosphatum. Syrupus Senegas. 

Syrupus Hypophosphitum. Syrupus Sennas. 

Syrupus Hypophosphitum cum Ferro. Syrupus Tolutanus. 
Syrupus Zingiberis. 



PHARMACEUTICAL PREPARATIONS. 



597 



Tabellae, Tablets (Unofficial), — are largely manufactured by several 
reliable firms, and consist of various medicinal powders pressed into tab- 
let shape by machinery. They are extremely convenient preparations 
for the physician's use, as quite a variety can be carried in a pocket-case, 
and as slight pressure is sufficient to reduce them to powder they can 
be dispensed with facility and accuracy of dosage. The following list 
includes the most important of these preparations, the figures represent- 
ing the number of grains in a tablet in each case : — 



Benzoic, 5. 
Gallic, 5. 
Salicylic, 2^ 
Salicylic, 
Tannic, 2, 5. 

Aloes, 2. Aloes et Ferri (U. S. P.). 
Aloes, 2, et Myrrh, I. 
Aloes, %, et Rhei, 1^, et Gentian, -/, 
Aloin, \ ? %,y 2 . 
Ammonium Bromide, 5, 10. 
Ammonium Chloride, 3, 5, 10. 
Antiseptic, Hydr. Chlor. Corros. , "]%. 
Atropine, -£■■§. 
Bismuth Subcarb. , 5. 

Subnitrate, 5, 10. 

Borax, 5. 

Caffeine Citrate, I, 

Calcium Sulphide, jL, y{ , J4, *■ 

Calomel, #, *4, I, 2, 3, 5. 

Calomel, 2, Opium, 1. 

Camphor Monobromated, 2, 3, 5. 

Carbo Animalis, 10. 

Cathartic, Compound (U. S. P.). 

Vegetable (U. S. P.). 

Cerium Oxalate, 2. 
Chloramine Pastilles (Spencer). 
Cinchona Alkaloids (Mixed). 
Cinchonine Sulphate, 2, 3, 4, 5. 
Cinchonidine Sulphate, 2, 3, 4, 5. 
Cocaine Hydrochlorate, y^. 
Codeine, y(. 

Digitalin, ¥ V 

Extract of Cannabis Indica, %. 
Extract of Ignatia Amara, }£, y^. 
Extract of Nux Vomica, X' X- 
Fehling's Test for grape-sugar in urine. 
Ferrum (Quevenne's), I, 2. 

Arsenate, yi, %. 

Proto-carbonate, 3, 5. 

Lactate, I. 



Ferrum Pyrophosphate, 2. 

and Quinine Citrate, 2, 

Hydrargyrum, I, 3, 5. 

Chloridum Corros., J, 



3,5- 



0> ¥0> 2 0' TO' 

' l /s, Ye, X- 
1 

Ipecac, et Opii, 2, 3, 5. 

Morphine Sulphate, J-, %, Ye, %, l / 2 

Opium, Deodorized, I. 

Opium, y 2 , and Lead Acetate, 1^. 

Pepsin, Saccharated, 2, 5. 

Podophyllin, T \, %, % , }4, I, 2. 

Potassium Bromide, 5, 10. 

Chlorate, 5. 

and Borax, aa 2^. 

Iodide, 5. 

Nitrate, 5. 

Permanganate, }4, I, 2. 

Quinine Bisulphate, ]/ 2 , I, 2, 3, 4, 5. 

Salicylate, 2. 

Quinine Sulphate, ^, I, 2, 3, 4, 5. 

Quinquinine, 2, 3. 

Rhubarb, 3. Rhei Co. (U. S. P.). 

Rhubarb, 2, and Magnesia, 2. 

Salicin, 2^, 5- 

Santonin, I. 

Santonin, I, and Calomel, I. 

Sodium Bicarbonate, 5. 

Salicylate, 3, 5. 

Strychnine, T ^, £>, up to -L. 
Zinc Phosphide, y 1 ^ up to l / 2 . 

Hypodermic Tablets. 

Morphine Sulphate, jL to \. 
Morph. Sulph. and Atropine Sulph. 
Atropine Sulphate, - 2 iyo~"5V 
Strychnine Sulphate, ^bo' 
Apomorphine Hydrochlorate, ^V-To* 
Pilocarpine Hydrochlorate, ^"i- 
(And several others.) 



The terms Tabloid and Soloid are proprietary designations of compressed tablets 
manufactured by a particular firm, Messrs. Burroughs, Wellcome and Co., of London, 
England. 



Tincturae, Tinctures, — are alcoholic solutions of medicinal substances, 
and with one official exception (Tincture of Iodine) are made from non- 



193 



PHARMACEUTICAL PREPARATIONS. 



volatile bodies. They are prepared by percolation, maceration, solution 
or dilution ; the menstrua employed being chiefly Alcohol, Diluted Alco- 
hol, and Alcohol and Water in various proportions. In one case (Tinc- 
ture of Sanguinaria) Acetic Acid is an ingredient of the menstruum, in 
two the Aromatic Spirit of Ammonia, and in several Glycerin. 

For Tinctures of Fresh Herbs [Tinctura Herbartim Recentiuni), the Pharmaco- 
poeia prescribes a general formula, according to which, when not otherwise directed, they 
are to be prepared by macerating 50 grammes of the fresh herb, bruised or crushed, in 
100 cubic centimeters of alcohol, for 14 days, then expressing the liquid and filtering. 

The official Tinctures number 71, and are named in the following list, 
the figures placed after each name giving the number of grammes of the 
drug in each 100 cubic centimeters of the tincture : — 



Tinctura Aconiti, 35. Tinctura 

Tinctura Aloes, 10. Tinctura 

Tinctura Aloes et Myrrhas, 10. Tinctura 

Tinctura Arnicas Florum, 20. Tinctura 

Tinctura Arnicas Radicis, 10. Tinctura 

Tinctura Asafcetidae, 20. Tinctura 

Tinctura Aurantii Amari, 20. Tinctura 

Tinctura Aurantii Dulcis, 20. Tinctura 

Tinctura Belladonnas Foliorum, 15. Tinctura 

Tinctura Benzoini, 20. Tinctura 

Tinctura Benzoini Composita, 12. Tinctura 

Tinctura Bryoniae, 10. Tinctura 

Tinctura Calendulas, 20. Tinctura 

Tinctura Calumbae, 10. Tinctura 

Tinctura Cannabis Indicae, 15. Tinctura 

Tinctura Cantharidis, 5. Tinctura 

Tinctura Capsici, 5. Tinctura 

Tinctura Cardamomi, 10. Tinctura 

Tinctura Cardamomi Composita, 2. Tinctura 

Tinctura Catechu Composita, IO. Tinctura 

Tinctura Chiratae, 10. Tinctura 

Tinctura Cimicifugas, 20. Tinctura 

Tinctura Cinchonas, 20. Tinctura 

Tinctura Cinchonas Composita, 10. Tinctura 

Tinctura Cinnamomi, 10. Tinctura 

Tinctura Colchici Seminis, 15. Tinctura 

Tinctura Croci, 10. Tinctura 

Tinctura Cubebas,-20. Tinctura 

Tinctura Digitalis, 15. Tinctura 

Tinctura Ferri Chloridi, 13.6. Tinctura 

Tinctura Gallas, 20. Tinctura 

Tinctura Gelsemii, 15. Tinctura 

Tinctura Gentianae Composita, IO. Tinctura 

Tinctura Guaiaci, 20. Tinctura 

Tinctura Guaiaci Ammoniata, 20. Tinctura 
Tinctura Zingiberis, 20. 



Humuli, 20. 

Hydrastis, 20. 

Hyoscyami, 15. 

Iodi, 7. 

Ipecacuanhas et Opii, 10. 

Kino, 10. 

Kramerias, 20. 

Lactucarii, 50. 

Lavandulae Composita, 0.8, 

Lobelias, 20. 

Matico, 10. 

Moschi, 5. 

Myrrhae, 20. 

Nucis Vomicae, 20. 

Opii, 10. 

Opii Camphorata, 0.4. 

Opii Deodorati, 10. 

Physostigmatis, 15. 

Pyrethri, 20. 

Quassias, IO. . 

Quillajas, 20. 

Rhei, 10. 

Rhei Aromatica, 20. 

Rhei Dulcis, 10. 

Sanguinarias, 15. 

Scillas, 15. 

Serpentarias, 10. 

Stramonii Seminis, 15 • 

Strophanthi, 5. 

Sumbul, 10. 

Tolutana, IO. 

Valerianae, 20. 

Valerianae Ammoniata, 20. 

Vanillas, IO. 

Veratri Viridis, 40. 



Triturationes, Triturations, — form a class of powders having for 
their diluent Sugar of Milk, and possessing a definite relation between the 
active ingredient and the diluent. The Pharmacopoeia prescribes a gen- 
eral formula for these preparations, according to which 10 grammes of the 



PHARMACEUTICAL PREPARATIONS. 599 

Substance and 90 of Sugar of Milk are to be well mixed by a spatula, the 
latter being added in successive quantities, and both triturated in a mortar 
until the substance is intimately mixed with the diluent and finely com- 
minuted. There is but one official trituration (Trituratio Elaterini), 
though the Pulvis Ipecacuanhas et Opii practically belongs to this class, 
except in respect to the proportions prescribed. Sugar of Milk is em- 
ployed as the diluent because of its hardness and its comparative insolu- 
bility. The first of these qualities secures the fine comminution of the 
active ingredient, whereby the action of the medicine is increased and 
better distributed. Its insolubility makes it the best diluent for powders 
or triturations administered from a spoon or glass with fluid, as is so often 
done, for unlike cane sugar it is not readily dissolved and does not leave 
the active substance behind on the surface of the utensil. Triturations 
are excellent forms for the administration of powerful alkaloids, which 
may thus be divided with great accuracy into the minute quantities re- 
quired. Mercury and its salts are especially adapted to this method of 
preparation, being more uniformly divided and hence more active than 
when administered in any other form. Triturations of mercury with sugar 
were commonly used in England a hundred years ago, and triturations of 
many substances were employed by the Arabian physicians of the 13th 
century ; but the subsequent adoption of these preparations by the home- 
opathists produced such a prejudice against them in the ranks of the regu- 
lar profession, that until recently any one using them stood in danger 
of being stigmatized as a homeopath. Their recognition by the U. S. 
Pharmacopoeia under their proper title does away with any such implica- 
tion, though it is much to be regretted that the compilers of the last two 
revisions of the British Pharmacopoeia should have shown their fear of a 
name by continuing the title Pulvis Elaterini Compositus to designate 
a preparation which in every respect is a trituration. The preparations 
of Pepsin daily prescribed by physicians all over the country are really 
sugar-of-milk triturations of that ferment, and not pure pepsin as many 
suppose. Professor H. G. Piffard, Med. Dept. Univ. of the City of New 
York, in his treatise on the Materia Medica and Therapeutics of the Skin 
(N. Y., 1881), after detailing several microscopical examinations of pills 
and triturations, uses the following language : — 

"It is to be expected, therefore, that the protoiodide trituration will prove, ceteris 
paribus, more active than the pill, and such we have found it. Since we have 

used the triturations, however, in preference to the ordinary pills, patients more rarely 
complain of disagreeable sensations. We have been enabled to materially reduce the 
size of the dose in order to obtain the desired effect. In other words, a larger proportion 
of the drug is utilized for specific purposes, while but a small amount remains to give rise 

to local irritation I have nothing to add to this, except that I continue to 

use triturations of Mercury and other substances with increasing satisfaction. Beside 
those mentioned I employ Calomel, Cyanide of Mercury, Black Oxide of Mercury and 
Corrosive Sublimate in this form. ' ' 



6oo 



PHARMACEUTICAL PREPARATIONS. 



The following examples will illustrate the mode in which Triturations 
may be prescribed : — 



R . Hydrarg. Oxidi Flavi, . gr. 
Sacchari Lactis, . . . gr. 
Trit. et div. in chartulas xxiv. 
Sig. — One twice daily. 



R. 



Hydrarg. Chlor. Mitis, 
Sacchari Lactis, q. s. 

Trit. et div. in chartulas x. 

Sig. — One powder daily. 



gr. x. 



R. Morphinae Sulph., . . . gr. j. 
Sacchari Lactis, . . . . gr. xvj. 
Trit. et div. in chartulas viij. 
Sig. — One every six hours. 



B 



Acidi Arsenosi, . . . . gr. 

Sacch. Lactis, . . . . gr. 
Trit. et div. in chartulas xx. 
Sig. — One powder thrice daily. 



Trochisci, Troches, also called Pastilles, or Lozenges, — are small 
flattened cakes of medicinal substances, prepared from a mass made with 
a basis of Sugar, some having Mucilage of Tragacanth, others Orange- 
flower Water, Syrup of Tolu, etc., as excipients. They are especially 
useful when the active ingredients are intended to come into contact with 
the mucous surface of the throat. There are 15 official Troches, named 
as follows : — 



Trochisci Acidi Tannici. 

Trochisci Ammonii Chloridi. 

Trochisci Catechu. 

Trochisci Cretse. 

Trochisci Cubebae. 

Trochisci Ferri. 

Trochisci Glycyrrhizse et Opii. 



Trochisci Ipecacuanhas. 
Trochisci Kramerise. 
Trochisci Menthae Piperita^. 
Trochisci Morphinae et Ipecacuanhas. 
Trochisci Potassii Chloratis. 
Trochisci Santonini. 
Trochisci Sodii Bicarbonatis. 



Trochisci Zingiberis. 



Troches are not readily compounded at the dispensing counter, but 
may be obtained in all first-class shops, being prepared in great variety 
by the manufacturers. Besides the official Troches, those named in the 
following list are generally for sale : — 



Alum, gr. ij. 

Alum, gr. I^, Catechu, gr. ij. 

Ammonium Chloride, gr. ij, and Cubeb, 

gr- j • 
Ammon. Chlor., gr. ij, Liquorice, gr. viij. 
Benzoic Acid, gr. ]/ 2 . ■ 
Borax, gr. iij. 

Bismuth, gr. ij, and Charcoal, gr. v. 
Bronchial, — Oleores. Cubebae.gr. A, Tolu, 

gr. \, 01. Sassafras, gr. t 'q, and Ext. of 

Liquorice, gr. vij. 
Brown Mixture. 
Carbolic Acid, gr. j. 



Ginger and Sodium Bicarbonate. 

Guaiac, gr. ij. 

Kino, gr. ij._ 

Lettuce, gr. j. 

Lime-juice. 

Logwood, gr. ij. 

Magnesia, gr. iij. 

Pellitory, gr. j. 

Pepsin, gr. iij, Charcoal, gr. iij, Magnesia, 

gr. ij, and Ginger, gr. j. 
Potassium Bitartrate, gr. iij. 
Potassium Citrate, gr. iij. 
Santonin, gr. y 2 , and Calomel, gr. ]/ z . 



Unguenta, Ointments, — are soft, fatty mixtures of medicinal agents 
with a basis of lard, petrolatum, or fixed oils with a solid fat such as wax 
or spermaceti. They are intended for application to the skin by inunc- 
tion, and have a melting point which is below the ordinary temperature 



PHARMACEUTICAL PREPARATIONS. 6(31 

of the human body. Of the 23 official Ointments I is prepared by chem- 
ical reaction (Unguentum Hydrargyri Nitratis), 3 by fusion and 17 by 
incorporation of the ingredients with each other, they being mixed to- 
gether by trituration or through the agency of a spatula and a porcelain 
slab. Unguentum itself is prepared by fusing together 80 of Lard and 20 
of yellow Wax, and is the basis of 3 other ointments, while 14 have Benzo- 
inated Lard as their basis. The official Ointments are — 

Unguentum. Ung. Hydrargyri Oxidi Flavi (io). 

Unguentum Acidi Carbolic! (5). Ung. Hydrargyri Oxidi Rubri (10). 

Unguentum Acidi Tannici (20). Unguentum Iodi (4). 

Unguentum Aquae Rosae. Unguentum Iodoformi (10). 

Unguentum Belladonnas (10). Unguentum Picis Liquidae (50). 

Unguentum Chrysarobini (5). Ung. Plumbi Carbonatis (10). 

Unguentum Diachylon. Ung. Plumbi Iodidi (10). 

Unguentum Gallae (20). Ung. Potassii Iodidi (12). 

Unguentum Hydrargyri (50). Unguentum Stramonii (10). 

Ung. Hydrargyri Ammoniati (10). Unguentum Sulphuris (30). 

Ung. Hydrargyri Nitratis (7). Unguentum Veratrinae (4). 
Unguentum Zinci Oxidi (20). 

The figures in parentheses show the percentage of the extract or other active ingredi- 
ent in the ointment. The composition of each may be found in the section on Materia 
Medica under the title from which the preparation is named, except Unguentum, which 
will be found under the title Adeps, and Unguentum Diachylon under Plumbum. 

Ointments and Cerates are frequently ordered on extemporaneous for- 
mulae, though the numerous official preparations of these classes would 
seem to give the physician a sufficiently wide field for selection. The 
basis is usually either the official Ceratum or Unguentum, but Petrolatum, 
Lard, Lead Plaster with a fixed oil, etc., may be employed. Lard is 
probably the best basis for all ointments, as it softens the skin better than 
any other similar substance. Its disadvantage is that it soon becomes 
rancid, so that preparations made with it must be quickly used. Cerates 
only differ from ointments in their firmer consistence, melting at tem- 
peratures above 104 F., while the latter melt below the ordinary tem- 
perature of the body. Oleates are described fully on page 103. 

The process of compounding an ointment or a cerate is sufficiently sim- 
ple, being generally a mere matter of triturating the ingredients together 
in a mortar, or of their incorporation on a slab by means of a spatula. 
Rarely will melting be required in the compounding of extemporaneous 
ointments. When extracts, powders or gritty substances are ordered, the 
ingredients should be first pulverized into a fine powder, then triturated 
with a small quantity of the basis into a smooth, impalpable paste, the 
remainder of the basis being added gradually, until the whole is thor- 
oughly incorporated. A warm mortar may be required for hard extracts. 
Soluble salts should be triturated with a little water before adding the 
excipient. Camphor needs a little alcohol to enable it to be pulverized. 
Iodine should be rubbed to a fine powder, then a little alcohol added 



602 



PHARMACEUTICAL PREPARATIONS. 



and finally the excipient by degrees. Sulphur Iodide requires persevering 
work with a small portion of olive oil. Borax should be triturated with 
glycerin and Red Mercuric Oxide with distilled water. A bone or horn 
spatula should be used for all ointments, as steel or iron blades will injure 
many substances, particularly alkaloids, free acids, tannin, iodine and 
several of the mercurial salts. Volatile substances are added last and 
quickly worked in, so that their evaporation may be as slight as possible. 
Ointments are dispensed usually in amber-colored glass pots with wooden 
or metallic covers, or in porcelain jars called Gallipots. In hospital and 
dispensary practice the common chip pill-box is used, but soon becomes 
exceedingly dirty and disagreeable to handle. 



Unguentum Iodoformi Compositum. 

. Iodoformi, , gj. 

01. Anisi rrycx. 

01. Rosse, 

01. Ylang-ylang, . . aaTT\v. 

Ung. Aquae Rosse, . . ^j. 
M. Fiat unguentum. 
Sig. — Ointment. 



Unguentum Anti-pruriticum . 



R 



Camphorae, 
Chloralis Hydrat., . . aa gj. 
Tere una ad liquorem, dein 
adde cum tritu — 

Unguenti Aquae Rosae, . gj. 
M. Fiat unguentum. 
Sig. — Ointment for itching. 



Vina, Wines, — when medicated are practically the same as tinctures. 
The menstruum directed to be used is the official White Wine (Vinum 
Album), which should contain from 10 to 14 percent, by weight of abso- 
lute alcohol. It is however reinforced by the addition of alcohol to the 
amount of 15 per cent, in all the medicated wines except that of Ipecac, 
which has 10 per cent. In the two Ferric Wines the alcoholic reinforce- 
ment is in the shape of the tincture of sweet orange peel. The official 
Wines are 10 in number, 2 of which are not medicated and stand first 
in the following list; 4 are prepared by solution or admixture, 2 by 
percolation and 2 by maceration during seven days. They are — 



Vinum Album, 10-14. 
Vinum Rubrum, 1 0-14. 
Vinum Antimonii, 0.4. 
Vinum Colchici Radicis, 40. 
Vinum Colchici Seminis, 15. 



Vinum Ergotae, 15. 
Vinum Ferri Amarum, 5. 
Vinum Ferri Citratis, 4. 
Vinum Ipecacuanhae, 10. 
Vinum Opii, 10. 



The figures placed after the first two show the percentage of absolute alcohol by weight 
required in each ; those placed after the others indicate the quantity of the principal in- 
gredient in grammes to each 100 cubic centimeters of the preparation. 



PART III. 

SPECIAL THERAPEUTICS. 



Authorities. The principal authorities to whom references are made, 
with their initials, are included in the following list. When a statement 
is not followed by any reference by name or initial, it is to be understood 
as coming from the writer of this book. 

References and Bibliography. 

(A) Aitken. — The Science and Practice of Medicine, by Wm. Aitken. 
(Ag) Agnew. — The Principles and Practice of Surgery, by D. Hayes Agnew. 

(B) Bartholow. — Materia Medica and Therapeutics ; also On the Antagonism between 

Medicines and between Remedies and Diseases, by Roberts Bartholow. 
(Br) Brunton. — Pharmacology, Therapeutics and Materia Medica, by T. Lauder Brunton. 

(C) Carter. — A Practical Treatise on Diseases of the Eye, edited by Green. 
(CI) Clarke. — A Manual of the Practice of Surgery, by W. Fairlie Clarke. 

(Da C) Da Casta. — Notes of Clinical Lectures, delivered by Professor J. B. Da Costa at 
the Pennsylvania and Jefferson Hospitals. 

(D) Druitt. — A Manual of Modern Surgery, by Robert Druitt. 

(E) Emmet. — Principles and Practice of Gynecology, by Thos. Addis Emmet. 
(El) Ellis. — A Practical Manual of Diseases of Children, by Edward Ellis. 

(F) Fothergill. — The Practitioner's Handbook of Treatment, by J. M. Fothergill. 

(G) Goodell. — Lessons in Gynecology, by William Goodell. 

(H) Hamilton. — Nervous Diseases, etc., by Allan McLane Hamilton. 

(L) Leishman. — A System of Midwifery, by William Leishman. 

(M) Murrell. — A Manual of Pharmacology and Therapeutics, by Wm. Murrell. 

(Mn) Manson. — Tropical Diseases, by Patrick Manson. 

(M & P) Meigs and Pepper. — Diseases of Children, by J. F. Meigs and Wm. Pepper. 

(N) Niemeyer. — A Text-book of Practical Medicine, by Felix von Niemeyer. 

(O) Osier. — The Principles and Practice of Medicine, by Wm. Osier. 

(P) Phillips. — Materia Medica and Therapeutics, by Chas. D. F. Phillips. 

(Pf) Piffard. — Materia Medica and Therapeutics of the Skin, by H. G. Piffard. 

(R) Ringer. — A Handbook of Therapeutics, by Sidney Ringer. 

(Ros) Rosenthal. — Diseases of the Nervous System, by M. Rosenthal. 

(S) Sdlle. — Therapeutics and Materia Medica, by Alfred Stille. 

(St) Sturgis. — The Student's Manual of Venereal Diseases, by F. R. Sturgis. 

(T) Tanner. — An Index of Diseases and their Treatment, by Thos. H. Tanner. 

(Tr) Trousseau and Pidozcx. — On Therapeutics, by Trousseau, Pidoux and Paul. 

(Tt) Tail. — Diseases of Women, by Lawson Tait. 

(Ty) Tyson. — The Practice of Medicine, by James Tyson. 

(W) Wood. — Therapeutics, its Principles and Practice, by H. C. Wood. 

(Wa) Waring. — Practical Therapeutics, edited by Buxton. 

(Y) Yeo. — A Manual of Medical Treatment, by I. Burney Yeo. 

Besides the above-named, occasional references are made to other works by the same 
authors. References will also be found, with names in full, to Anstie, Brown-Sequard, 
Clymer, Cohen, Flint, Fordyce-Barker, Gross, Hammond, Hilton, Lister, Loomis, Mitch- 
ell, Nelaton, Noyes, Nussbaum, Ricord, Roosa, Simpson, A. A. Smith, Thomas, several 
authors in Allbntf s System of Medicine, and many writers in current medical literature. 

603 



604 



ABASIA ABDOMINAL PLETHORA ABORTION. 



Applied Therapeutics may be studied either with the various thera- 
peutic agents as the objects of chief consideration, as in the first part of 
this work ; or with the different diseases and morbid conditions forming 
the objects of study in respect to their modification and treatment by 
medicines. In the following pages the latter method is followed, the 
therapeutics of each affection being exhibited in the form of an Analyti- 
cal Index to the recognized text-books of the day. Every indication for 
the use of a drug, or statement regarding its value, is followed by the 
name or initial (in parenthesis) of its author : these references enabling 
the book to be used as an Index to the Authorities, for more strict differ- 
entiation between indicated remedies, — while the brief analyses given 
include sufficient material to make each section a synopsis of the most 
advanced therapeutics of the disease named in its title. 



Abasia and Astasia. 

Sodium Phosphate, by hypodermic injection, once a day for 25 days, cured 
a case of unilateral abasia-astasia (Charcot's " neurasthenie dimidiee"), in the 
municipal hospital at Jerusalem. The patient should be taught to walk as one 
teaches an infant, and compression of the posterior region of the trunk may 
be made with an appropriate bandage (Roux). [Compare Hysteria.] 



Abdominal Plethora. 

Cathartics, saline and hydragogue cathartics are of value in congestion of 
the portal circulation (B). Saline Mineral Waters, especially the purgative 
saline waters, as Vichy and Saratoga, in plethora of the abdominal viscera (B). 
Grape-cure has helped many cases, particularly those of hepatic engorgement 
and sluggish portal circulation ; is best used after a preliminary course of 
powerful mineral waters (P). Aliment is very important ; a dry diet is particu- 
larly indicated in cases of dyspepsia and hepatic enlargement due to excessive 
beer-drinking. Avoid much bread, also salted or twice-cooked meats, rich 
sauces, solid vegetables, especially cucumbers, soups and fruits. Biscuits, 
fresh meat, lemons, fish, fowl and game, may be used. [Compare Hepatic 
Congestion, Obesity.] 



R . Potassii Bicarbonatis, 

Sodii Sulphatis, .... aagiv. 
Solve in Ojss Aquae, et adde — 

Acidi Tartarici (cryst.), . ^ij. 
Cork quickly and firmly. ^d to be 
taken thrice daily. 



5L . Resinse Podophylli, . . . gr. vj. 
Ext. Colocynthidis Co., . gr. xij. 
Ext. Belladonnas Fol. 

Alcoh. , gr. iij. 

Fiat massa, et div. in pil. no. xij. 
Sig. — One pill every night. 



Abortion. 

Opium, cautiously in threatened abortion, is often very valuable (Wa); the 
tincture, rtpcx-xxx by rectum (Parvin) ; Opium to check uterine action and 
Ergot to restrain hemorrhage (B). Ergot, small tonic doses give excellent 
results in threatened abortion (P). Tannin, combined with Opium and Ipecac 
(W). Cimicifuga, to prevent miscarriage when uterus is irritable and pro- 
lapsed (R). Savine, the dried powder of the leaves, gr. xv-xx, thrice daily, 
one of the most powerful remedies against the hemorrhage indicative of ap- 
proaching abortion (Wa) ; the tincture in doses of 5 to 10 drops, every y 2 to 3 



ABSCESS. 



605 



hours, useful against the hemorrhage (P). Viburnum Prunifolium, in threat- 
ened and habitual abortion, has a very high reputation. Aurum Chloride, to 
avert the tendency to habitual abortion (B). Iron, with Potassium Chlorate, 
throughout the pregnancy, when fatty degeneration the cause of habitual abor- 
tion (McLane). Asafcetida, is highly efficient in habitual abortion; given in 
pills of gr. jss each, 2 daily, gradually increased to 10 daily, as soon as a new 
pregnancy occurs, and continued until the labor is over (Turazzo). Tampon- 
ade, of the cervix uteri, with cotton or sponge, dipped in vinegar or glycerin, 
when abortion is inevitable and it is desirable to hasten it and restrain hemor- 
rhage. Empty the uterus thoroughly with the finger, placenta-forceps liable 
to do harm (Barker). Abortifacients (see page 58); Quinine and Ergotin, 
of each gr. ij in pill every 3 hours, the routine abortifacient of many irregular 
practitioners. Only by the production of such violent irritation of the ab- 
dominal and pelvic organs as generally endangers life, can the pregnant 
uterus be stimulated to expel its contents (P). The abortifacient effect of 
Savine and other drugs cannot be obtained unless by the administration of a 
quantity sufficient to endanger life (B). 



R. Ext. Ergotae Fluidi, . . . 3 v. 
Tinct. Opii Deodorat, . . ^iij. 
Syrupi Limonis,. . . . ^j. 
M. Sig. — Ateaspoonful thrice daily. 



R . Acidi Tannici, . . , . . gr. xv. 
Pulv. Ipecacuanhae, . . . gr. xij. 

Extracti Opii, gr. iij. 

Ft. pil. xij. Sig. — One every six hours. 



Abscess. 

Poultices to check or to assist in maturation ; may be smeared with Bella- 
donna or Opium (R). Belladonna, as plaster to subdue (B) ; painted around 
areola (Wa) ; internally often successful in aborting abscesses (R). Calcium 
Sulphide, half-grain doses frequently repeated, to abort abscess or to hasten 
formation of pus (B) ; gr. ^ every hour or two, gives striking results in healing 
large abscesses (R). Calcium Phosphate, in large abscesses (R). Mercury 
and Morphine, the Oleate locally, diminishes induration due to old abscesses 
and prevents the formation of new ones (R). Carbolic Acid, a weak solution 
as injection after evacuation, also as a dressing (Lister). Silver Nitrate, a 
strong solution in Nitrous Ether if applied early to adjacent surface will check 
inflammation (B). Blisters or Iodine, as counterirritants around or adjacent 
to seat of disease (R). Potassium Permanganate, Z) to the pint of water, to 
correct fetor (B). Iodine, the tincture injected after opening large abscesses 
(R) ; especially in scrofulous abscess (Wa). Salicylic or Boracic Acid, as 
dressings (B). Sarsaparilla, a very useful remedy in chronic abscess with pro- 
fuse discharge (P). Cod-liver Oil, improves and lessens discharge from scrof- 
ulous abscesses (Wa). Surgical. Opening necessary in all deep abscesses, 
or when on face, near anus, mammary, or if danger of its opening into an in- 
ternal cavity. Open with grooved director and forceps ; never open a deep 
abscess with a plunge (Hilton). Drainage-tube may be required, also irriga- 
tion of the cavity and pressure (Agnew). Weaning of child necessary in 
chronic mammary abscess (Gross). Psoas abscess may result from strain or 
laceration of muscle, as by heavy lifting, effort to recover balance when skat- 
ing, etc., as well as from spinal disease; the symptoms are often obscure, sim- 
ulating those of chronic malaria. Early opening by lumbar incision neces- 
sary ; then tonics, good food, and daily irrigation of the cavity with an 
antiseptic solution. [Compare Suppuration, Carbuncle.] 



R. Quininae Sulph., .... gj. 
Ferri Pyrophosphatis, . . gj. 
Strychnine Sulph., . . . gr. j. 
Ac. Phosphor. Dil., . . gij. 



Syrupi Zingiberis, . . . . % ij . 



Aquae, q. s. ad 
M. Fiat mistura. 
thrice daily. 



Sig. — A teaspoonful 



6o6 



ACIDITY ACNE. 



Acidity. 

Acids, Hydrochloric or Phosphoric before meals ; acid wine, a genuine 
Rhine wine best; Sulphurous Acid tt\,v-xxx well diluted, for acid fermentation 
of starchy foods (R) ; acids after meals for alkaline pyrosis (R). Tannic Acid, 
useful in pill, gr. iv with rr\j of Glycerin (B). Carbolic Acid, often arrests 
eructations (B). Alkalies, after meals, for immediate relief, effects only tem- 
porary, Bicarbonates best (R) ; frequent use of alkalies enhances the mischief 
(B). Nux Vomica, K\,ij-iij of tincture before meals ; is excellent in small doses 
(B) ; especially in acidity of pregnancy (R). Pulsatilla, TT\,v of tincture every 
4 hours in acid dyspepsia (P). Silver Oxide, extremely useful (B). Man- 
ganese Oxide, gr. x-xx of the purified black oxide relieves (B). Kino, a favorite 
remedy (B). Ipecacuanha, in acidity of pregnancy (R). Mercury, gr. ss of 
gray powder thrice daily, when acidity with clayey stools (R). Atropine, the 
sulphate, thrice daily by mouth, gave excellent results in a case of gastric hy- 
persecretion of acid; after the third day pain had stopped and vomiting 
ceased. Bismuth, gives excellent results, combined with Opium or Morphine, 
sometimes with Magnesia (R). Diet, use lemon-juice, aerated or old bread, 
plain biscuits ; avoid new bread, pastry, and vegetables. 



& . Bismuthi Subnitrat, . . giij. 

Acidi Carbolici, .... gtt. ij-v. 

Mucil. Acacise, . . . . t ^j. 

Aquae Menth. Pip., . . ^iij. 
M. Sig. — A tablespoonful 3 or 4 times 
daily for adults. 



R-. Sodii Bicarbonatis, . . gij. 
Spt. Ammonias Aromat., gij. 
Tinct. Zingiberis, . . . ^j. 
Infus. Gentianae Co. (U. 

S. P., 1870), q. s. ad jfviij. 
M. Sig. — A tablespoonful or two. 



Acne. 

Alkalies, internally, yield the best results in a number of cases (Bulkley) ; 
alkaline lotions for cases with seborrhea (B). Borax, a weak solution in rose- 
water (3j-^viij), of great benefit locally in acne simplex (Wa). Potassium 
Bromide, in moderate doses, has proved curative in some obstinate cases (R). 
Sulphur, internally and as a lotion ; in severe forms an ointment of the Iodide 
or Hypochlorite, gij ad ^j (R). Belladonna, locally, is of some service, 
checking the abundant secretion from the sebaceous follicles (R). Arsenic, in 
old cases, especially in acne indurata, but often disappoints ; given with Brom- 
ides it prevents the bromic acne (R) ; Arsenic Bromide is adapted to most cases 
of acne vulgaris (Pf). Phosphorus, is an excellent substitute for arsenic (B) ; 
the compound syrup of the Hypophosphites in acne indurata (R). Mercury, 
in lotion, is much employed (B) ; a weak lotion of the Bichloride to the face two 
or three times daily (R) ; the Iodo-chloride (gr. v-xv ad j§) as irritant applica- 
tion (Fox) ; or ointments containing the Bichloride or Biniodide may be 
employed instead of the green soap application (Pf ). Glycerin, internally, has 
been used with success (B). Berberis, tt\,v of a fresh tincture thrice daily for 
the acne of girls at puberty. Calcium Sulphide is indicated in cases character- 
ized by a tendency to pustulation (Pf ). Bismuth, locally, as a cosmetic (B). 
Magnesium Sulphate, as a purgative daily before breakfast, in cases of acne 
vulgaris depending on derangement of the stomach and bowels (Duhring) ; the 
salt, finely triturated, is an excellent dusting-powder and in five-grain doses 
internally, 3 or 4 times a day, is often very efficient in acne vulgaris and other 
obstinate eruptions due to derangement of the gastro-intestinal tract. Ergot, 
is well used in various forms of acne (See Acne Rosacea). Sapo Mollis, as an 
active irritant in subacute cases, applied every night as long as bearable, then 
emollients until irritation subsides, when the soap should be removed (Pf). 
Water, hot sponging for 15 or 20 minutes several times a day, followed by Gly- 
cerite of Starch to allay irritation (R) ; the local use of very hot water is of the 
greatest benefit in all inflammatory forms of acne (Bulkley). Puncturing each 



ACNE ROSACEA ACTINOMYCOSIS. 



607 



papule with a lancet point, followed by very hot water, and ointments of Sul- 
phur Iodide, Ammoniated Mercury, etc., diluted (Pf). Diet and Hygiene, 
require careful attention (B) ; powerful tonics are often required (Bulkley). 
[Compare Acne Rosacea, Seborrhea.] 



R. Potassii Acetatis, . . . spv-^j. 

Tinct. NucisVom., . . 3 ij. 

Infusi Quassias, vel 

Tinct. Cinchonse Co^ad^xv. 

M. Sig. — Teaspoonful in water 

meals, as an antacid tonic. 



after 



R 



M 



Magnesii Sulphatis, . . ^jss. 
Ferri Sulphatis, . . . gr. xvj. 
A cidi Sulphuric! , . . . gij. 
Aquae, . . . . q. s. ad % viij. 
Sig. — A tablespoonful in a glass of 



water before breakfast. 



R . Sulphuris, . . 
Glycerini, . . 
Aquas Rosas, 
M. Sig.— Lotion. 



3 VI J- 



R. Bismuthi Subnit., . . gj. 
Ung. Hydr. Ammoniat., % ij. 
Ung. Aq. Rosas, . . ad ^j. 
M. et fiat unguentum. 



R 



Hydrarg. Iodo-chlor., . gr. v-xv. 

Adipis, gj. 

Fiat unguentum. An irritating applica- 
tion, requiring care. 



Acne Rosacea. 

Resorcin, as paste with equal part of Zinc Oxide, applied to the affected 
part several times a day, to promote peeling of the skin in the treatment of 
acne rosacea ; in 3 or 4 days the skin becomes like parchment, when the appli- 
cation must be stopped to avoid cracking of the skin, and a dressing of gelatin, 
glycerin, zinc oxide, and hot water is applied, covered with cotton wool; in a 
few days the dressing will come off, bringing the skin with it. Some few dan- 
gerous results have followed this practice, but there have been a number of 
very satisfactory cases (Unna). Ergot is well used in acne rosacea and other 
forms of acne; a good fluid extract with glycerin and water, giving £ss inter- 
nally per diem (B). Magnesium Sulphate, finely triturated, is an excellent 
dusting-powder for cases of acne rosacea ; also in 5-grain doses thrice daily 
internally (See Acne). Bismuth, the Oleate as an ointment, and the greased 
surface powdered over with a mixture of Oleate of Zinc, Bismuth Subcarbonate 
and Starch (Shoemaker). Antipyrin, with Coca, often gives marked relief, when 
abnormal irritability of the gastric nerve endings leads to vaso-motor disturb- 
ances of the nose and face (Whitla). Bromides, with Arsenic, for women, 
when acne rosacea due to cessation of menstruation (Id). Electricity, the gal- 
vanic current, 5 to 8 elements of an ordinary battery, both poles applied to the 
nose and continually moved about, or the anode on the zygoma and the nose 
gently stroked with the cathode; these applications repeated once in 2 or 3 
days, for at least 10 to 15 sittings, have proved uniformly successful in 31 cases 
(Helbing). Chloral will aggravate rosacea. 



R. Antipyrini, 3J SS - 

Extr. Cocas Fluidi, . . ^ij. 

Tinct. Aurantii, 

Glycerini, aa ^j. 

M. Sig. — gj thrice daily between 
meals. {Whitla.) 



R . Potassii Iodidi, .... 
Potassii Bromidi, . . . 
Liq. Acid. Arsenosi, . . 
Tinct. Sumbul, .... 
Aquas Camphoras, . ad 



gr. xl. 

3*j- 

3Jss. 

"xij. 



M. Sig. — ^ ss in water after meals. 



Actinomycosis. 

Sodium Salicylate, produces amelioration of symptoms (Netter). Potassium 
Iodide, in full doses, 80 grains daily at first, diminished as its physiological 
effect is produced, is promptly curative, acting probably by augmenting tissue 
resistance. This drug has cured six human cases in Holland, and one in. 
France ; also 71 out of 185 oxen so treated in Chicago (Netter). 



6o8 



ADDISON S DISEASE ADYNAMIA. 



Addison's Disease. 

Arsenic, with cod-liver oil, gives the best results (Da C). Iron and other 
tonics are useful, especially a combination of the chloride, glycerin and chloro- 
form (Greenhow). Phosphorus, has seemed to exert a beneficial influence 
(Wilks). Adrenal Extract has been employed in a few cases with some benefit 
while used. (See page 165.) Treatment must be symptomatic, and is of little 
use, the disease being always fatal (H). 



R . Tinct. Ferri Chloridi, 

Spt. Chloroformi, . . aa t !f j. 
Glycerini, ^vj. 



M. Sig.- 
thrice daily. 



-A dessertspoonful in water 
{Greenhow.) 



Adynamia. 

Cinchona, or Quinine, with Arsenic, for pale, badly-fed town-dwellers (R) ; 
as a general tonic when flesh flabby, skin perspiring (P). Arsenic, for swelled 
feet of old or weakly persons, and breathlessness from weak heart (R) ; as a 
tonic in continued doses of gr. g 1 ^ to -^ (Wa). Nux Vomica, in adynamia of 
drunkards ; Tinct. Capsici £vj ; Tinct. Nucis Vom. gij ; gtt. xx in water every 
four hours (B). Calcium Phosphate, when from prolonged town-life or over- 
work ; gr. j with grain j each of Iron Phosphate and Calcium Carbonate as a 
dose (R) ; Hypophosphites of Lime or Soda, in nervous or general debility 
(R). Iron, promotes appetite and digestion ; gr. j-iij of the Sulphate, or the 
official Iron and Aloes pill, or with Manganese (B) ; anemic subjects (R). 
Hydrastine, as substitute for Quinine, to promote appetite and digestion and 
improve assimilation (B). Digitalis or Eucalyptus, in debility with weak heart 
action (B). Bitters, especially Calumba and Gentian, are useful for a short 
time (B). Sanguinaria, when stomach needs stimulation (P). Sarsaparilla, in 
broken-down, syphilitic constitutions (P). Orchitic Extract. [See page 163]. 
Alcohol is of great value, but has been abused ; hurtful when it increases tem- 
perature and pulse, dryness of tongue, etc. (B) ; a wine with much ether in 
debility of old age, especially where sleeplessness, indigestion and stomach 
cramps (R). Aliment, sugar and saccharine fruits, vegetables, oil, milk, cod- 
liver oil, wine of good body and strength (B) ; Porter or Rum-and-milk for 
town-living women (R). Sea-bathing is useful in chronic illness, with much 
debility (R). Turkish Baths, when debility is caused by the tropics, but cau- 
tion necessary ; when town-dwellers become stout and flabby, are easily tired, 
suffer from a lack of energy and from mental depression, a course of baths is 
beneficial (R). [Compare Anemia, Convalescence, Neurasthenia.] 



Tonic Presc7'iptions. 



R 



Liq. Potas. Arsenitis, . . Tf\x. 
Ext. Nucis Vom. Fluidi, . ir^xx. 
Tinct. Gentianse Compos., 
Tinct. Cinchona, 
Tinct. Calumbas, 

Vini Kolas, aa jfiv. 

M. Sig. — A wineglassful after each 
meal. 



R. Tinct. Nucis Vom., . . . gij. 
Tinct. Cinchonas, . . . ad^'vr. 
M. Sig. — A teaspoonful after each 
meal. 



R. Acidi Arsenosi, gr. j. 

Quininas Sulphat., .... ^j. 

Ferri et Potass. Tart., . . gij. 
M. Ft. pil. no. xxx. Sig. — One 
after each meal. 



pill 



R. 



Quininas Sulph., 
Strychninas Sulph., 
Tr. Ferri Chloridi, 
Ac. Phosph. Dil., 
Syr. Limonis, . . 
M. Sig. — A teaspoonful in water thrice 
daily, in nervous debility. 




AFTER-PAINS AGALACTIA ALCOHOLISM. 



609 



After-pains. 

Opium, more certain in action than any other remedy (Wa) ; Morphine and 
Atropine (gr. X anc * gr. tw)» combined (B), hypodermically (Wa). Bella- 
donna, as ointment, much used in France (L). Camphor, gr. x with gr. yi of 
Morphine, an effective remedy (B) ; §j in ^vj of mucilage, tablespoonful doses 
every hour or two (Wa). Chloral, will stop the pains, but large doses (gr. xx- 
xl) are necessary (R). Chloroform, the Linimentum Chloroformi, ^j with 
Linim. Saponis ^vj, applied on flannel to the abdomen (Barker). Quinine, gr. 
v-x night and morning, with the above chloroform liniment locally, in neural- 
gic after-pains which do not yield to opiates, the uterus being tender on pres- 
sure (Barker). Gelsemium, suspends them, large doses (n\,xx) necessary (B). 
Cimicifuga, relieves the pains, and allays general nervous excitement (P). 
Ergot, is better than Cimicifuga (R). Poultices, warm, over the hypogastrium, 
with soothing injections into the vagina (L). 



Agalactia. 

Ricinus, gr. v. of extract, or 3j-ij of strong decoction, daily in water; also 
the leaves, or an infusion, locally to mammas (T). Gossypium, an emulsion 
of the seeds has repute in India as a galactagogue ; a wineglassful of the de- 
coction every 20 to 30 minutes (P). Pilocarpus, remarkably increases the se- 
cretions (B) ; Pilocarpine is a galactagogue, and probably the only example of 
this class we possess, it distinctly increasing the secretion of milk in nursing 
women (M). Tea, a good black tea is thought to promote the milk supply. 
[Compare Lactation.] 

Albuminuria. 

Aconite, in incipient albuminuria with high body-temperature (R). Lead, 
diminishes the albumin (R). Turpentine, gtt. ss-j, every 2 to 4 hours, or one 
to two drop doses night and morning, of great value in chronic albuminuria 
without other marked symptoms of Bright's disease (P). Gallic Acid, the most 
efficient agent in the acute form to restrain loss of albumin (P). [See Aitken's 
formula below.] Cannabis Indica is indicated when bloody urine (R). Chim- 
aphila, has unquestioned power over albuminuria (P). Cantharis, tr\j of the 
tincture every 3 hours, after the subsidence of acute symptoms, especially 
when bloody urine (R). Fuchsin, in doses of gr. j-iij, completely arrested al- 
buminuria with edema in many cases (Bouchut). Alkalies, the citrates and 
acetates as diuretics (R) ; the Buffalo Lithia Water of Virginia is highly recom- 
mended. Strontium Lactate, has been used with benefit, but should not be 
given when scanty urine or symptoms of uremia are present. Nitro-glycerin, 
tt\J of a one per cent, solution to dilate the peripheral vessels, relieving the 
heart and lessening the renal congestion (B). Turkish Baths, benefit by re- 
lieving the kidneys of work (R). Milk-cure, with buttermilk, has proved very 
efficient in many cases (B). Chalybeate Waters, especially those having pur- 
gative qualities, are beneficial (B). [Compare Bright's Disease.] 



R-. Acidi Gallici £j -r j- 

Ac. Sulphurici Dil., . . ^ss. 
Tinct. Lupuli, . . . . z]. 
Infusi Lupuli, . q. s. ad gvj. 
Sig. — Tablesp. thrice daily. — [Aitken.) 



R . Liq. Ferri et Ammonii 

Acetatis (U. S. P.), . ^vj. 
Sig. — Teasp. to a tablesp. according to 
age, well diluted, thrice daily. 

[B as ham.) 



Alcoholism. 

Arsenic, for distressing vomiting, one drop of Liquor Arsenicalis (Fowler's 
solution), before breakfast (R). Capsicum, in dyspepsia of chronic alcoholism,- 
and to induce sleep ; also as a substitute for the alcohol ; with Bromides or 

39 



6io 



ALCOHOLISM. 



Arsenic and bitters to assist in overcoming habit, by removing the distress at 
pit of the stomach ; the tincture in io-minim doses should be taken shortly 
before meals, or whenever there is a depression or craving for alcohol ; it obvi- 
ates the morning vomiting, and promotes appetite and digestion (R). Ammo- 
nia, a full dose (3ss) of the spirit will often sober a drunkard speedily (R) ; 
a few drops of Liquor Ammoniae, diluted, have prompt action (S) ; Z] of the 
aromatic spirit with Capsicum (see formula below). Ammonium Chloride, is 
remarkably efficient in straightening up a subject of acute alcoholism ; 3ss in 
Yz pint of water, swallowed at one draught, by a patient on the verge of deli- 
rium tremens, is said to quickly restore the faculties. Ammonium Acetate, 
the solution, in full doses, is one of the most efficient agents for quickly straight- 
ening up a drunkard. Hydrastine, the sulphate in doses of gr. g 1 ^ increased to 
gr. ^L, hypodermically four times a day, is one of the " cures," and has been 
used for this purpose in Canada for many years. Aurum and Arsenic Bromide, 
the solution (Barclay's), is an excellent tonic remedy for alcoholism, and may 
be used by hypodermic injection, in doses of rt\,x four times daily. Kola is a 
good general tonic for cases of chronic alcoholism. Cinchona, especially Cin- 
chona Rubra, for gastric catarrh of drunkards (B) ; Quinine, gr. ij-vj daily to 
raise the nervous tone (P). Nux Vomica, for after stomachal disorders (B) ; 
in the tremor of chronic alcoholism is of much value (P); the tincture in 5-minim 
doses with 15 of Tinct. Capsici, in water every 4 hours, is exceedingly effective 
in diminishing the craving for spirits and sustaining the nervous system. 
Strychnine, the Nitrate, gr. -^-j^ hypodermically thrice daily for ten days, is 
an absolute cure for dipsomania (Luton) ; a very valuable remedy for chronic 
alcoholism and dipsomania, not merely curing the attacks, but abolishing the 
desire for drink, the patients abstaining from spirits of their own accord (Pom- 
brak). Glycozone, is one of the very best remedies for the chronic gastric 
catarrh of chronic alcoholism (Edson). Potassium Bromide, Z] every 4 to 6 
hours in the " horrors " (B). Phosphorus, in chronic alcoholism, recommended 
by Anstie (R). Opium, cautiously, if at all (B) ; Morphine with tonics before 
meals for pain, nausea, and want of appetite (R). Cocaine has been pro- 
nounced of great benefit, restoring appetite, inducing sleep and promoting 
digestion, while it soothes the brain and induces a feeling of contentment and 
calm (R). Cimicifuga, is said to be useful in the treatment of the drunkard's 
stomach (R). Chloral is very successful, but must be cautiously used with old 
worn-out drunkards with weak hearts (B). Picrotoxin, small doses for the 
tremor, gr. fo repeated (B). Lupulin, is the best substitute for alcohol, and is 
extremely serviceable in delirium tremens (B). Zinc Oxide, is very useful in 
chronic alcoholism, to diminish the craving, to relieve the gastric catarrh and 
lessen the tremor (B). Keeley Injection contains Strychnine and Atropine, 
also Codeine and Cocaine for subjects of the opium-habit. (A r . Y. Med. 
Record.) [See under Patent Medicines.] Acute Alcoholic Poisoning [see 
page 137] requires an emetic or the stomach-pump, cold douche to the head 
and breast, warmth to the feet and limbs. Artificial respiration may be re- 
quired. Milk, mucilaginous drinks, and black coffee, are the principal reme- 
dies. A milk diet often creates a disgust for alcohol. [Compare Delirium 
Tremens, Vomiting, and Neuritis.] 



R- . Tinct. Capsici, . . . . % ss. 

Potass. Bromidi, ^ ss. 

Vel Liq. Potass. Arsenit., rr\L 

Vel Tinct. Nucis Vom., gij. 

Spt. Ammonia; Aromat. , ^iij. 

Syr. Tolutani, . q. s. ad % vj. 
M. Fiat mistura. Sig. — A dessertspoon- 
ful in water four or five times daily. 



R- . Zinci Oxidi, . . 
Piperini, .... 
M. Fiant pil. no. xx, 
thrice daily. 



• - z)- 

. . gr. xx. 
Sig. — One pill 



R 



Tinct. Gentianae Co., 
Tinct. Calumbge Co., 
Tinct. Nucis Vom., . 
M. Sig. — A dessertsp. 
meal, for rum -stomachs. 



. rr\L\xx. 
before each 
{Loomis.) 



ALOPECIA AMAUROSIS. 



611 



R. Tinct. Nucis Vom., . . gj. 
Tinct. Gentianae Co., . . giij. 
Spt. Limonis, TT^yj. 

Spt. Chloroformi, . . . gj. 
Aquae, . . . . q. s. #</ 25 vj. 
M. Sig. — One-sixth to be taken 3 or 4 
times daily, for insomnia. 



R. Ext. Lupulini Fl., . . . 5J. 
Ext. Aromatici FL, "} 
Tinct. Capsici, . . laa^vj. 
Mucil. Acaciae, . . J 
Aquae Menth. Viridis, ad % iv. 
Fiat emulsum. Sig. — A teaspoonful or 

two as required. 



Alopecia. 

Cantharides, the tincture, 1 part to 8 of castor oil, well rubbed into roots of 
hair, night and morning (Wa). Arsenic, rr^v of Liq. Arsenicalis ter die, exer- 
cises a more or less powerful influence (Wa). Nitric Acid, with olive oil, makes 
a serviceable liniment (Wa). Pilocarpine, has a decided influence on the growth 
of the hair (B). Glycerin in combination with the above remedies (Wa). Sul- 
phur Iodide, has been found very effectual, used internally and externally 
(Wa). Thyroid Extract, [see page 158]. Oxygen, applied under a rubber cap 
fitted to the head, into which oxygen was pumped, with entire satisfaction, in 
the case of a girl who had lost nearly all her hair in consequence of alopecia 
areata (Stoker). Frequent Shaving may often save the hair in alopecia after 
illness. Use clean brushes with long bristles, and brush against the natural 
lay of the hair. [Compare Tinea.] 



R 



01. Amygdalae Expres., 
Aq. Ammoniae, . . 
01. Rosmarini, . . 
Alcoholis, .... 
Aq. Destillat., . . 
Mellis Despumat., . q 
Sig. — Lotion for the hair 



aasj. 
• 3*j- 

ad ^ viij. 
{Wilson.) 



R . Tinct. Macis, 

Olei Olivae, . . . q. s. ad 
Sig. — Lotion for baldness. 



gjss. 

39- 

(Hebra.) 



R. Tinct. Cantharidis, . . ^jss. 
Tinct. Capsici, .... rr^xx. 

Glycerini, 5 ss. 

Spt. Odorat., . . . ad Jvj. 
M. Sig. — Hair tonic. [Gross. 



R . Pilocarpin. Hydrochlorat. , gr. j. 
Aquae Destillat., . . . ■ %]- 
M. Sig. — Ten to thirty drops twice 
daily, according to age, to improve the 
growth of the hair. (Bartholow.) 



Amaurosis and Amblyopia. 

Arnica, has long been a popular remedy for amaurosis in Germany ; Man- 
noir employed it with much success (P, Wa). Rue, in minim doses night and 
morning, for dimness of vision from functional amaurotic condition ; Elgajaki 
says it produces dimness of vision, and in smaller doses improves the eyesight 
(P). Strychnine will cure amblyopia from lead, tobacco, and alcohol (B) ; gr. 
■£q hypodermically (Nagel) ; hypodermically in tobacco and traumatic ambly- 
opia, and in progressive nerve atrophy not dependent on intercranial disease 
(R). Guaiac, is advised for cases of amaurosis occurring in persons of rheu- 
matic diathesis (Wa). Santonin, has given very satisfactory results in amau- 
rosis (Wa). Veratrine, as lotion brushed over eyelids, brows and temples once 
a day, is often useful, but should not be permitted to touch the conjunctiva, or 
great pain will result (Wa) ; [see formula below]. Potassium Iodide, in 
amblyopia from lead-poisoning (Wa). Opium, with champagne, has caused 
recovery from tobacco amaurosis without the abandonment of the habit of 
smoking (Hutchinson). Seton, a small seton in the temple kept open for a 
long period, has been found effectual when other remedies failed (Wa). 
Amaurosis and Amblyopia are names formerly used to denote the various 
forms of blindness, before ocular diagnosis became as exact as it now is. 
Amblyopia is still used to designate certain impairments of vision not accounted 
for by any organic changes visible {Roosa). 



6l2 



AMENORRHEA. 



R . Veratrinse, gr. x. 

^Etheris, £ij. 

Alcoholis, ijj. 

M. Sig. — Use with a brush once a day- 
over eyelids, eyebrows and temples. 



R. Strychninse Sulphatis, . . gr. j. 

Alcoholis, zj. 

Aquae Destillatae, . q. s. ad 3 iv. 
Sig. — A teaspoonful thrice daily before 
meals, when not used hypodermically. 



Amenorrhea. 

Aconite, in sudden suppression from cold or wet feet (R, P). Pulsatilla, in 
sudden suppression (B) ; often of the greatest value in the functional form (P). 
Iron, when from anemia, the most frequent cause ; small doses preferred. 
Solution of Acetate, or Ferri et Ammonii Citras (gr. ij), or Ferri et Strychninse 
Citras (gr. j), also chalybeate waters; make a careful diagnosis before giving 
iron (B). Aloes, when dependent on anemia (B) ; at the periods, with hot 
pediluvia, friction, etc. (R, P). Potassium Permanganate, gr. j thrice daily in- 
creased to gr. ij, is the best of all remedies for bringing back the menses, having 
specific action on the uterine tissue (R) ; excellent in amenorrhea from, cold 
feet, and is by far the best emmenagogue ; in pill it may explode, best in cap- 
sule with powdered elm or licorice (Parvin). Manganese Binoxide, in pill, 
gr. ij thrice daily, is a very efficient emmenagogue. Mercury, the Biniodide is 
a certain and safe emmenagogue, gr. y% in pill, four times daily. Oxalic Acid, 
is highly praised, gr. x /z-% in mixture, every hour (Poulet). Apiol, when from 
functional inactivity; first give Iron for the blood; next aloetic purgatives, 
then apiol (gr. xv) just preceding the period ; or a daily dose for a week or 
several days before (B) ; the best emmenagogue next to Potass. Permang. 
(Parvin). Senega, a saturated decoction of the root, to extent of a pint in 24 
hours, during the preceding two weeks, advantageous (P). Polygonum, has 
given excellent results when used in £ss doses four times daily for a week (B). 
Cimicifuga, has been recommended (R) ; is of very great value (P). Arsenic, 
combined with Iron, when from functional inactivity of ovaries (B). Aurum 
Salts, in amenorrhea from torpor of ovaries (B). Ignatia, in suppression of 
hysteria (P). Cinnamon, causes a flow of blood to the womb (Goodell). Indigo, 
is considered very efficient in doses of from 3j to giv ; larger doses produce 
nausea and vomiting*. Nux Vomica, small doses of the extract, of benefit in 
some obstinate cases (Wa). Silver Nitrate, in substance, applied lightly to the 
os uteri, at time of the expected discharge (Wa). Colocynth, in chlorotic 
amenorrhea (P). Ergot, has cured when due to plethora (B) ; when anemia 
after use of iron (R) ; in chlorotic (P) ; rr\j every l / z hour for 5 or 6 hours the 
■ day before and that of the expected flow, is very efficient when the cessation is 
not due to anemia (A. A. Smith). Senecio Aureus, will provoke menstruation 
in cases of functional amenorrhea but will not do so when there is anemia or 
advanced phthisis (M). Rue, in functional form, rr\j-v of the oil (B, P). San- 
guinaria, is indicated for functional amenorrhea in the absence of plethora (B, 
P). Savine, general atony ; tt\,v-x of the fluid extract (B, R, P). Serpentaria, 
with anemia or chlorosis (B). Ammonium Chloride, for headache (R). Sitz- 
baths, hot, for six days before period ; mustard may be added at period ; often 
effectual 4n sudden suppression (B). Spinal Ice-bag, to lower dorsal and lum- 
bar vertebras, or cold sponging; useful (R). Electricity, in atony of uterus and 
ovaries (B). [Compare Anemia, Chlorosis.] 



R . Olei Sabinse, 

Olei Rutse, aa^j. 

Tinct. Polygon Hydropip.,^j. 

01. Amygdalae Expres., 

Mucil. Acaciae, 

Aquae Menthae Pip., . . aasjij. 
Fiat mistura. Sig. — A teaspoonful two 
or three times daily. (Bartholow.) 



R. Tinct. Ferri Chloridi, . . ^iij. 
Tinct. Cantharidis, . . . Zj. 
Tinct. Guaiaci Ammon., . t ^iss. 

Tinct. Aloes, % ss. 

Syrupi, . . . . . q. s.adgv]. 
Fiat mistura. Sig. — A tablespoonful 
thrice daily, in simple atonic amenorrhea. 
{H. C. Wood. Dewees. ) 



ANEMIA. 



613 



R. Ext. Aloes, 3J. 

Ferri Sulph. Exsic, . . . ^ij. 

Asafcetidae, . ^iv. 

Fiant pilulae 100. Sig. — One pill after 
each meal, gradually increased to three. 
{Goodell.) 



R. Quininae Sulphat., . . . . ^iss. 

Extr. Nucis Vom., . . gr. xij. 

Olei Sabinae, £ss. 

Aloes Socotrinae, . . . . gr. viij. 

Cantharidis, gr. xxiv. 

Fiant pilulae xlviij. Sig. — One pill thrice 
daily. 



Anemia. 

Nux Vomica, stimulates the blood-making organs, and is used as an adjunct 
to restorative remedies (B). Iron, its chief value is to improve digestion, also 
to furnish hematin to the blood; the astringent preparations are the best and 
they should be given after meals; chalybeate waters are also useful (B). Some 
persons require bland preparations, especially when the gastric mucous mem- 
brane is irritable ; a pale and flabby tongue indicates large doses of the chloride 
or sulphate (R). Arsenic, as an adjunct to Iron, and when iron cannot be borne 
or fails (B). Aurum Arsenate, is highly beneficial ; the solution of Aurum and 
Arsenic Bromide renders excellent service in anemia. Orchitic Extract, has 
seemed serviceable. Adrenal and Thymus Extracts have been used with bene- 
fit. Nuclein, has rendered good service. Bone Marrow, is highly efficient in per- 
nicious anemia. [See page 160.] Cerebrinin, has been used with good results. 
[See page 164.] Quinine, for badly-fed town dwellers (R). Hypophosphites, 
are useful, but should not be given with iron, cod-liver oil, or stimulants (R). 
Calcium Phosphate, in anemia of growing persons, and of women weakened by 
rapid child-bearing or excessive menstruation (R). Calcium Lacto-phosphate, 
for nursing mothers, or in waste from suppuration (B). Acids, added to purga- 
tive salts as tonics to the mucous membrane (R). Pepsin, is recommended by 
Hollmann. Manganese, alone not of much use; is best combined with Iron 
(B) ; is not, like iron, found in the feces, nor does it cause constipation (Wa). 
Pepto-mangan, is highly esteemed by many competent clinicians. Gal- 
vanization, as an aid to remedies (B). Cold Sponging, needs great caution, as 
it may lower the tone by minute degrees (R). Diet and Hygiene, of prime 
importance. Nourishing, digestible food, in as large quantities as can be as- 
similated — milk, eggs, animal broths ; afterward fish, poultry, game, mutton, 
etc. Moderate daily out-of-door exercise, in pure air, is indispensable. Bath- 
ing, especially sea-bathing, aids restoration. Wines, often useful. Red wines 
are the best. [Compare Adynamia, Chlorosis, Convalescence, Leucocy- 

THEMIA, LYMPHADENOMA.] 



Tonic Prescriptions. 



R 



Tinct. Ferri Chloridi, . giv. 

Ac. Phosphorici Dil., . ^vj. 

Spt. Limonis, £ij. 

Syrupi, . . . q. s. ad ijvj. 
Misce. Sig. — A dessertspoonful in water 
after meals. To the above may be added 
3J ij of the Liquor Strychnine Hydrochlo- 
ratis of the B. P. ( Goodell. ) 



R. Hydrarg. Chlor. Corr., . gr. j— ij. 

Liq. Acidi Arsenosi, . . %). 

Tinct. Ferri Chlor., 

Ac. Hydrochlor. Dil. , aa % iv. 

Syrupi, ^iij. 

Aquae, . . . . q. s. ad ^vj. 
Misce. Sig. — A dessertspoonful in a 
wineglassful of water after each meal, as 
an alterative tonic. [A. H. Smit/i.) 



R. Ferri Sulph. Exsiccat., 

Potass. Carbonatis, . aa^ij. 

Syrupi, q. s. 

Fiant pilulae no. xlviij. Sig. — One pill 
after each meal, gradually increased to 
three. {Bland.) 



gr. xx. 

gr xl. 



R . Quininae Sulphatis, 

Ferri Sulph. Exsic, 

Strychnine Sulph., . . gr. ss. 
Fiant pilulae xx. Sig. — One pill thrice 
daily. ' (Bart/iolozv.) 



R . Massae Ferri Carbonat. , 5 j. 
Acidi Arsenosi, . . . . gr. j. 
Quininae Sulphatis, . . gr. xl. 
Fiat massa et div. in pilulas no. xl. 
Sig. — One or two pills thrice daily. 



614 



ANESTHESIA. 



Anesthesia, General. 

Morphine, subcutaneously before the inhalation, diminishes danger, and les- 
sens the after-pain if operation is performed (Nussbaum); Morphine gr. -^ and 
Atropine gr. T ^ 5 , hypodermically, after emergence from anesthesia, will re- 
lieve the nausea and vomiting; a preliminary injection of Morphine lessens 
the stage of rigidity and spasm, enables a smaller quantity of the anesthetic 
to be used with full effect, prolongs the stage of insensibility, prevents shock, 
and antagonizes the cardiac and respiratory depression (B). Chloral, as an 
aid to Chloroform in surgery and obstetrics, 10 to 15 grains given 20 minutes 
before the anesthetic, seems to intensify the effect and enable a less quantity 
to be used, also tiding the patient over the excited stage (Brodnax); in children 
a full dose of chloral before anesthesia enables the latter to be obtained during 
sleep without using force (Id). Atropine, is decidedly the best antagonist to 
the respiratory paralysis of Ether, and should be given hypodermically (gr. -£q) 
as soon as alarming symptoms manifest themselves (Amidon) ; the writer of 
this book has saved at least four subjects of chloroform-narcosis by the hypo- 
dermic use of Atropine after both heart and respiration had apparently failed. 
Alcohol, §j-ij of whiskey or brandy before inhalation, to sustain the heart 
and prolong narcosis (B). [Compare page 115 for the general subject of 
Anesthesia.] 

Anesthesia, Local. 

Ether, as spray, projected upon the skin in a continuous stream, produces 
cold and local anesthesia by its rapid evaporation, and may be used for any 
minor operation. Rhigolene, a volatile petroleum product, freezes the part when 
sprayed thereon from a hand atomizer and produces local anesthesia. Guaiacol 
in sterilized olive oil, 1 part in 10 or 20, hypodermically, is a powerful local an- 
esthetic [see page 291 J. Cocaine, in 1 to 4 per cent, aqueous solutions injected 
hypodermically or applied to mucous membranes, produces profound local an- 
esthesia [see page 278] ; injected into the spinal canal between the 2d and 3d lum- 
bar vertebrae, produces anesthesia of the lower limbs and the scrotum (Corning). 
Eucaine, is equally effective and less dangerous than Cocaine [see p4ge 283]. 
Holocaine, is too toxic for hypodermic use, but in a 1 per cent, solution instilled 
on the eye it causes complete, rapid and painless anesthesia [see page 283]. 
Tropacocaine, is less toxic than cocaine and equally anesthetic on the eye [see 
page 278]. Orthoform, is too insoluble for hypodermic use, but is efficiently 
employed as a dusting powder or ointment for painful surfaces where it comes 
into contact with exposed nerve endings [see page 283]. Infiltration Method 
is based on the theory that fluid infiltration of the tissues is the cause of the 
anesthesia produced by local injection of anesthetic solutions; distilled water 
being too painful, weak anodyne solutions are used for injection, as follows : 
No. 1, Strong, — Cocaine Hydrochloride gr. iij, Morphine Hydrochlorate gr. ss, 
Sodium Chloride gr. iij, Distilled Water, sterilized, ^iij 3iij, of which gvj may 
be used during one operation. No. 2, Normal, — Cocaine Hydroch. gr. jss, 
Morph. Hydroch. gr. ss, Sod. Chlor. gr. iij, Distilled Water, sterilized, giij 3>»j, 
of which ^iijss maybe used at one operation. No. 3, Weak, — Cocaine Hy- 
droch. gr. \, Morph. Hydroch. gr. ss, Sod. Chlor. gr. iij, Distilled Water, steril- 
ized, Sjiij giij, of which a pint maybe used at one operation (Schleich). [Com- 
pare the List of Local Anesthetics and Anodynes on page 32.] 



R. Chloroformi, partes xij. 

Camphorse, ...... partes ij. 

Tinct. Aconiti, partes xij, 

Tinct. Capsici, partes iv. 

Tinct. Pyrethri partes ij. 

01. Caryophylli, .... partes ij. 



Dissolve camphor in chloroform, add 
the oil of cloves and then the tinctures. 
This is credited with almost magical local 
anesthetic effect. 

(Parson's Local Anesthetic.') 



ANEURISM — ANGINA PECTORIS. 



615 



Aneurism. 

Potassium Iodide, in large doses (gr. xv-^ss), 3 or 4 times a day, gives great 
relief and has cured (B) ; combined with recumbent position and restricted 
diet (R). Veratrum Viride aids surgical expedients ; also in large internal 
aneurisms, with absolute recumbence and a little Opium to relieve pain, vom- 
iting to be avoided (B). Ergot, with recumbent position ; favors coagulation 
of the blood in sac (B) ; Ergotin (P). Gallic Acid and Iron, internally, have 
cured cases of aortic aneurism (Speer). Chloroform inhalation for great dysp- 
nea (R). Lead Acetate, a valuable auxiliary to the more important items of 
rest, diet and mechanical appliances, gr. iij-v ter die (Wa) ; its use limited to 
the sacculated form (S). Electrolysis, galvano-puncture in deep aneurisms ; 
not very successful (B). The object sought is the coagulation of blood within 
the aneurismal sac ; cures have not been attained by this treatment, but in 
many it has produced great amelioration of the most distressing symptoms 
(Petit). Aliment, milk regimen, for denutrition (B) ; a low diet, with absolute 
rest; Ergotin and Potassium Iodide for deep aneurisms beyond reach of surgi- 
cal treatment (B). Rest, in recumbent posture, and light, unstimulating diet, 
are primary and essential elements in the treatment of aneurisms. Surgical 
Treatment includes ligation of the vessels, also pressure by a tourniquet or 
bags of shot, the operator's fingers, etc., applied to the main artery above the 
tumor, and the introduction of fine wire into the sac to favor coagulation. 



R. Potassii Iodidi, .... ^j. 

Tinct. Veratri Viridis, . gjss. 

Tr. Cinchonae Co. , . . ^j. 

Tr. Cardamomi Co., . . ,^jss. 

Tr. Gentians Co., . . . ^ss. 

Syrupi Simplicis, 

Alcoholis, . . . aa^iv. 

Aquae, . . . . q. s. dd^xv'). 
Misce. Sig. — ^ss thrice daily. Each 
dose has gr. xv of Potassium Iodide. 



R. Acidi Gallici, 5J. 

Ext. Ergotae, 

Digitalis, aagr. xx. 

Fiat massa et div. in pil. xx. 
Sig. — One every two hours. 



R 



r. xxxvj. 
r. iv. 



, Plumbi Acetatis, 

Extracti Opii, . . . 

Confectionis Rosae, . . q. s. 
Ft. pil. xij. One every four hours. 



Angina Pectoris. 

Aconite, believed by Gubler to be appropriate, and by Fleming to have been 
curative in many severe cases resisting other remedies (P) ; in cardiac disease 
its action is uncertain (Br). Arsenic, lessens or prevents paroxysms, if used in 
the intervals (Anstie). Amyl Nitrite, as inhalation, affords signal relief (R) ; 
unsafe in advanced degeneration of cerebral vessels and fatty degeneration of 
heart (B) ; gives great relief during paroxysms (Br). Sodium Nitrite, is less 
rapid in action than Amyl Nitrite, but is more efficient in preventing return of 
symptoms (Br). Laurocerasus, as anodyne (P). Strychnine, in the milder 
forms ; very small doses, gr. ^^ to -£% (P). Glonoin, doses of TH/rJjo" have been 
used with success (Pf, R). Chamomile, in pseudo-spasms of hysterical persons 
(P). Ether, aborts a mild attack (B) ; Sulphuric Ether in the nervous form, a 
spoonful immediately on commencement of attack will greatly mitigate it 
(Anstie). Phosphorus, often serviceable (R). Morphine, hypodermically, 
especially when cardiac dyspnea ; strengthens the heart (R). Turpentine ap- 
plications, hot over chest, to mitigate severity of the paroxysms, especially in 
the aged (Wa). Quinine, when intermittent (Wa) ; or when any malarial taint 
present (Br). Brandy, in frequent small doses, with hot bran poultice over 
heart and warmth to extremities. Cocaine, in doses of gr. */j to % thrice daily 
for two days, proved curative in four very severe cases (Laskevitch). Cactine 
is efficient in pseudo-angina pectoris. Chloral, may be well prescribed in 
pseudo-angina pectoris (De Holstein). 



6l6 ANTHRAX ANTRUM DISEASE ANUS. 



Anthrax. 

Nitric Acid strong, applied steadily, after thorough cleansing and drying, to 
destroy the diseased mass (D). Bromine, to saturate the surface (D). Nitric 
Acid fuming, is the preferable caustic (Greenfield). Quinine and Carbolic Acid, 
internally, are indicated in all forms, also stimulants, as Ammonia, Ether, and 
Alcohol (Greenfield). Eschar should be promptly destroyed, to avoid con- 
tagion (R). Excision and Cauterization demanded, when from direct inocula- 
tion ; the two most successful measures (Greenfield). Carbolic Acid, a 2 or 3 
per cent, solution injected subcutaneously around the pustule thrice daily, and 
applied on compresses soaked in the solution (Jarnvosky) ; of 24 cases so treated 
17 recovered (Matveieff). 



Antrum Disease. 

Hydrogen Dioxide, the solution, 1 to 12 of water, injected through the ostium 
for diagnosis of empyema of the antrum ; if pus be present it is driven out, and 
fills the nose as a white foam (Brown). Chloroform, by inhalation, small 
quantities frequently, for treatment of acute catarrh extending to the antrum, 
extremely efficient, both as a remedy therefor and as a preventive of suppura- 
tion therein (Potter). Operative Measures, that in most favor is to enter the 
antrum through the alveolus of the second molar tooth (Garretson) ; to give 
free drainage and enable medication of the diseased mucous membrane it is 
best to enter the antrum in its most dependent portion, through the upper part 
of the alveolus or immediately above it, between the roots of the 2d bicuspid 
and 1st molar; a gold tube then fitted to the opening, so as to project beyond 
the mucous membrane, will give free drainage, without sacrificing a sound or 
even diseased tooth (Brown), Boric Acid, in saturated solution, as wash to 
cavity twice a day, the after-treatment; occasionally injecting Iodine, Zinc Sul- 
phate or Bismuth Subnitrate (Id). 



Anus, Fissured. 

Hydrastis, locally, promotes healing (B). Rhatany, as injection, night and 
morning, after enema in the morning to move the bowels (Pf, Tr). Iodoform, 
improves and relieves pain (B). Iodo-tannin, well applied, effective (B). 
Belladonna, locally of great service for painful spasms of sphincter (P). 
Opium, with gall-ointment for fissures of anus ; mild purgatives should be 
simultaneously employed (R). Sulphur, as a mild purgative, to cause soft 
motions (R). Tannin, Z\ m Glycerin ^ij, introduced on a tent, night and 
morning, with great advantage (Wa). Collodion, as protective covering (P). 
Potassium Bromide, with 5 parts of Glycerin, as local application (R). Silver 
Nitrate, in solution, to the ulcer after careful cleansing and applying a 4 per 
cent, solution of Cocaine, which prevents the pain due to the silver solution ; 
followed by Iodoform oint. gr. xxx to the j| ; this is most efficient (Adler). 
Castor Oil, as a mild purgative (R) ; to keep motions soft (Br). Surgical 
Means, the most efficient; forcible dilatation of sphincter or partial division 
in severe cases, through the mucous membrane and a few fibres of sphincter. 
Anal fissure, when uncomplicated with some other rectal affection, is curable 
in many cases by non-operative methods of treatment (Adler). Mercury, an 
ointment of the Oxide, 30 grains to the £, has cured many cases (Id). 



R. Tinct. Krameriae, . . . . gj. 

Ext. Krameriae, % ij. 

Aquae, rt-/^viij. 

M. Sig. — One-fourth as injection, night 



R. Sulphuris, %]. 

Pulveris Aromat., 
Confec. Rosae, . . . . aa gij. 
Misce. Sig. — One-third to be taken at 



and morning, after using enema. ' bedtime as a laxative. 



APHONIA APHTHAE. 



617 



R. Hydrarg. Chlor. Mitis, . . gr. iv. 

Ext. Belladonna, 

Pulv. Opii, aa gr. ij. 

Ung. Sambuci, . . . . ^j. 
M. Sig. — To be applied frequently in 
anal fissure. (Alling/iam.) 



R . Plumbi Acetatis, 

Zinci Oxidi, aa gr. x. 

Pulv. Calaminae, . . . . gr. xx. 

Adipis Benzoinat., . . . 3 iv. 
M. Sig. — Ointment for use in anal 
fissure. (Allingham.) 



Aphonia. 

Ignatia, in aphonia of hysterical women (P). Atropine, in hysterical apho- 
nia and for fatigue of vocal cords, gr. t \q to -^q, morning and evening (B). 
Ethyl Bromide, for rapid anesthesia, during which it was suggested to the pa- 
tients to shout out loudly their names, count numbers, etc. ; this successful in 5 
cases of hysterical aphonia in women (Arslan). Nitric Acid, n\,v-x of the di- 
lute acid, for hoarseness of singers, in fatigue of vocal cords, and when apho- 
nia is stomachal (B). Benzoin, the tincture by inhalation in laryngeal catarrh 
(Br). Oil of Rue, as inhalation in chronic catarrh (Br). Uranium Nitrate, as 
spray in very chronic catarrh (Br). Alum, gr. x-^j aquae, as spray, in chronic 
coughs and hoarseness (R). Borax, a piece the size of a pea allowed to dissolve 
in the mouth (R). Glycerite of Tannin, locally in chronic inflammation of the 
throat (R). Sulphurous Acid, by inhalation, spray, or fumigation, in clergyman's 
aphonia (R). Ipecacuanha wine, as spray, when congestion of vocal cords 
(R) ; in laryngeal catarrh (Br). Ammonium Chloride, as vapor inhaled, of 
great value in catarrhal aphonia (Wa). Turkish Bath, at commencement of a 
feverish cold (R) ; in acute laryngeal catarrh (Br). Galvanism, localized, the 
best treatment for hysterical aphonia. 



R. Acidi Nitrici Dil., . . . . gij. 

Tinct. Calumbae, . . . . %]. 

Aquae, ad J iv. 

M. Sig. — A dessertsp. in a winegl. of 
water thrice daily. . 



R. Liq. Ammoniae, 

Aquae, aa |jj. 

M. Sig. — A teaspoonful in a pint of 
hot water for each inhalation. 



Aphthae. 

Potassium Chlorate, the best remedy ; a solution of gr. x to the 3 as wash, 
alone or with borax (Br) ; and gr. x to xx by the stomach (B). Borax, with 
honey, or as glycerite of borax, frequently used (R) ; crystals allowed to dis- 
solve in the mouth (W). Sulphurous Acid, as solution, strong or diluted, locally 
(R), diluted as spray (B). Mineral Acids, formerly much used (B). Mercury, 
Hydr. cum Creta in small doses to remove the indigestion on which aphthae 
often depend (B) ; Borax being used locally when aphthae exist in the mouth 
(Wa). Copper Sulphate, a weak solution painted over mucous membrane (R). 
Potassium Iodide, gr. j-v in 3jj aquae, locally (B). Salicylic Acid, one part 
dissolved in alcohol to 250 of water (R). Quinine, gr. j every 2 or 3 hours, in 
infants (B), especially when consequent on diarrhea (Br). Coptis, the infu- 
sion has repute in New England (B). Bismuth, freely to the parts (B) ; as a 
local application (Br). Glycerin, will sometimes cure (R). Rhubarb, the com- 
pound powder to remove indigestion (Br) ; is highly useful in small doses 
(Wa). Limewater, as a mouth-wash, is much used. 



R . Acidi Sulphurosi, . . . . gij. 
Aquae, . . . . . q. s. ad Jij. 
M. Sig. — Mouth-wash, or may be used 
as a spray. 



R . Pulv. Rhei Co. , . . . . 
Sacch. Lactis, . . 
Triturat. et div. in pulv. 
One powder thrice daily. 



• o'J- 
. q. s. 
xij. Sig. 



6i8 



APOPLEXY APPETITE — ARTHRITIS. 



Apoplexy. 

Aconite, when full, strong pulse, hot, dry skin, plethoric cases, is the best 
remedy (P) ; to lower blood-pressure and prevent further hemorrhage, where 
the pulse is strong and arterial tension high (Br). Elaterium, as a purgative ; 
a large dose (gr. ij) in suppository with soap ; or as an injection into the large 
bowel (P). Croton Oil, as purgative, a drop may be put on the back of the 
tongue (Br) ; n\,# or % each hour (R). Colocynth, as a derivative purgative 
(Br) ; appears to act well (P). Cold Water, often harmful, though frequently 
used; is injurious when face pale, surface cool, circulation depressed (B). 
Electricity, very mild galvanic currents to promote absorption ; caution neces- 
sary, especially if much headache and vertigo (B). Diet and Hygiene, of great 
importance in patients subject to apoplexy ; avoid stimulating food and drink, 
especially beer, over-eating, excitement, haste, exposure to hot sun, heated 
rooms, etc. At no subsequent period should a full animal diet or the use of 
undiluted wines be indulged in (A). Diagnosis. Should be carefully differ- 
entiated from alcoholism, with which it is often confounded. [Compare Cere- 
bral Congestion, also page 137. J 



R . Tinct. Aconiti, .... TTVx. 
Aquae Cinnamomi, q. s.ad% ij. 
M. Sig. — A teasp. every % hour for 2 
hours, then every half-hour. 



R- . Ext. Colocynthidis Co., gr. xx. 

Olei Tiglii, rryj. 

Fiat massa et div. in pil. iv. Sig. — 
One pill as required, until free purgation. 



Appetite. 

Ignatia, will correct diseased appetite (P) ; especially in hysterical subjects 
(Br). Anthemis, will stimulate the appetite. Cannabis Indica, produces a 
ravenous appetite. Bitters, to stimulate the appetite (R). Food should be 
savory and well cooked. Habits require examining into, when lost appetite 
complained of. Fluoride of Sodium or Potassium will produce almost total 
anorexia, and may be employed with advantage in bulimia (Da C). [Compare 
Dyspepsia.] 



R- , Gentianae, Quassiae, 

Cinnamomi, . . . . aagij. 
Sig. — Put into a pint of boiling water, 
and when cold strain ; take a winegl. thrice 
daily as an appetizer. 



R- . Anthemidis, 

Quassiae, aa£j. 

Sig. — Put in a pint of boiling water, and 
when cold strain ; take a winegl. thrice 
daily before meals as an appetizer. 



Arthritis, Rheumatoid. 

Aconite, highly spoken of as liniment, conjoined with internal use (Wa). 
Cimicifuga, when joints enlarged and much stiffened, and when traceable to 
uterine derangement, is very useful (R) ; when pains worse at night (Wa). 
Viburnum Prunifolium, the fluid extract with that of Cimicifuga, 20 drops of 
each thrice daily, gradually increased to 30, produced steady improvement in 
a well-marked case of eight years' standing, involving nearly all the articula- 
tions. Iodine, the tincture internally, said to be better than potassium iodide 
(R). Iodoform, 10 parts to 20 of Ether and 20 of Alcohol, as liniment to the 
joint, applied by a pencil, and covered with oiled silk (Gubler). Iodides, often 
signally benefit, especially when due to syphilitic, mercurial, or mineral poison- 
ing (B) ; large doses of Potassium Iodide sometimes required (R) ; combined 
with Guaiac, or Corrosive Sublimate, often curative in cases resisting these 
remedies given separately (Wa) ; Potassium Iodide should always be fairly 
tried (Da C). Guaiac, the ammoniated tincture, in doses of 3j-ij m milk, often 
gives excellent results (Da C). Colchicum, with alkalies, extremely useful (B). 
[See Gout, for formulae.] Arsenic, when referable to nervous affections (B) ; 
as a bath containing ^iv washing soda and gr. xx of Sodium Arsenate ; in 



ASCITES. 



619 



large doses continued, sometimes of great benefit but action is capricious (R) ; 
in small doses is of great benefit (Da C). Aurum, the Bromide of Gold and 
Arsenic has proved curative in arthritis deformans, characterized by great pain, 
stiffness and swelling of the joints (E. A. Wood). Lithium Salicylate, very effi- 
cient in acute and progressive subacute articular rheumatism, and has some 
effect also in chronic cases where some of the joints are deformed, swollen and 
painful ; 5j may be given daily, in doses of gr. vij to x, in water (Vulpian). 
Lithium Bromide, of great value in acute and chronic (B). Phenocoll, with 
Piperazin, 15 grains of each daily, in a pint or more of carbonated water, has 
rendered good service in gouty and rheumatic affections. Piperazin, should be 
used in all cases of difficult diagnostic differentiation for its remarkable power 
over uric acid and urate concretions. Potassium Bromide, sometimes allays 
the severe pain (R). Arnica, the tincture and infusion are said to be of great 
value (P). Cod-liver Oil, internally and locally, of much value (R). Baths, 
Turkish or sulphur ; the cold douche, which may be slightly warmed in winter, 
use for one or two minutes and rub dry (R). Dry Heat, by the Tallerman appa- 
ratus, has been used in many cases with great benefit; in my experience it has 
very little value in this affection (W). Adhesions, may be broken up under 
anesthetics (Da C). Massage may be used to ameliorate the condition in 
chronic cases where a cure cannot be obtained (Da C). Counterirritation, by 
the actual cautery or flying blisters to the affected articulations, passive move- 
ments of the joints, sulphurous baths, in conjunction with Potassium Iodide 
internally in doses of 7^ to 30 grains in the 24 hours (Letulie). 



R. Vini Colchici Seminis, . giij. 
Spt. Aramon. Aromat., ^xiij. 
M. Sig. — A teasp. every 3 hours, until 
some physiological effect is produced. (B.) 



R. Lithii Bromidi, .... ^iij. 

Syr. Zingiberis, . . . . ^ ss. 

Aquae, §j ss> 

M. Sig. — A teasp. thrice daily, 
jointly with a lotion of the same. 



Ascites. 

Digitalis, when ascites is part of a general dropsy due to cardiac or renal 
diseases ; is of the greatest service, except where aortic regurgitation and car- 
diac hypertrophy (P) ; a fresh infusion the best preparation (R) ; its action 
increased by combination with Squill and Mercury (Br). [See formula below.] 
Jalap, the most generally approved hydragogue purgative is the compound 
powder of Jalap with Podophyllum (B) ; with Potassium Bitartrate, combined 
iri form of electuary, may be persevered with daily, though apt in some cases 
to cause gastric derangement (Saundby). Stillingia, in ascites due to hepatic 
changes (B). Elaterium, as hydragogue cathartic, gr. ye, with a grain of Ext. 
Hyoscyami, and a drop of some aromatic oil, is the most efficient of its class in 
ascites but its action is very exhausting (W) ; cautiously in debilitated subjects, 
and is contraindicated where gastro-intestinal irritation or inflammation present 
(B). Arsenic, when ascites is due to feeble heart, and in that of old age (B) ; 
did excellent service after tapping in a woman aged 82, from whom the writer 
removed 6j4. gallons of ascitic fluid at one tapping, when almost moribund, 
with the result that she lived ten years longer (Potter). Diuretin, is often of 
very marked benefit, especially in cases of cardiac and renal origin. [See 
under Dropsy.] Aurum, has an ancient reputation ; is efficient in ascites due 
to chronic hepatic disease (Gcetzner), or induration of the abdominal organs 
(Schroff ). Diuretics, are of little use when the accumulation is excessive, the 
venous pressure seems to be too great for them to act (Saundby). Copaiba is 
an excellent remedy in hepatic dropsy (Br) ; the resin in doses of 10 to 1 5 grains 
is often serviceable in cases of moderate effusion (Saundby). Milk-diet is an 
ancient remedy for ascites, and often successful, causing profuse alvine and 
urinary discharges (B) ; is sometimes very serviceable when the renal action 
is inadequate (Br). Surgical, paracentesis abdominis should be done in all 
cases where excessive effusion ; laparotomy and washing out of the peritoneal 



620 



ASPHYXIA AND APNEA. 



cavity, in cases of tubercular peritonitis with effusion, which has recently been 
treated successfully thereby (Saundby). [Compare Dropsy.] 



R. PotassiiBitart., . . . . £ ss. 

Mellis, '^j. 

Sig. — A teasp. every 2 hours until bowels 
are freely moved. 



R 



Resinse Copaibse, . . . giij. 

Alcoholis, 3 v. 

Spt. Chloroformi, . . . £j. 
Mucil. Acacise, . . . . % ij. 
Aquae, ... q. s. ad ^xij. 
M. Sig. — A tablesp. thrice daily. 



R. Potassii Bitart., . . . . * ss. 

Pulv. Jalapae, .... ^jss. 

Mellis, -fj. 

Sig. — A teasp. every 2 hours 
bowels are freely moved. 



R. 



Mit 



is, 



until 



Hydrarg. Chlor. 

Pulv. Digitalis, 

Pulv. Scillae, . . . . aa gr. vj. 
Fiat massa et div. in pil. vj. 
Sig. — One pill thrice daily, in ascites 
from hepatic changes. 



Asphyxia and Apnea. 

Of the New-Born. — Clean the mucus out of nostrils and throat; catheterize 
the trachea, and suck up the mucus. Marshall Hall's method, — by placing 
child on abdomen, then bringing into lateral posture, repeating slowly and 
deliberately. Schultze's method, — by placing the thumbs upon the anterior 
surface of thorax, the indices in the axillae, and the other fingers along the 
back, the face of the child being from you ; rotate the child, by swinging 
upward, so that the inferior extremities turn over toward you. In a moment 
re-rotate to the original position. Do not support head or legs in the forward 
rotation ; their bending upon or toward the abdomen gives a forced expiration. 

From Foreign Bodies in Air Passages. — If the foreign bodies are round and 
smooth, invert the patient head downwards and strike upon the back. The 
bristle-probang is a good instrument for the removal of fish-bones, coins, etc., 
from the gullet ; or a pair of curved forceps will often render good service. 
The writer removed a gold plate with three teeth attached, from the esophagus" 
of an insane woman, by passing down a curved piece of stout wire, having the 
end bent upon itself to form a hook. After the hook was passed to one side of 
and below the obstruction, the wire was half rotated, so as to engage the plate, 
which came up on the second trial of the improvised instrument. Tracheot- 
omy or Laryngotomy may be necessary, as a final resort. 

From Drowning. — Remove the person from the water as rapidly and gently 
as possible, turn the face downwards for a moment and depress the tongue, in 
order that water, mucus, etc., may be removed from immediately over the 
entrance of the windpipe. Give the patient plenty of fresh air, fully exposing 
neck and chest to the breeze, unless that be inclement. Turn gently on the 
face, one forearm being under the forehead, and raise the body up that the 
water may have free discharge from the mouth. Place the patient upon the 
side and apply stimulants (Ammonia, etc.) near to the nostrils; or the .cold 
douche to the face and chest in order to excite respiration. 

The above measures being ineffectual, convey the body to the nearest con- 
venient spot, strip it carefully and dry it, and place it on a warm bed, with 
head and shoulders slightly raised, and at once employ one of the following 
methods : — 

Silvester's Method. — Pull the tongue forward, to prevent obstruction to en- 
trance of air into the windpipe ; produce expansion of the chest by drawing 
the arms from the sides of the body and upwards until they almost meet over 
the head. Then bring the arms down to the sides again, causing the elbows 
almost to meet over the pit of the stomach, thus producing contraction of 
the chest. This imitation of the act of respiration should be continued at the 
rate of fifteen or sixteen times a minute, as in health. 

Marshall Hall's Method. — The person should be placed flat on the face, 



ASTHENOPIA. 62 1 

gentle intermittent pressure being made with the hands on the back, the body- 
turned on the side, or a little beyond, then on the face, and the same pressure, 
etc., continued as at first. The whole body must be worked simultaneously. 
The same number and frequency of these artificial processes of respiration 
should be employed as in the other method. 

The Michigan Method. — Lay the body face down, the head upon the arm, 
and stand astride it ; grasp it then about the shoulders and armpits, and raise 
the chest as high as you can without lifting the head quite off the arm, and 
hold it about three seconds; then replace the body upon the ground, and press 
the lower limbs downward and upward, with slowly-increasing force, for ten 
seconds ; then suddenly let go, to perform the lifting process again. 

Whichever process be employed, the effort to restore the temperature of the 
body must be maintained, the body being well rubbed in an upward direction 
with the hands, with warm flannels, etc. ; bottles of hot water, hot bricks, etc., 
being applied to the stomach, the axillae, the soles of the feet, etc., stimulants 
and beef tea being judiciously administered when restoration is about taking 
place. The attempts at resuscitation must be persevered in for several hours, 
if necessary. In artificial inflation, always press the larynx and trachea against 
the vertebral column, so as to close the esophagus and thus prevent the air 
entering the stomach. Laryngotomy or Tracheotomy, with or without cathe- 
terization, or forced insufflations of air or oxygen, have proved successful, as 
also has electro-puncture (Garratt). 

After Long Submersion is Recovery Possible ? — According to Harley, dogs 
kept under the water 1% minutes always died, if water had entered the lungs. 
If it had not, the trachea being plugged, they survived a submersion of 4 min- 
utes. When persons rise after sinking they usually get some air, and less 
speedily come into a state from which recovery is impossible. The greatest 
period between the last inspiration and the stoppage of the heart is 4 minutes. 
Some think that no recovery has been made after complete cessation of the 
heart's action. We infer that after complete submersion for 5 minutes recovery 
is improbable, unless the person had been previously choked or in a fainting 
state, so that no water entered the lungs. But in Anderson's case, the patient 
had been under water at least 15 minutes, and in Garratt's the time was vari- 
ously estimated at from 15 to 60 minutes. 

When is a Case Hopeless ? — Harley says, " If the eyes are open, the pupils 
dilated, the conjunctiva insensible, the countenance placid, the skin cold, 
frothy mucus round the nostrils and mouth, no attempt at respiration, and the 
heart's action inaudible (when the ear is applied to the chest), the case is 
hopeless." 

Signs of Death. — The following have been suggested as methods of decid- 
ing whether death has occurred: Tie a string firmly about the finger; if the 
end of the finger becomes swollen and red, life is not extinct. Insert a bright 
steel needle into the flesh ; if it tarnishes by oxidation in the course of half an 
hour, life may be considered not extinct. Inject a few drops of Liquor Am- 
monias under the skin ; during life a deep red or purple spot is formed. Moisten 
the eye with Atropine ; during life the pupil will dilate. Look at a bright 
light or at the sun, through the fingers held closely side by side ; during life 
the color is pink ; after death a dead white. After death a dark spot is said 
to form gradually on the outer side of the white of the eye, from drying of the 
sclerotic, so that the dark choroid shows through. Putrefaction is an absolute 
sign of death ; better delay for it than run any risk of burying alive. 



Asthenopia. 

The proper glasses; cold douche; rest of eyes. Atropine, systematically 
instilled, to prevent strain, and control spasm of the accommodation (C) ; c; u- 
tiously in persons over 35 or 40 years old. [Compare Eye Diseases, Myopia.] 



622 ASTHMA. 



Asthma. 



Potassium Iodide, when from acute bronchial catarrh, gr. xv-xx each 2, 3, 
or 4 hours (R) : the best medicament to suppress the asthmatic attack, in bron- 
chial asthma, is Potassium Iodide and Chloral (Lazarus) ; is the specific in 
asthma, if any drug can be so called ; should be given with Lactucarium (See). 
Chloral, is highly efficient in spasmodic asthma ; may arrest a paroxysm (R). 
Paraldehyde, tt\,xlv-3j, used in 30 cases of asthma with rapid and complete 
relief in most and lessening of distress in the others (Hearder). Nux Vomica, 
in nervous subjects (B) ; often of great benefit in spasmodic asthma (P) ; the 
tincture, in drop doses every five minutes has rendered extraordinary results 
in both cardiac and bronchial asthma, and in asthma of peripheral reflex 
origin, as from phimosis (Macfarlan). Antipyrin, is successfully employed in 
bronchial asthma. Aconite, in spasmodic (P) ; often averts the attack, if given 
at commencement ; useful also in the asthma following coryza and sneezing in 
children (R). Ipecacuanha, the wine as spray to the fauces, sometimes useful 
in severe bronchial asthma, but not of much service in genuine asthma (R) ; 
nauseant and emetic doses in the spasmodic form (B). Lobelia, gtt. x of the 
tincture every % hour during paroxysm ; tt\,x ter die, with additional doses at 
night, in bronchitic asthma when worse at night; cautiously if heart disease 
(R) ; often gives permanent relief (B). Pilocarpine Hydrochlorate, gr. \ in 
water, at bedtime, promptly and effectively relieves, in cases of bronchitic 
asthma with hypertrophic rhinitis ; in some of nine years' standing it appar- 
ently gave permanent relief (Wyss). Grindelia, gives relief in spasmodic form 
(B) ; three grains of extract thrice daily, to prevent attacks, or TT^xx-xxx of 
fluid extract every half-hour or hourly from onset of paroxysm (R). Arsenic, 
as cigarettes, as well as by internal administration (B) ; rr\, j of liquor arseni- 
calis ter die, in attacks from bronchitis, local irritation, etc., allied to hay 
fever (R). Belladonna, relieves paroxysm when expectoration abundant, skin 
cool and moist (B) ; internally in large doses, also in cigarettes (Br). Atro- 
pine, hypodermically is more efficient, gr. -^ at bedtime to abort morning par- 
oxysm (B) ; large doses required, but very satisfactory (R) ; was much valued 
by Salter and See (P). Duboisine, may be used instead of Atropine. Stra- 
monium, twenty grains of the dried leaves or ten of the powdered root may 
be smoked ; Datura is sometimes better; Stramonium preparations are often 
of bad quality, asthmatics advised to grow the drug themselves (R). Cocaine, 
hypodermically, is used with the best results, even where other remedies failed 
to relieve (Mosler) ; the leaves of the coca-plant make the best cigarettes 
for asthma (Nachtigal). Chloroform, inhaled from warm water; anesthetics 
relieve, but increasing doses required, leading to habit (R). Ether, in full dose, 
may avert a mild attack (B). Amyl Nitrite, inhaled, quickly checks spasmodic 
asthma (R). Ethyl Iodide, very valuable in spasmodic form, and lessens lia- 
bility to subsequent attacks ; tt^v-xx thrice daily by inhalation (B). Cannabis 
Indica, has been useful (R). Sulphurous Acid, by inhalation, spray, or fumi- 
gation (R). Morphine, hypodermically, quickly cuts short a paroxysm (B) ; in 
some cases morphine will induce a paroxysm (R). Apomorphine, gr. ^ hypo- 
dermically, has been found effective ; orgr. T ^ every 3 or 4 hours in camphor 
water, with or without Morphine or Ipecacuanha. Hyoscine, the Hydrobro- 
mate, gr. -^q, with Morphine Sulphate gr. ^-\ and Strychnine Sulphate gr. 
-^ T5 —^ u , the best combination for the paroxysm (S. Solis-Cohen). 

Euphorbia Pulifera, gss-j of the fluid extract thrice daily, used with excel- 
lent results in asthma and asthmatic bronchitis (Dujardin-Beaumetz). Bro- 
mides, relieve but soon lose effect (R). Eucalyptus, smoked with Stramonium, 
Belladonna, Tobacco (B). Quinine, after acute symptoms subside, as antipy- 
retic to succeeding fever and restorative tonic (B). Potassium Nitrate, the in- 
halation of fumes of burnt nitre paper will sometimes avert a paroxysm ; differ- 
ent methods of preparation useful for different cases (R). Silver Nitrate, some- 
times injected into trachea (R). Chamomile Oil, has been found very service- 



ASTIGMATISM. 



623 



able (P). Sanguinaria, is very useful in humid asthma, and occasionally so in 
the spasmodic form (R). Antimony, in an affection of children like asthma, 
dissolve a grain of Tartar Emetic in half a pint of water, and give a teaspoon- 
ful of this every % hour for the first hour, then hourly ; if vomiting induced, 
lessen the dose (R). Coffee, a small cup of very strong coffee often useful in a 
paroxysm (R) ; asthmatics should not use it as a beverage (P). Tobacco, 
smoking, sometimes relieves (R). Pyridine, the fumes are highly efficient 
(See). Asafcetida, has been recommended (R) ; palliative only (P). Colchi- 
cum, in gouty subjects (R). Oxygen inhalations are serviceable, but should 
not be used if heart disease is present (R). Carbonic Acid, in 5 to 10 per cent, 
solution, by inhalation, is well borne and renders good service (P). Carburetted 
Hydrogen, the inhalation of ordinary illuminating gas never failed to abort 
a paroxysm in a lady who had sought professional assistance in vain, and 
who was in the habit of shutting herself up in a small room, in which she 
allowed the gas (unlighted) to escape, and after three minutes her maid, who 
stood outside the door, came in and brought her out ; the patient was always 
in a semi-dazed state, but in a few minutes became quite herself, with free and 
easy breathing (White). Galvanism, of pneumogastric often relieves, -f- pole 
beneath mastoid process, — pole to epigastrium. Faradism of no use (B). 
Prophylaxis, avoidance of exciting causes, especially indigestible food, wet, 
damp, and sudden changes of temperature. Attention to the stomach will do 
most for many asthmatic patients. An important point is to take the heaviest 
meal early in the day, and very little solid food after 2 p. m. Shower-bath and 
out-of-door exercise, not however to a fatiguing extent (R). In special cases 
of reflex origin from exposed nerve-filaments, operative treatment of the nose 
and naso-pharynx, by galvanic cautery or otherwise is required (Lazarus). 



Ammonii Bromidi, . . gr. clx. 
Ammonii Chloridi, . gr. xc. 
Tinct. Lobelias, . . . . ,^iij. 
Spt. Athens Comp., . . !§j. 
Syrupi Acacias, q. s. ad £ iv. 
M. Sig. — A dessertspoonful in water, 
every hour or two, for the paroxysm. 

(Pepper.) 



R 



Ext. Grindelias Fluidi, 
Ext. Lobelias FL, . . 
Ext. Belladonnas FL, 
Potassii Iodidi, . . . 
Glycerini, . . . . 



£ss. 

XV 

iij. 



M. Sig. — A dessertspoonful as required. 



R . Ext. Stramonii, . . 
Potassii Iodidi, . . . 
Ammonii Carbonatis, 
Tinct. Lobelias, . . . 
Aquas Chloroformi, 

q. s. 
Ft. mistura. Sig. — A tablespoonful 
every four to six hours. 



ad 



gr. ij. 

3Jss. 

3h 

3J SS - 

viij. 



Arsenical Cigarettes. 



R 



Sodii Arsenatis, .... ^ss-j. 

Aquae Destillatas, . . . 5J. 

Moisten unsized white paper, and roll 

into cigarettes, each containing gr. % to 

gr. j of the salt. Two or three of these to 

be inhaled daily. (Bartholow.) 



R- . Belladonnas Fol., . 
Stramonii Fol., 
Hyoscyami, ... 
Extracti Opii, . . . 
Aquas Laurocerasi, 
Dissolve the opium in 



• Eh 

aa % ss. 

• gr-iij. 

• q- s - 

the water, anc 



moisten the leaves therewith. When dry, 
roll into twelve cigarettes. Smoke two to 
four daily. ( Trotisseati.) 



R. Spt. ^Etheris Compos., 
Liq. Morph. Sulph., 

(g r -j *d %])> • ■ • aa^j. 
M. Sig. — Ateaspoonful every half-hour 
or hour during the paroxysm. 



Astigmatism. 

Atropine, a weak solution to aid examination of the eye by dilating pupil and 
paralyzing accommodation (B). Duboisine, as substitute for atropine, has more 
rapid action, with shorter duration of effects and less conjunctival irritation. 
Glasses, of suitable form, cylindrical in simple astigmatism, bi-cylindrical in 
mixed astigmatism. Pray's Test Letters, to determine degree and direction of- 
the defect (C). [Compare Eye Diseases, Myopia.] 



624 ATHEROMA — BERIBERI. 



Atheroma. 

Phosphorus, in minute doses, with cod-liver oil (B). Arsenic, often of great 
value in atheroma, especially where imperfect action of kidneys (Br) ; indicated 
when there are puffy eyes, drowsiness, intellectual torpor (B). Lemon-juice, 
daily used, is said to retard atheromatous degeneration of the vessels. Aurum 
and Arsenic Bromide is very efficient in atheroma and calcareous degeneration 
of the arteries (Barclay). Quinine, gr. iij-x daily, in atheroma, is used with 
advantage (B). Ammonium Bromide, to promote absorption of deposit (Wa). 
Digitalis, may be useful in general capillary atheroma ; cautiously ! (W). 
Cod-liver Oil, with Phosphates, Hypophosphites, or Calcium Lactophosphate, 
in combination (B). [Compare Aneurism.] 

Atrophy. 

Cod-liver Oil, has proved beneficial (Wa). Olive Oil, by inunction, every 
12, 6, or 4 hours, successfully employed (Wa). Arsenic, has had remarkable 
success in muscular atrophy (Tr). Electricity, in progressive muscular atrophy, 
the induced current very strong at first, then weaker as improvement ; inter- 
rupted currents from vertebral column and plexuses to nerves of affected mus- 
cles ; in more extended forms, the constant current to the nerves, the induced 
to the muscles (Ros). Massage, removes the waste products and restores the 
muscular power (Br). [Compare Emaciation, Locomotor Ataxia.] 

Balanitis. 

Mercury, Hydr. Chlor. Corr. gr. j to ^jss Aquae Calcis, as lotion, if not much 
inflammation (Br). Oil, on linen, to inflamed part beneath foreskin, which 
must be again drawn forward ; strict cleanliness. Astringent Lotions, of Alum 
or Zinc Sulphate, with warm water injections (Br). Lime-water, the best lotion 
if much inflammation (D). Tannin, in alcohol, equal parts, as dressing after 
washing with a weak solution of common salt. Carbolic Acid, a 5 per cent, 
solution, on cotton rag after washing, thrice daily, is generally sufficient. 
[Compare Phimosis, Gonorrhea.] 

Bed-sores. 

Alcohol, Brandy, or Eau-de-Cologne, to harden skin of parts exposed to 
pressure (R) ; as wash to parts threatened (B). Glycerin, or glycerin cream, 
rubbed over the parts exposed to pressure, after washing, morning and even- 
ing, is one of the best preventives (R). Alum, ^ss, whites of four eggs, Tinct. 
Camphorae ^ij, an excellent application (B). Charcoal, sprinkled over the 
black slough, which then should be covered with a poultice (R). Galvanic 
Couplet, of zinc and silver, connected by a copper wire ; one element on sore, 
the other on the adjacent part (B). Silver Nitrate, a solution (gr. xx ad ^j) to be 
painted on the threatened but unbroken skin, as soon as it becomes red, will 
prevent sores ; if Nitrous Ether solution be used, gr. v to the g is enough (R). 
Iodoform, dusted over sores (R). Linen, air-dried better than that which is 
ironed or mangled, by reason of its greater softness. Aristol, is an excellent 
application. 

Beriberi. 

Methylene Blue, caused rapid amelioration of all the symptoms in eleven 
cases (Thur). Digitalis or Strophanthus, small doses seem to do good in the 
cardiac cases (Mn). Nitroglycerin, full doses, rt^iij-v of the one per cent, solu- 
tion every % or l / z hour, when signs of acute cardiac distress appear (Simon). 
Amyl Nitrite, by inhalation in sudden cardiac attacks, pending the action of 
nitroglycerin (Mn). Bleeding from the arm or external jugular, 8 or 10 ounces, 
if signs of cardiac distress or failure persist and increase, in spite of the above- 



BILIOUSNESS. 



625 



mentioned drugs (Id). Oxygen inhalations, are worth trying in cardiac cases. 
Magnesium or Sodium Sulphate, in small and repeated doses from the outset, 
to counteract constipation and drain the tissues of fluid (Mn). Potassium 
Bromide and Aconite, with anodyne liniments, for cramps and excessive mus- 
cular hyperesthesia (Id). Strychnine, Arsenic and Silver Nitrate, as tonics for 
the nervous and muscular complications. Medication should be purely symp- 
tomatic, no drug known has any specific influence on the disease (Mn) ; the 
symptoms are treated as in other forms of neuritis (Ty). Faradization and 
Massage, are of great service for the muscular atrophy and cutaneous anes- 
thesia ; but should not be employed until the muscular hyperesthesia has sub- 
sided (Mn). Diet, should be nutritious but not bulky, animal food in reasonable 
amount, milk, eggs, wheaten flour, oatmeal, beans, are all indicated. Rice is 
a bad food for beriberics, being too bulky (Mn) ; withdraw suspected food or 
drinking water (Ty). Rest in bed for the worst cases, especially those showing 
cardiac complications ; the milder cases should be up and out in the open air. 
Removal from the infected house or district (Ty), is essential to recovery ; a 
dry locality best, the room sunny, thoroughly ventilated and in an upper story 
(Mn). A sea-voyage has often a marvelously restorative effect (Id). 



Biliousness. 

Podophyllum acts as a cathartic (B) ; corrects deficient secretion of bile, espe- 
cially in children and infants ; gr. -£$ to ^, every six hours, to correct white or 
clayey stools ; also in general hepatic derangement (P). Aconite, in occasional 
doses, improves the effect of Podophyllum (R). Mercurial Cathartics, act only 
as purgatives ; Calomel gr. j-x, or Pil. Hydrarg. gr. v-x ; Mercury as purga- 
tive restricted to cases where there is excess or deficiency of bile (B) ; frequent 
small doses of gray powder for deficiency (R) ; Calomel, gr. iij, followed by 
3ij each of Rochelle and Epsom Salts, when the tongue is heavily coated and 
furred (Gross). Mercury, Yellow Oxide, in doses of gr. -£$ to -£$, in trituration 
with sugar of milk, exceedingly efficient in many disordered conditions of the 
alimentary canal and its appendages (Schaffer). Bryonia, is worthy of com- 
mendation in the ordinary bilious headache with vomiting, and in the general 
hepatic derangement known as sluggish liver (P). Hydrastis, gtt. v-xv of 
fluid extract daily before meals, for biliousness with chronic gastric catarrh and 
dyspepsia (B). Mineral Acids, before meals, Hydrochloric Acid and Pepsin 
after meals, in atonic dyspepsia (B). Stillingia, when deficient biliary secre- 
tion (B) ; may be used in place of Mercury (Br). Ammonium Iodide, gr. j — iij 
in water each, 2, 3 or 4 hours, for catarrh of duodenum and biliary ducts (B). 
Ammonium Chloride, is much employed in Germany for hepatic derangements, 
and with success. Euonymus, is considered a very efficient remedy by many 
practitioners in cases of hepatic dyspepsia, or " bilious attacks," so called. Man- 
ganese, for gouty subjects. Rhubarb, as a cholagogue. Aloes, in biliousness 
with constipation. Angostura, is suitable in the worst forms of bilious fevers 
(P). Calumba, is of benefit in many forms (P). Alkalies, and their laxative 
salts, in the bilious state, with uric acid diathesis (B). Milk-cure, in obstinate 
cases ; buttermilk or skimmed milk often agrees best (B). [Compare Dys- 
pepsia, Hepatic Congestion, Duodenal Catarrh.] 

R . Hydrarg. Oxidi Flavi, . gr. j. 
Sacch. Lactis, . . . . q. s. 

Triturat. et div. in chart, xlviij. 

Sig. — One powder dry on the tongue 
twice daily. 

R. Ext. Euonymi, . . . . 5Jss. R. Massse Hydrargyi 7 

Ext. Hyoscyami, . . . gr. xv. Ext. Colocynthidis Co.,aagr. uj 

Ext. Gentianae, . . . . gr. vj. M. et div. in pil. ij. 

Fiat massa et div. in pil. xij. Sig. — Sig. — Take at once, and follow it in 

One pill every other day. few hours with a saline cathartic. 
40 



R. Ext. Stillingiee Fl., . . 5 v. 

Tinct. Aloes, £ij. 

Tinct. Nucis Vora., . . 3J. 
M. Sig. — Twenty drops in water thrice 
daily. (B.) 



626 



BLADDER BLEPHARITIS BOILS. 



Bladder, Irritable. 

Belladonna, in nocturnal incontinence, due to relaxation of sphincter, or 
irritable mucous membrane (B) ; gtt. v-xx of tincture every 3 or 4 hours 
give gradual but sure relief (P). Cantharis, in women, without acute inflam- 
mation (B) ; incontinence on coughing (R). Benzoic Acid, when from en- 
larged prostate, removes fetor of urine ; also renders phosphatic or alkaline 
urine acid (P). Ammonium Benzoate, may be used instead of Benzoic Acid 
(Br). Gelsemium, the best remedy for irritable bladder of women of hysterical 
type, with constant desire to urinate (B). Cubeb, is often successful in women, 
but Cantharis generally better (B) ; is of especial value when vesical catarrh 
present (P). Aquapuncture, strange to say, has been used with considerable 
success (B). Cannabis Indica, in spasm of the bladder and in irritable condi- 
tions of that organ, is generally useful. Eucalyptol, is often very efficient, but 
frequently fails, TT\,ij on sugar two or three times a day. Carbonic Acid, by in- 
jection through a catheter, after washing out the bladder, may be employed in 
almost all forms of irritability of the bladder, unless acute inflammation be 
present (P). Antipyrin, 20 grains in solution, by rectal or vesical injection, 
powerfully lessens irritability of the bladder (Chastelet). [Compare Cystitis, 
Dysuria, Enuresis, Lithiasis, Calculi, Urinary Disorders.] 



R. 



Tinct. Gelsemii, . . 


. 3SS. 


Sodii Bromidi, . . 


• 3"j- 


Ext. Triciti Fluidi, 


. giss. 



Sig. — A teaspoonful in water every four 
hours, for irritable bladder. 



Bladder, Paralysis of. 

Cannabis Indica, in retention from spinal disease (R). Ergot, in paralytic 
dysuria, especially when sensation of bladder being only partially emptied 
(P) ; when incontinence from paralytic sphincter, and in paralysis from over- 
distention (Wa). Arnica, has proved curative (P). Strychnine, gr. ¥ X q to ^, is 
useful (B). Cantharis, often given with excellent effect, when bladder atonic 
(Wa). Galvanism, may greatly benefit (B) ; electro-magnetic current from the 
bladder to the spine, of great use (Wa). 



Blepharitis. 

Pulsatilla, internally and externally (P). Mercury, after detaching crusts, 
rub in brown citrine ointment (B) ; should be diluted with vaselin or simple 
ointment (Br). Tannin, powdered, or tannic acid solution, gr. j-x to the ^ 
(B). Alum, after acute symptoms subside (B) ; a solution, gr. viij to £j aquae, 
every % or % hour, an excellent application (R). Hydrastis, as lotion, very 
serviceable (P). Bismuth, equal parts of the Subnitrate and Glycerin, to the 
inflamed surface, in ciliary and glandular blepharitis (Wa). Ergot, the fluid 
extract locally, gives excellent results (B). 



&. Aluminis, gr. x. 

Aquae Rosse, ijij. 

M. Sig. — Lotion for the eyelids. (B.) 



rjt • Unguent. Hydrarg. Nitrat., gj. 

Petrolati Molli, giij. 

Sig. — Ointment for margins of lids. 



Boils. 

Chloral Hydrate, is probably the best local application ; the boil should be 
kept covered with a tampon of cotton soaked in a solution of Chloral Hydrate 
gijss in Glycerin and Water, aa gv (Spehn). Salicylic Acid, locally, to destroy 
the staphylococcus pyogenes [see formula below] ; a 2 per cent, solution in 
alcohol, washed over small boils, or in plaster of 50 per cent, strength, changed 
4 or 5 times daily, to hasten the necrotic process in a well-formed boil ; a 2}4 



BONE DISEASES BREATH. 



627 



per cent, ointment in vaselin rubbed over daily after bathing the part with warm 
water, in general furunculosis (Philipson). Calcium Chloride, in solution, ex- 
ternally as a fomentation, will hasten maturation ; or Lime-water on compress 
covered with oiled silk, promotes suppuration more quickly than ordinary 
poultices (P). Sulphides, in small doses (gr. ^to yi of Calx Sulphurata) every 
hour or two, or Sulphurous Mineral Waters, will abort or mature, and aid to 
expel pus (R) ; of no use in the boils of diabetes (R). Belladonna, as plaster, 
to subdue inflammation, or lint wetted with Atropine, gr. iv, Rose-water, ^j 
(B) ; with Glycerin locally, to allay pain ; internally often successful (R, Wa). 
Aromatic Sulphuric Acid, for the tendency, gtt. x-xv, in plenty of water thrice 
daily. Silver Nitrate, gr. v-xx to gj of Nitrous Ether, painted over adjacent 
part, to abort ; specific if used early (R). Boric Acid, gr. xij daily, in 2 wafers ; 
also a 4 per cent, aqueous solution warm, externally by gentle friction, 4 or 5 
times a day, and on compresses to the parts — will abort furuncles yet in the 
commencement of development, rapidly cure those matured, and prevent new 
ones (Alison). Arsenic, long-continued for succession of boils (B); to lessen 
tendency to recurrence (Br). Opium, a thick extract locally (R). Alcohol, 
pure, or containing 5 per cent, of tincture of Benzoin, applied thrice daily to 
arrest minute boils (Philipson) ; Camphorated Alcohol, smeared over boils in 
early stage, then when the skin is dry smear with camphorated oil, to abort 
them (R). Sodium Phosphate, the best remedy for the systemic condition 
which produces boils (R). Carbolic Acid, undiluted, on a thread passed through 
center of boil while recent, will abort it ; a Carbolic Acid solution (5 per cent.) 
on dressings after opening a boil, will prevent a second crop, due as is often 
the case to the migration of cocci into the skin from the original boil. Counter- 
irritation, by blisters or Iodine around the boil (R). Collodion, at papular or 
pustular stage (R). Hydrarg. Biniodide, the ointment locally, with Calcium 
Sulphide, gr. j daily in divided doses internally, leaves little to be desired so far 
as treatment is concerned. Corrosive Sublimate, the B. P. solution, 1 in 875, 
dropped into the ear twice daily, in furunculosis of the ear, also on cotton wool 
in the canal, gives satisfactory results and prevents return; as lotion, 1 in 1000, 
to frequently cleanse the part, then powder with Boric Acid and Starch, and 
cover with a clean and dry antiseptic dressing (Mn). Iodine, the tincture, lo- 
cally to the initial papule, may often abort a threatening boil (Id). Aluminum 
Acetate, a solution in water (1 to 4) causes the speedy abortion of boils in the 
external auditory canal (Grosch). Poultices to assist maturation and allay 
pain, may be smeared over with Belladonna or Opium (R) ; should never be 
used, except in exceptional cases, as they sodden the adjacent area and are 
prone to be followed by more boils therein (Mn). Mangos are frequently 
blamed for boils in tropical countries. [Compare Acne, Carbuncle.] 



R- . Calcis Sulphurat, . . . gr. iij. 
Sacch. Lactis, . . . q. s. 
Triturat. et div. in chartas xxx. 
Sig. — One powder every 2 hours. 



Bl . Acidi Salicylici, . . . . .^ij. 

Emplast. Saponat., . . !|ij. 
Emplast. Diachyl., . jfj. 

Sig. — Ointment for boils. [Heitzmann.) 



Bone Diseases. 

Iodine, in scrofulous affections of bones, should be used locally, with Fer- 
rous Iodide or Cod-liver Oil internally, nutritious diet, wine, out-door exercise 
(Wa). Cod-liver Oil, in scrofulous affections, may be relied on if perseveringly 
used and accompanied by good hygienic conditions (Wa). [Compare Caries, 
Exostosis, Nodes, Periostitis, Rachitis, Spina Bifida, etc.] 



Breath, Fetid. 

Potassium Permang., gr. j to ^j aquse rosse, as a wash for the mouth (B). 
Chlorine, as solution of chlorinated lime, to remove fetor (B). Carbolic Acid, 
a dilute solution, as wash for mouth (W). Camphor, is used as a corrective (R). 



628 



BRIGHT S DISEASE. 



Thymol, in solution, as a mouth-wash is very efficient in removing the odor of 
tobacco from the breath. Look for bad teeth, disordered digestion, and in very 
offensive cases for gangrenous lungs ; cleanliness of teeth is essential. 



R. Calcis Chlorat. , . . . . ^iij. 

Aquae destillatae, 

Alcoholis, aagij. 

Olei Rosae, mjv. 

M. Sig. — A teaspoonful in a glassful of 
water as a lotion for the mouth. (B.) 



5c. Acidi Salicylici, .... gj. 
Liq. Ammonii Acetatis, t ^iij. 
Glycerini, gj. 

Aquae, . . . . q. s. ad ^vj. 
M. Sig. — A tablespoonful every six 
hours. (Robinson.) 



Bright's Disease, Acute. 

Aconite, should be given immediately on the appearance of the nephritis in 
scarlatina (R); as a diuretic, advocated (P). Strontium Lactate, is highly 
efficient and is much more useful in acute nephritis than in chronic (Da C). 
Pilocarpus, is much used (Da C); large doses very depressant to the heart, but 
tt\,v-x of the fluid extract every half-hour or hour will produce sweating ; may 
be combined with tincture of Digitalis (Smith) ; or Pilocarpine Nitrate, to excite 
skin when symptoms urgent, gr. ^2 t0 ¥ mr adult (B) ; the dose should be small 
at first ; it is not a suitable drug for children (Y) ; I have latterly resumed its use, 
often with benefit (O). Turpentine, in drop or half-drop doses every 2 to 4 
hours, controls the dropsy in a remarkable manner (P) ; hot turpentine epithems 
are serviceable but may increase the action of the kidneys (Wa). Belladonna, 
has often proved useful (P) ; may be used with benefit (Wa). Hyoscyamus, 
may be used instead of Belladonna (Wa) ; is useful in irritable kidneys (P). 
Cantharis, after subsidence of the acute stage, one-minim dose every 3 hours 
will stop the hematuria (R). Digitalis, (infusion ^ss) the best remedy in renal 
dropsy from acute desquamative nephritis (B) ; is diuretic only as long as dropsy 
lasts (R). Cannabis Indica, as diuretic ; is especially useful when bloody urine 
(R). Eucalyptus, sometimes effective ; cautiously, or it will aggravate symp- 
toms (B). Jalap, the compound powder is the most generally useful purgative, 
used in the early morning to produce free watery evacuations when uremic 
symptoms supervene (B). Gallic Acid, checks albuminuria (B). [See Albu- 
minuria, for formula.] Juniper, as diuretic; often aggravates (P). Diuretics, 
the stimulating ones, which act on the secreting cells of the kidneys, are con- 
traindicated ; but this is not the case with those which simply favor the flow of 
water through the kidneys, and of such diuretics Water is the best (Y). Alkaline 
Salts, as Potassium Citrate, Sodium Benzoate, or Sodium Bicarbonate, may be 
usefully added to the water (O). Diluents, as milk, and Potassium Bitartrate 
in solution, should be used freely to relieve the congestion and remove obstruc- 
tions from the tubules (B). Iron, after the acute symptoms have subsided, as a 
tonic, the most suitable preparation being Basham's mixture (the now official 
Liquor Ferri et Ammonii Acetatis) in ^ss doses thrice daily (Da C). Poultices, 
large, of linseed meal, made light and soft as possible, beneficial (Wa). Cup- 
ping, in lumbar region, ameliorates acute desquamative nephritis, and con- 
gestion of the kidney (B) ; cupping or leeches over the loins, with opiates freely, 
diluents, and demulcents, with rest and antiphlogistic regimen, often suffice 
(Wa). A Vapor-bath or Warm Pack, to increase the action of the skin. [Com- 
pare Albuminuria, Hematuria, Scarlet Fever, Uremia.] 

R. Potassii Acetatis, . . . fpjss. 

Infusi Digitalis, . . . . ]fiij. 

Infusi Juniperi, . q. s. ad^v]. 
M. Sig. — A tablesp. every 2 to 4 hours 
as a diuretic. 



R- . Ext. Pilocarpi Fl. 
Vini Ipecac., . . 
Mucil. Acacife, . 


, . . -fss. 

. . . 3jss. 


Aq. Cinnamomi, 
M. Sig. — A teasp. 
until free diaphoresis. 


every four 



hours 



3 IV. 



R • Pulv. Jalapae Comp. , 
Div. in chartulas no. iv. 
Sig. — One in water before breakfast. 



R 



Liq. Ferri et Ammonii 

Acetatis (U. S. P.), . gvhj. 
Sig. — A tablesp. thrice daily, as soon as 
hematuria disappears. 



BRIGHT S DISEASE BRONCHIECTASIS. 



629 



Bright's Disease, Chronic. 

Lead, diminishes the albumin (R). Gallic Acid, to lessen albuminuria (A)« 
[See under Albuminuria for formula.] Hydrastis, lessens excretion of albu- 
min (B). Potassium Bitartrate, to prevent dangerous accumulations in cellu- 
lar tissue or important cavities, also to draw off effete matters ; care must be 
used, as it is a brisk purgative and is weakening (R) ; in form of cream-of-tartar 
lemonade an agreeable diuretic (B). Jalap, the compound powder occasion- 
ally as derivative cathartic, to relieve the kidneys (Da C). Nitroglycerin, 
^Tiro t0 dilate peripheral vessels, relieves the heart and the renal congestion 
and diminishes albumin (B). Fuchsin, in doses of gr. vij-xv daily, used with 
considerable success in different stages of the disorder, and was well borne 
(Riess). Oleum Erigerontis, lessens albumin, lowers vascular tension, im- 
proves general condition, and favorably influences the headache, nausea, and 
other uremic symptoms (B). Cod-liver Oil, is very useful (R). Cannabis In- 
dica, as diuretic when bloody urine (R). Turpentine, sometimes given in very 
small doses as a diuretic, and to check hematuria (R) ; half-drop or drop doses 
every 2 to 4 hours very successful in dropsy with albuminous urine depending 
on non-desquamative disease of the kidneys. Jaborandi, is very satisfactory 
in uremia (B) ; large doses very depressant to the heart (Smith) ; r^xx of the 
fluid extract ter in die if the urine decreases much (Da C). Iron, to improve 
digestion and correct anemia ; the tincture of the Chloride or Tinct. Ferri Ace- 
tatis preferred (B) ; in chronic tubular nephritis with cardiac hypertrophy the 
Liq. Ferri et Ammonii Acetatis, ^ss ter in die, with an occasional vapor-bath 
(Da C). Chimaphila, has power over various forms of nephritic disease, espe- 
cially when albuminuria present (P). Eucalyptus, in chronic desquamative 
nephritis, cautiously used, will improve (B). Elaterium, for the dropsy, as a 
derivative cathartic ; must be cautiously used (R). Bromides, are useful in the 
convulsions (R). [See under Uremia.] Potassuim Iodide, has improved some 
cases, which were possibly due to syphilis (R). Aurum, the Chloride in pill 
gr. -^ to -^ ter in die, persistently, in chronic interstitial nephritis, to arrest 
hyperplasia of the connective tissue ; may be combined with Arsenic, which 
has a similar influence (B). Mercuric Chloride, acts in the same manner, 
gr. -^ bis die (Da C). Milk-cure, has been very successful ; skim-milk alone 
for some time, then gradual addition of other diet (B). Water, in large draughts 
as diuretic, when excretion of solids is deficient (Br) ; hot fomentations to lum- 
bar region (B). Baths, warm and Turkish, when uremic symptoms and 
dropsy ; discretion needful, as baths may weaken (R). Mineral Waters, espe- 
cially the Buffalo Lithia Water, of Virginia, which has many advocates. Food 
should be nourishing ; milk, eggs, and rare beef are particularly suitable (Da C). 
Peanuts are an excellent article of food for subjects of kidney disease, by whom 
foods rich in animal albumin are to be avoided (Furbringer). [Compare 
Dropsy, Uremia.] 



R-. Strychnine Sulphatis, . . gr. %. 

Tinct. Ferri Chloridi, . . J ss. 

Acidi Acetici, .^jss. 

Curacose, ^j. 

Liq. Ammonii Acetat., ad % vj. 
M. Sig. — A tablesp. every 6 hours, fol- 
lowed by a glass of water. For the anemia. 



R . Tinct. Nitro-glycerini, I per cent. 

Sig. — One drop, gradually increased to 
five, four times daily, on sugar. (B.) 



R- . Auri et Sodii Chloridi, 
Aquae Destillatse, . 



7- jss. 



Solve. Sig. — A teasp. ter in die. 



Bronchiectasis. 

Quinine, the most useful remedy as a tonic (B). Phosphates, are undoubt- 
edly useful, so also are the Hypophosphites (B). Chlorine, in solution as a 
stimulant and deodorizer, or as inhalation to lessen fetor (Br). Palliation of 
the cough and expectoration, with care of the general health of the patient, is 
all that can be accomplished. [Compare Emphysema.] 



630 



BRONCHITIS. 



Bronchitis, Acute. 

Acetanilid, in dose of gr. iv every two hours, has often arrested the attack 
within 24 hours. Aconite, gtt. ss-j every hour (B) ; in catarrh and bronchitis 
of measles (R). Tartar Emetic, in the first stage, gr. -^ to T ^, especially if 
cough is violent (B) ; gr. j to a quart of water, a teasp. of this every hour for 
the wheezing and cough of slight bronchitis in children (Smith) ; gr. ^ to y 2 
every 2 or 3 hours (R). Ipecacuanha, as wine, when expectoration profuse and 
difficult to expel (R) ; in dry stage (P) ; Ipecac, when secretion is scanty and 
dry, but use Squill when the secretion, though copious, is difficult to expel 
(Br). Lobelia, as expectorant (B) ; for paroxysmal dyspnea (R). Camphor, 
in oil by hypodermic injection in bronchitis from cold ; the first injection acts 
like an expectorant, and after the fourth the expectoration ceases completely, 
even in the most serious cases (Alexander) ; has but slight value in the bron- 
chitis of the emphysematous. Sanguinaria, after subsidence of acute symp- 
toms, as expectorant (B) ; very successful (P). Quinine, to reduce temperature 
(R). Colchicum, useful when gouty diathesis (P). Opium, Morphine and 
Quinine combined, or Dover's powder, to abort an attack; also with expecto- 
rants to allay cough (B) ; in frequent and violent coughs, without obstructed 
oxidation ; also to check excessive secretion (R) ; as sudorific, gr. x of Dover's 
powder very useful (P). Carbolic Acid, as spray, a 5 per cent, solution with 
steam atomizer, prompt and efficient. Apomorphine, the Hydrochlorate inter- 
nally in doses of gr. -^ every three hours, the best of all expectorants. Cimi- 
cifuga, an excellent expectorant, and useful when acute symptoms have sub- 
sided (B). Nitric Acid, tt^x of the dilute acid relieves (B). Asafcetida or Am- 
moniacum, the last best, in bronchitis with wheezing of old people (R). Asa- 
fcetida, is an excellent stimulant of respiration, especially when the capillaries 
have become clogged with the products of inflammation, and suffocation seems 
imminent ; here also the Cold Bath is a means of enabling the patient to expel 
the mucus, the equal of which has not been yet advanced ; it may be used for 
even very young infants, and should be but momentary for them (W). Am- 
monium Carbonate, when the expectoration is profuse, and the condition low 
(R). Ammonium Acetate, from its sudorific action, is always indicated, espe- 
cially in children (Dessau). [See formula below.] Cubeb, very useful, espe- 
cially when secretion copious and system relaxed (P). Copaiba, after subsid- 
ence of the fever, the most serviceable expectorant, but nauseous (B). Counter- 
irritants, mustard as large poultice, with linseed or oatmeal, or both, very 
useful (R). Iron, Lead, Zinc Oxide, to check profuse secretion (R). Heat to 
chest by linseed poultices, of great service. Diet, should be light and in liquid 
form. Temperature of atmosphere in room should be about 8o° F., and the 
air moistened by steam. [Compare Cough.] 



R. Antim. et Potassii Tart., gr. ij. 

Liq. Ammonii Acetatis, % iv. 

Spt. Athens Nitrosi, . §j. 

Tinct. Aconiti £ss. 

Syr. Simplicis, . q. s. ad Jvj. 
M. Sig. — A teaspoonful every 2 or 3 
hours. In first stage. 



U. Liq. Ammon. Acetatis, giv. 
Spt. Athens Nitrosi, 
Syr. Ipecac. , . . . . aa^jss 

Syr. Senegae, £j. 

Syr. Limonis, ^j. 

M. Sig. — A teaspoonful every 3 hours 

for children. {Dessau. ) 



R 



Tinct. Sanguinaria, 

Tinct. Lobelia?, . . . aa ^j. 

Vini Ipecac, gij. 

Syrupi Tolutani, q. s. ad ^ iv. 
M. Sig. — A teaspoonful every 3 hours. 

(B.) 



R. Apomorph. Hydrochlor., gr. }(. 

Ac. Hydrochlor. Dil., . n\iij. 

Syrupi Senegse, . . . . Zv. 

Aquae Destillat gj. 

M. Sig. — A teaspoonful every 2 hours, 
for a child of 3 years as expectorant. 
Should be put up in a blue bottle. 



BRONCHITIS. 



6ii 



R. Ext. Cimicifugae Fl., . . ^ss. 
Tinct. Opii Deodorat., . gj. 
Syr. Tolutani, . q. s. ad ^ij. 
M. Sig. — Ateaspoonful every 4 hours. 

(B.) 



R. Tinct. Aconiti, . . . . TT^viij. 

Aquae Cinnamomi, . . . ^j. 
M. Sig. — A teaspoonful every ]/ 2 hour 
for 2 hours, then every hour. In acute in- 
flammatory form. 



R. Vini Ipecac, gij. 

Liq. Potassii Citratis, . £ iv. 
Tinct. Opii Camphorat. , 
Syr. Acaciae, . . , . aa^j. 
M. Sig. — Tablesp. terdie. In first stage 

of ordinary acute bronchitis. {Da Costa.) 



R 



M 



Ext. Eriodyctii Fl., . . gyj. 
Ext. Senegas FL, . , . % iv. 
Syr. Pruni Virginianae, . Jij. 
Aquae, . . . . q. s. ad % iv. 
Sig. — Teaspoonful every 3 hours. 



Bronchitis, Capillary. 

Ipecacuanha, as emetic, preferred to tartar emetic in capillary bronchitis of 
very young or very old (B) ; as wine, when expectoration profuse and difficult 
to expel (R) ; in very young infants should be used in place of antimony 
(M & P). Squill, as expectorant, may be used with benefit (Wa). Antimony 
Sulphurated gr. ^ in combination with Dover's powder, every 2 or 3 hours, 
when the temperature very high, and pulse full and strong; must be stopped 
as soon as nausea and vomiting begin (M & P). Lobelia, for paroxysmal dysp- 
nea (R). Ammonium Carbonate, when expectoration profuse and strength 
diminishing ; in severe bronchitis or broncho-pneumonia of children, especially 
when prostrate and livid (R) ; has probably a specific action on the diseased 
tissue and its products (Clymer). Ammonium Iodide, in small, rapid doses, 
often gives great relief to the catarrhal process (Da C) ; often gives the most 
astonishing relief (B). Ammonium Muriate, gr. ij every 2 hours, either alone 
or with Potassium Chlorate (Clymer). Serpentaria, in capillary bronchitis of 
children gives excellent results (B). Turpentine, one of the best stimulants when 
vital powers are depressed and peripheral circulation feeble (B). Camphor, to 
allay cough and promote expectoration (B). Hydrocyanic Acid, for cough and 
tendency to spasm. Hydrargyrum Subsulphate, is effective as emetic (B). 
Mustard, as poultice or bath, useful (R) ; the most important part of the treat- 
ment (M & P). Poultices, to encircle the whole chest in children (R); fol- 
lowed by a jacket of cotton wool around the chest. Steam, by inhalation, 
may be impregnated with sedatives, or with Carbolic Acid ; is of great impor- 
tance (M & P). Quinine, in that form of capillary bronchitis occurring in trop- 
ical climates, and where marked debility (M & P). Stimulants, are often 
necessary, especially in the suffocative form, and where marked prostration 
(M & P). Emetics are necessary when suffocative symptoms become prom- 
inent. [Compare Cough.] 



R. Ammonii Iodidi, .... gj-ij. 
Ammonii Carbonat., .. . . gij-iij. 
Syr. Glycyrrhizae, 

Syr. Tolutani, aa^ij. 

M. Sig. — A teasp. every 2 or 3 hours. 

R . Quininae Sulphatis, . . . gr. vj. 

Ac. Sulphurici Dil., . TT^xij. 

Syr. Simplicis, % ss. 

Aquae, ^ij ss - 

M. Sig. — A teasp. every 2 hours to 
child of 2 or 3 years ; older children re- 
quire more quinine. (M. & P.) 



R. Liq. Ammonii Acet., . . Jss. 

Syr. Ipecac, gj. 

Morphinae Sulph. , . . . . gr. ^ 

Syr. Acaciae, Sf j. 

Aquae, ^j ss - 

M. Sig. — A teasp. every 2 hours for a 
child 2 years old. When surface pale and 
expression languid, skin cool. (M. & P.) 



R 



. Ext. Serpentariae Fl., . . ^ss. 

Ammonii Carbonat., . . . gij. 

Syr. Tolutani, . . . . . ^ jss. 
A teasp. every 2, 3, or 4 hours. 



632 BRONCHITIS. 



Bronchitis, Chronic. 

Antimony, when expectoration copious and difficult to expel (R). Arsenic, 
in cigarettes, when emphysema (B). [See Asthma, for formula.] Sulphur, 
gr. v-x, in severe cases, with abundant discharge, especially where constitu- 
tional debility (R). Sulphurous Acid Gas, inhalations, or the acid in form of 
spray, sometimes beneficial (R). Hydrogen Dioxide, the solution internally, 
doses of 3j-hj, diluted with 3 to 4 of water, gives great relief in chronic bron- 
chitis with dyspnea. Lobelia, for paroxysmal dyspnea (R). Ammonium 
Chloride, combined with stimulating expectorants, such as Serpentaria, Sangui- 
naria or Eucalyptus (B) ; when secretion is thick and abundant the salt may be 
applied by an atomizer (R). Carbolic Acid, as inhalation of spray, 1 part to 100 
of water ; may be combined with tincture of Iodine (R) ; a 5 per cent, solution 
in steam atomizer as inhalation. Hydrastis, fluid extract, locally and internally 
(B) ; of great value internally and externally in chronic coryza (P). Senega, 
especially in the aged (R). Iodine, by inhalation, sometimes used (R) ; the 
Iodides, especially Ammonium Iodide, are very serviceable in combination 
with expectorants (B). Colchicum, in gouty subjects (R). Balsam of Peru and 
of Tolu, when copious secretion of pus (R). Ammonia, as inhalation, to lessen 
expectoration (R). Oleum Anthemidis, in pulmonary catarrh with excessive 
secretion and difficult expectoration, a very useful remedy, n\jj-iv (P). Am- 
moniacum, the mistura, with Ammonium Chloride or Carbonate, efficient in 
the bronchitis of old people, with wheezing and abundant secretion (R). 
Benzoin, gj of the compound tincture on boiling water, as inhalation ; eases 
cough and lessens expectoration (R) ; is sometimes used by atomization (B). 
Phosphates, for the resulting cachexia (B) ; the Calcium Phosphate (R). Ser- 
pentaria, as stimulant. Alum, powdered, dusted over surface (B). Silver 
Nitrate, locally in solution, gr. v-xx to the ^, on sponge probang (B). Cam- 
phor, to allay cough and promote expectoration (B). Sumbul has decided 
efficacy (P). Opium, with expectorants, to allay cough (B) ; when cough 
frequent and violent without any signs of obstructed oxidation, also to check 
excessive secretion (R). Codeine, gr. l /e every 3 to 6 hours, when other opiates 
are not well borne (P). Morphine, gr. ^ with 5 grains of Dover's powder at 
bed-time, followed by whiskey on the next morning, used in more than 200 
cases of bronchitis with excellent results (English). Euphorbia Pulifera, is very 
successful in asthmatic, chronic and advanced or subacute bronchitis (Dujar- 
din-Beaumetz) ; ^ss-j of the fluid extract thrice daily. Ethyl Iodide, by in- 
halation, is very valuable by reason of its local influence, TT^v-xx thrice daily 
(B). Grindelia, an excellent expectorant, especially when cough is troublesome 
(B). Strychnine, as a respiratory stimulant and to check the reflex vomiting 
(B) ; the Syrup of the Phosphates of Iron, Quinine, and Strychnine. Squill, 
in chronic forms with tenacious sputa, but not when fever or acute inflamma- 
tion (R) ; the Pil. Ipecac, cum. Scilla, of the Br. Ph. in 10-grain doses night 
and morning, is a most useful remedy (Br). Tar, diminishes the secretion and 
allays the cough (P)'; gr. ij in pill every 3 or 4 hours in chronic paroxysmal 
winter cough (R). Digitalis, when interstitial pneumonia and general ana- 
sarca (B). Eucalyptus, valuable in chronic cases of broncho-pulmonary 
catarrh (B). Apomorphine, by the mouth, as an expectorant, alone or along 
with morphine (Br). Chekan, a fluid extract of the leaves is said to be 
highly efficient (M). Carbonic Acid, diluted, may be inhaled with benefit 
(P). Formalin, in dilute solution administered as spray. Nuclein, has been 
administered with benefit, as a general tonic. Gallic Acid, is useful in some 
forms of chronic broncho-pulmonary catarrh (B). Iron, with free expectoration, 
Mistura Ferri Composita ; or better, the Phosphate of Iron, Quinine, and 
Strychnine (B) ; to check profuse bronchial secretion (R). Myrtol, in fetid 
bronchitis, of great value (Gubler). Copaiba, when purulent secretion (R) ; 
for profuse secretion the best of all expectorants, but nauseous (B). Cubeb, 
when profuse expectoration, has similar remedial influence (B). [See Bron- 



BRONCHORRHEA. 



633 



CHORRHEA, for formula.] Terpin Hydrate, gave immediate and curative re- 
sults in cases of long-standing and obstinate bronchitis, which had resisted 
all other treatment ; gr. xlviij, in Glycerin, q. s. ut. ft. solutio, Syr. Lactucarii, 
q. s. ad §ij, of which a teasp. every three hours (Boyland). Terebene, is 
proving very valuable ; requires an equal weight of light magnesium carbonate 
to suspend it. Koomiss-cure, possesses great value (B). Cod-liver Oil, a tea- 
spoonful ter die, after meals, of great service, if continued (B) ; to control 
expectoration (R). Poultices, made large, of hot linseed meal to cover the 
chest, when congestion of lungs. Olive Oil, inunctions to chest, has soothing 
and strengthening effects. Diet, nutritious, and stimulants necessary when 
great prostration ; Koomiss is an excellent article of diet. [Compare Cough, 
Emphysema.] 



R. Ext. Eucalypti Fl., . '. gj. 
Ammonii Chloridi, . , gj. 
Ext. Glycyrrhizas, . . . gij. 
Syrupi Tolutani, . . . ^iij. 
M. Sig. — A teasp. 4 to 6 times daily. 



B 



M. 



Tinct. Sanguinarias, . 


• 3J- 


Ammonii Chloridi, 


• 3J- 


Syrupi Tolutani, . . 


• 2?ij. 


Spt. ^Etheris Nitrosi, 


^ss. 


Aquas, ... 


. ifiijss 


Sig. — Tablesp. p. r. 


n. 



R . Syrupi Scillas, . . . 

Tinct. Opii Camph., . 

Ammoniaci, . . . . 

Syrupi Tolutani, . . 

M. Sig. — A teasp. p. r. 



3ss. 

3 SS - 
3 X - 



R. Ammonii Chloridi, . . Jjiij. 
Syrupi Picis Liquidas, . j§vj. 
Sig. — A tablesp. 4 times daily 



M. 



R . Ammonii Carbonat., . . gr. xl. 
Infusi Serpentarias, . . ^ iv. 
M. Sig. — A tablesp. every 3 hours. 



Bronchorrhea. 

Ammonium Iodide, often improves the condition, especially if used with 
Arsenic (B). Eucalyptus, the oil of great utility (B) ; rr\jj ter die on sugar, or 
see formula above. Sulphurous Acid Gas, as inhalations, or in solution as 
spray, sometimes improves (B). Lead Acetate, as astringent to restrain secre- 
tion (B) ; gr. j-ij every 2 hours. Petroleum, crude, in capsules, has been ad- 
ministered with rapid amelioration as the result (Blache). Grindelia, an 
efficient remedy (B). Iodine, as liniment, over front and back of chest (R). 
Spinal Ice-bag, to restrain excessive secretion (R). Quinine, and the Phos- 
phates, also Cod-liver Oil, as restoratives (Wa). Copaiba, the most serviceable 
expectorant, but nauseous (B) ; when copious secretion of pus (R). Cubeb, 
has remedial effect in chronic bronchial affections with profuse expectoration 
(B). Asafcetida, is of great benefit (B). Turpentine, an excellent remedy when 
fetid expectoration ; may be used internally or by inhalation from atomizer. 
Terpin Hydrate, seems to be even more efficient than turpentine, in doses of 
gr. x-xx daily. Carbolic Acid, internally (Try), and by spray (gr. v ad 5J aquas), 
often of great utility (Da C). Benzoin, by inhalation, for its local influence. 
Myrtol, is largely eliminated by the lungs, and is a most valuable agent in 
bronchorrhea and fetid bronchitis, acting as a stimulant and antiseptic (Gubler) ; 
dose, rr^ij in capsules (Br). [Compare Cough.] 



R . Copaibas, 

Syrupi Tolutani, . . aa^ss. 
Spt. yEtheris Xitrosi, . ^j 
Aquse Menth. Pip., . . ^ij. 
M. Sig. — A teasp. every 4 hours. 



R. 



Ammonii Chloridi, 
Emulsi Asafostidas, 



Misce. Sig. — Tablesp. as required. 



R 



M. 



Copaibas, 
Bals. Tolutan., 
Pulv. Acacias, . . 
Ac. Sulph. Aromat. 
Aquas Destillat., . . . . 5vj. 
Sig. — Tablesp. bis vel ter in die. 



aa^ss. 
. Zss. 



R . Potassii Iodidi, . . 

Ac. Nitrici Dil., 

Tinct. Belladonnas, 

Ac. Salicylici, . . 

Aquas Camphoras, q.s. ad^iv. 
jSI. Sig. — Dessertsp. in water 3 or 4 
times dailv, for fetid bronchitis. 



3)- 

3i- 



634 BRUISES BURNS AND SCALDS. 



Bruises. 

Arnica, the infusion very useful as an external application for bruises and 
cuts ; also an excellent internal remedy for internal bruises, shake, falls, blows, 
or shock ; tt\,v-x every 2 or 3 hours (P) ; in bruises, sprains, etc. (Wa). Aconite, 
the liniment locally to painful sprains and bruises (Wa). Capsicum, a strong 
tincture applied with gum, said to act like a charm on discolored bruises (R). 
Sulphurous Acid, a solution constantly applied (R). Oil of Bay, as stimulating 
liniment (P). Opium, the tincture 3j with Linimentum Saponis §j diligently 
rubbed in two or three times a day, affords great relief (Wa). 

Bubo. 

Mercury, necessary in the indurated buboes diagnostic of syphilis (Ricord) ; 
Calomel locally applied for indolent buboes refusing to heal after opening (H). 
Nitric Acid, indolent and broken bubo (R). Sulphides, are less useful in ma- 
turating buboes than in the case of ordinary boils or abscesses (R) ; to check 
suppuration (St). Iodoform, locally, has proved useful (Wa). Iodine, applied 
to produce vesication around a bubo, relieves inflammation (R) ; freely every 
day, with rest and compression, to cause absorption (St). Silver Nitrate, lightly 
to surface, to stimulate indolent buboes (Wa). Potassio-tartrate of Iron, 30 
parts to 250 aquae destil., three tablesp. daily, also as lotion to sore (Ricord) ; 
in phagedena (St). Tartar Emetic, gr. j every two hours, reduces inflamma- 
tion in many cases (Wa). Ice, greatly relieves (B). Surgical, open freely with 
a bistoury when suppurating ; if the pus is virulent the open bubo is a chan- 
croid and must be treated as such (Keyes). Pressure, by compressed sponge 
under a spica bandage or a shot bag, the best local treatment for indolentbubo 
(Keyes) ; in all cases cleanliness, rest in recumbent posture, emollient poul- 
tices. Diet, should be generous with cod-liver oil in phagedenic bubo. Treat- 
ment of syphilitic bubo is that of general syphilis, local measures are useless 
and no treatment is called for until the general eruption appears (Keyes). 
[Compare Chancroid, Syphilis.] 

Bunion. 

Iodine, as paint, or Emplastrum Hydrargyri, for indolent form, thick but not 
tender (D). Rest, fomentations and anti-arthritic remedies for thickened 
bunion ; burst it by pressure if recent and sac thin (D). [Compare Bursitis.] 

Burns and Scalds. 

Carbolic Acid, 1 part to 30 of Linim. Calcis, or 1 part to 6 of Olive Oil ; the 
latter speedily relieves pain, and promotes healing without suppuration (Wa) ; 
1 part to 10 of Olive Oil, applied on layers of cotton batting, the best applica- 
tion for burns of all degrees. Boracic Acid, a saturated watery solution, used 
with great success (Lister). Lead Carbonate, as white lead paint, an excellent 
application to burns of small extent (B). Salicylic Acid, Z) to ^viij Ol. Olivse, 
is an efficient local application (B). Collodion, flexible, to burns of first degree 
(R). Phytolacca, relieves pain (B). Lime, as Lime-water and Oil, equal parts 
(R) ; or Lime-water with Linseed Oil, the celebrated Carron Oil, or better still 
with Olive Oil, a favorite and efficient application (P). Picric Acid, a saturated 
solution, Picric Acid 5, dissolved in Alcohol 80, then add Distilled Water 1000, 
applied on strips of sterilized gauze, gives better results than any other treat- 
ment (Power). Normal Salt Solution, applied on cotton, gives great satisfaction 
(Keen). Aristol j, Olive Oil, sterilized ij, Vaselin viij, as ointment for extensive 
burns (Walton). Acetanilid, powdered and dusted over the surface, is an ex- 
cellent application. Rhus Toxicodendron, the tincture externally, Z] to the pint 
of water, in superficial but extensive burns (P). Cantharis, the tincture diluted 



BURSITIS CACHEXIA. 



635 



with 40 of water and applied on rags, is a most excellent application. Sodium 
Carbonate in solution as lotion, immediately relieves pain and promotes rapid 
healing. Turpentine, in dangerous cases, where great constitutional depression 
(P) ; as wash to severe burns, then locally Basilicon Ointment mixed with Tur- 
pentine (B). Cotton-wool, to allay pain and exclude air (P). Warm Bath, 
immerse for some days (R); exclusion of air the main indication (H), Pinus 
Canadensis, the concentrated extract, painted on freely, relieves the pain 
effectually. 



Lime and Linseed. 



& 



Olei Lini, . 

Aquae Calcis, . 

M. Sig. — Apply 

cover with oiled silk. 



I vi J- 
gyiij. 



on sheet lint, and 



R . Sodii Carbonatis, . . . ^vj. 

Aquae, Oiij. 

M. Sig. — Apply freely for 3 days on 
old cloths or lint. 



R . Iodoformi, gj. 

Cetacei, . . . . . ^j. 

Ext. Conii Alcohol., . . gr. xl. 

Acidi Carbolici, .... gtt. x. 
M. Sig. — Spread on lint and cover the 
parts therewith. 



R. Pulv. Carbonis Ligni, . . ^viij. 

Sig. — To be dusted thickly over the 
burned parts. 



Bursitis. 

Iodine, painted on outside, after removal of fluid from aspirator (D) ; after 
blistering (Wa). Blisters, in rheumatic enlargement of bursas, are almost 
indispensable for a rapid cure (Wa). Fomentations, with rest, to relieve pain 
and swelling ; if unavailing, a crucial incision into the bursa, care being taken 
not to open the capsule of the knee (D). Excision, when chronic, tumor hard, 
resisting other measures (C). 



Cachexiae. 

Calcium Phosphate, in scrofulous affections and anemia (Wa) ; in phthisis 
and affections marked by mal-nutrition (B). Iron, in splenic, syphilitic and 
strumous, and especially in all anemic states ; also in the malarial and phthis- 
ical ; chalybeate waters (B) ; the Ammonio-citrate is the best tonic in the 
cachexia of gastric ulcers, especially in chlorotic females (Wa). Arsenic, a 
prompt remedy in the malarial cachexia ; also of real value in the cancerous 
(Wa). Hydrastine, in paludal and splenic cachexias, stands in high esteem 
(B). Nitric Acid, is adapted to the cachexia following acute diseases or intem- 
perance ; also as alterative after a long course of Mercury (Wa). Potassium 
Iodide, in constitutional syphilis and resulting affections of bones and skin 
(Wa). Mercury, in the syphilitic, but its utility much questioned (Wa). Aurum, 
in cancerous, mercurial, and syphilitic cachexias, especially when bones, 
glands, and oculo-nasal mucous membrane affected. Phosphates, in bone 
diseases, wasting, bronchitic, leucorrheic cachexias, etc. (B). Arnica, in very 
developed cachexias, has excitant action on the nervous system (Wa). Euca- 
lyptus, a serviceable tonic and stimulant in cachectic states generally (B). 
Manganese, the Syrup of Ferrous and Manganese Iodide, in anemic, syphilitic, 
strumous, malarial, cancerous cachexias, etc. (B). Grape-cure, often modifies 
most happily many conditions (P). Air, in good condition, an important 
element (B). Water, the Turkish bath and wet pack as aids to remedial 
action, in plumbic, mercurial and paludal cachexias (B). Oils and Fats, to 
promote constructive metamorphosis in many cachexias, especially cod-liver 
oil (B) ; the latter a most valuable remedy in scrofula, phthisis, atrophy, 
tubercular and jail cachexiae, anemia, etc. (Wa). Massage, has been produc- 
tive of remarkable results in many forms of cachexia (B). Aliment, of prime 
importance (B). [Compare the titles Anemia, Scrofula, Syphilis, etc., and 
the Formulas for Tonics under Adynamia and Anemia.] 



636 CALCULI. 



Calculi, Biliary. 

Chloroform, in 20- to 60-drop doses every 3 or 4 hours, is by some supposed 
to act as a solvent of gall-stones ; it cannot so act but undoubtedly affords some 
relief (B) ; as an inhalation it may be used to relieve the pain of the paroxysm 
(Br). Ether and Turpentine, equal parts of each, Z] once daily for a year, is 
Durande's solvent remedy ; is not solvent, and as an anodyne is inferior to 
morphine or chloral (B). Morphine, gr. % with Atropine, gr. t \q, hypodermic- 
ally, the best anodyne for the pain and vomiting during the paroxysm (Br). 
Chloral sometimes relieves the pain (R). Counter-irritants, as mustard poul- 
tices to relieve the pain during the paroxysm (Br). Olive Oil, ^ij at night, 
followed next morning by 3 or 4 seidlitz powders an hour apart, efficient in 
facilitating the expulsion of accumulated gall-stones ; this treatment is based on 
rational principles, as gall-stones placed in Olive Oil undergo solution, losing 
nearly 70 per cent, of their weight in 10 days (Brockbank) ; ^iv-viij per diem 
between the attacks the best prophylactic (Id). Sapo Animalis, of the Br. Ph., 
is still more efficient for their solution and breaking up (Id). Nitro-muriatic 
Acid, as bath, found useful in India to relieve the pain and promote expulsion 
of the calculus, ^iij of the acid to a gallon of water (Scott). Glycerin, is a good 
remedy for biliary lithiasis (Ferrand). Sodium Phosphate, in £-dose before 
each meal for several months, to prevent recurrence (B) ; should be given in 
plenty of water (B). Sodium Salicylate, increases the secretion of bile and 
renders it more watery ; it is therefore indicated in cases where there is a 
tendency to the formation of gall-stones (Br). Succinate of the Peroxide of 
Iron, hydrated, contains a large proportion of nascent oxygen, and is given in 
teaspoonful doses after meals for several months, and resumed at intervals 
afterwards to prevent reformation of the calculi (Buckler). Diet, is important ; 
withhold all starches, sugars, and fats, also malt liquors and spirits ; moderate 
exercise out of doors, lean meats, eggs, fish, fruits and succulent vegetables 
to be used freely. Mineral Waters, the alkaline are useful, especially Vichy, 
which is deemed of great benefit. [Compare Colic, Jaundice.] 



R- . Ferri Peroxidi Succinat. 

Hydrat., t ^iss. 

Aquse, 3 V J SS - 

M. Sig. — Teasp. after each meal for 
several months. 



R . Spt. ^Etheris Comp. , . . gij. 

Liq. Magendie, .... rr\xxx. 

Syr. Zingiberis, q. s. ad ^j. 
M. Sig. — Teasp. doses, an hour apart, 
until pain is relieved. 



Calculi, Renal and Vesical. 

Alkalies, especially Potassium salts, if long continued, will effect solution of 
uric acid calculi (R) ; Sodium salts should not be used (B). Calcium Carbon- 
ate, an old and efficient remedy, also Lime-water has been used with benefit, 
and may be injected into the bladder (P). Potassium Citrate, in large doses 
for bloody urine containing uric acid crystals (R) ; the Citrate and Carbonate 
are the most desirable solvents for uric acid gravel (Sir H. Thompson). Potas- 
sium Tartra-borate, if long used, is very efficient as a solvent for uric acid cal- 
culi (B). Potassium Salts, are much more efficient than those of Lithium as 
solvents for uric acid (Rogers). Alkaline Mineral Waters, those rich in Potas- 
sium preferred, especially Vichy (B). Ammonium Benzoate, long continued, 
will dissolve phosphatic calculi (B). Ammonium Biborate, will prevent attacks 
of colic where uric acid calculi, in 20-grain doses every two hours until free 
urination, then gr. xv thrice daily in a glass of flaxseed tea. Magnesium Boro- 
citrate is a good solvent of uric acid calculi (Madsen). Lithium Citrate, to 
promote oxidation (Da C). Piperazin, as a solvent for uric acid and urate con- 
cretions, is far superior to other agents. Olive Oil, internally, is of excellent 
service in renal as well as in hepatic calculi, controlling the crises of the disor- 
der with undoubted effect (Aussilloux). Hydrangea, in decoction, used by the 
Cherokees in all calculous affections with uniform success (Butler). Lead 



CANCER. 



637 



Acetate, gr. ]/ z to the 5jj of distilled water, injected into the bladder to prevent 
formation of phosphatic calculi, or a solution of Dilute HC1 Acid, n\,ij — iij to 
the ^ (Sir H. Thompson). Nitric Acid, very dilute, as injection for phosphatic 
calculi (R) ; gtt. j to the ^, as injection into the bladder in chronic cystitis and 
phosphatic deposits (B). Cotton-root, in decoction, as a demulcent for strang- 
ury and gravel (P). Castor Oil, of value as a purgative (P). Calumba, to 
relieve the vomiting (P). Counter-irritants, as mustard-poultices, or turpentine 
stupes, to relieve the pain of the paroxysm (R). Anesthetics, for the same 
purpose (B). Antipyrin gr. xxiv, Laudanum gtt. x, Water ^iij, injected into 
the rectum j( hour before beginning lithotrity, rendered the crushing and 
evacuation of the stone absolutely painless, the bladder seeming non-sensitive 
to touch or tension (Chastelet). Morphine, hypodermically, as an anodyne and 
to relieve the vomiting (B). Hot Fomentations, to alleviate spasm and pain 
while calctdus is passing. Diet. Restrict the use of sugar in any form or com- 
bination, also fats and alcoholic beverages. Fresh, green vegetables may be 
used freely, also skimmed milk or buttermilk. Mineral waters, preferably 
Vichy, Friedrichshall and Carlsbad. Frequent abstinence from animal food. 
Lemon-juice and soft water in large draughts, are useful. Surgical Measures. 
Lithotomy or Lithotrity for removal of a stone from the bladder. Solvents are 
of no use except for a very small calculus, and even then a considerable time 
must be occupied in the process. No operation in surgery more certainly safe, 
rapid, and successful than lithotrity (Sir H. Thompson). [Compare Colic, 

LlTHIASIS, OXALURIA, etc.] 



B 



Magnesiu7ti Boro-citrate. 

3J' 



aa 



Magnesii Carbonat., 
Sodii Biborat, 
Acidi Citrici, . . . 
Aquae Bullientis, . . .. 
M. Sig. — Tablespoonful 3 
daily. 



39;.. 

^ viij. 

or 4 times 
(B-) 



Potassium Tartra-b orate. 



R. 



Potassii Bitartratis, . . . partes iv. 

Ac. Borici, partem j. 

Aquas, partes x. 

By heating the above together, the salt is 
obtained as a powder, of which gr. xx in a 
large draught of water 3 or 4 times daily. 



Cancer. 

Opium, stands first on the list of palliatives, allaying pain and quieting irri- 
tation (Wa) ; as powder applied to cancerous sores ; also Morphine, dissolved 
in glycerin, and spread on lint, very useful where there is much pain ; Opium 
is also used in cancer of the stomach (R). Codeine, gr. ^ to ■^ u , a good hyp- 
notic (P). Arsenic, in cancer of the stomach, diminishes pain and checks 
vomiting ; also in scirrhus of stomach and epithelioma. Arsenous Acid, pure 
or with starch, as a caustic ; enough should be used to set up active inflam- 
mation (R) ; may cause arsenical poisoning by absorption. Belladonna, 
locally and internally, Tr\,v-x, of great benefit as palliative in severe pains of 
cancer (P). Conium, as poultice, and internally to relieve pain (R) ; is par- 
ticularly applicable to pain of cancer (P) ; as palliative (Wa). Hydrastis, has 
a renewed interest (Pf). Carbolic Acid, undiluted, to sore, and injected be- 
neath it, limits and retards (B) ; pure, as anesthetic, before applying caustics ; 
with glycerin as application to fetid cancers (R). Mercuric Chloride, in small 
doses, long continued, will retard the growth of gastric cancer (Da C). Citric 
Acid, Z) to ^viij aquas, useful in allaying pain of cancerous ulcerations (Wa). 
Acetic Acid, 1 to 3 aquae, tt\,xxx injected into the tumor, has been used with 
varying success (Wa). Chloral, in 10-grain doses, 3 times a day, has relieved 
the most severe pain of cancer (R). Chloroform, as vapor to raw surface (R). 
Pyoctanin (Methyl Violet) in solution, by injection into the neoplasm, to bring 
about the shrivelling up and final disappearance of carcinoma (Mosetig). Hy- 
oscyamus, bruised leaves, locally (P). Bismuth, relieves pain and vomiting 
of gastric cancer (B). Aurum, the Arsenate was extensively employed internally 
by Massart with benefit (see page 209). Iodoform, applied to diseased surface, 
relieves pain and removes fetid odor (P). Resorcin, 15 parts to 20 of Vaselin 



638 CANCRUM ORIS CARBUNCLE. 

as an ointment twice daily after washing with a solution of Pot. Permanganate, 
has successfully stopped epithelioma (Antonio). Potassium Chlorate, in im- 
palpable powder, dusted on epithelioma, said to be curative (B). Pepsin, in- 
jections into tumor (B). Salicylic Acid, pure, applied in powder (B). Zinc 
Chloride, the most efficient and safe escharotic ; parts j-ij to v of flour, as 
" caustic arrows " inserted at base of tumor (B). Potassa Fusa, as escharotic 
(B). Zinc Sulphate, dusted over, dry, an excellent caustic ; remove the eschar 
by poultice (B). Bromine, for destruction of uterine cancer, is preferred by 
some (B). Chromic Acid, a powerful escharotic (B). Calcium Carbonate, as 
calcined oyster-shell, very efficient in arresting growth of cancerous tumors, 
and in alleviating the pain thereof (Hood). Rumex Acetosa, an excellent 
local application ; has a popular reputation. Iron and Manganese, the Syrup 
of the Iodide, for resulting cachectic state (B). Toxins, the erysipelas and 
prodigiosus toxins have proved more efficient in sarcoma than in carcinoma 
(Coley). Ozone, locally applied as an antiseptic and anodyne agent in cancer 
of the tongue and throat, is highly efficient ; was used on Sir John Millais with 
great benefit during the last three months of his life and kept him comfortable 
without narcotics. Poultices, of starch, applied cold (R) ; or poultices of bread, 
sprinkled with charcoal or freshly ground coffee, as deodorizers to open can- 
cers. Water Enemata, to relieve pain and straining in intestinal cancer (R). 
Electrolysis, has been of great service in many cases, relieving the pain and 
diminishing the tumor. In a case of sarcoma of the thigh, in which amputa- 
tion was the only possible resource, after one application of the needles by Mr. 
Annandaie, the pain was relieved and the tumor diminished (Duncan). It 
seems proved that there is a less frequent return of cancerous growths removed 
by electrolysis than by the ordinary procedures ; the evidence in its favor has 
recently accumulated (Tibbits). In any case in which operative interference 
is necessary, electrolysis is the preferable method, and in others is advisable 
(Butler). In 18 cases of epithelioma treated by electrolysis, 13 were cured, 2 
improved, in 2 there were no results, and 1 ended fatally (Groh). [Compare 
Uterine Cancer.] 

Cancrum Oris. 

Arsenic, in medicinal doses (R). Nitric Acid, to surface (R) ; strong Nitric 
Acid the best caustic for worst forms of the disease (Wa). Potassium Chlorate, 
gr. xx-xl in 24 hours, has been strongly recommended (D). Quinine, made 
into a syrup, or as enema, to support the strength (Wa). [Compare Aphthae, 
Stomatitis.] 

Carbuncle. 

Boric Acid, administered internally and externally as for Boils (which see) ; 
equally efficacious in .carbuncle, diminishing pain, redness and hardness ; nu- 
merous apertures rapidly form for the elimination of the core ; the fever falls, 
excitation and insomnia abate, and the carbuncle heals, in the majority of 
cases without surgical interference (Alison). Mercury, Corrosive Sublimate, 
injected into tumor at several points, in doses of 2 drachms of a ■£§ per cent, 
solution dividedly, has produced good results; these injections were often 
repeated, in broken doses likewise, on the following days (Casson). Bella- 
donna, with Glycerin, as local application to relieve pain (P). Ammonium 
Acetate, to support the system (Cezard). Carbolic Acid, on lint, with Glycerin 
or Oil, into discharging sinuses (R) ; or hypodermically into the sloughing 
tissues. Iodine, to produce vesication around carbuncle ; reduces inflammation 
(R) ; part j of the tincture to iij aquae locally, has most striking effect (Wa) ; 
may be used with benefit internally or hypodermically (Cezard). Calcium Sul- 
phide, gr. y 1 ^ hourly or every two hours, of great service (R). Opium, a thick 
extract, locally (R). Potassium Chlorate, highly recommended, also Quinine 
and Iron freely, to support the system and counteract the carbuncular poison. 



CARIES CATALEPSY. 



639 



Poultices, the inflamed surface having been previously smeared with Belladonna 
and Glycerin (R) ; long-continued poulticing is thought to create a tendency 
to a fresh crop. Strapping, with plaster, concentrically from border inwards, 
leaving the centre free, will sometimes arrest extension (R). Collodion, as 
protective covering (P) ; as zone around base, leaving the centre exposed (Wa); 
Collodium cum Cantharide in a broad zone painted around the carbuncle, to 
relieve the tension (Ag). Ice, or Ice-bags or iced water on cloths in early 
stage, changing to warm fomentations as soon as suppuration has begun (He- 
bra). Galbanum and Opium, as plaster to relieve pain, the separation of the 
core then proceeding painlessly (Hill). Crucial Incisions are not so frequently 
made now as formerly ; they relieve tension but often give rise to severe hem- 
orrhage. Diet should be very supporting, and stimulants may be used freely 
when the patient is debilitated ; Saline purges occasionally (Hill). Cauteriza- 
tion, with fuming Nitric or Carbolic Acid, on top of a free crucial incision, fol- 
lowed by dressing with Carbolized Oil, is the course to pursue in malignant 
pustule. Caustic Potash, applied before an opening occurs, or small pieces 
inserted into openings made by scalpel, to cause the rapid separation of the 
slough. The resulting ulcer should be treated on general principles. [Com- 
pare Anthrax, Boils.] 



& . Calcis Sulphurat., . . . gr. iij. 
Sacchari Lactis, . . q. s. 

Triturat. et div. in chart, xxx. 

Sig. — One powder every 2 hours, to be 
taken dry on the tongue. 



R. Tinct. Ferri Chloridi, . . 5J. 
Potass. Chlorat., . . . . 3 iij. 
Liq. Ammonii Acetat. , . ^iij. 
Syrupi et Aquae, q. s. ad 3 viij . 
M. Sig. — Dessertsp. every 2 hours. 



Caries. 

Aurum, in syphiloma of bones (B). Calcium Chloride, where strumous 
cachexia (B). Phosphoric Acid, with 8 parts water, locally applied, has been 
of benefit (Wa). Phosphates, the best is Syrup of Calcium Lacto-phosphate, 
or Parrish's phosphates (R). Villate's Solution, injected through the sinuses 
to dissolve the carious bone, has cured many cases (B). [See formula below.] 
Sarsaparilla, a very useful medicine (P). Iodine, locally, with Iron or Cod- 
liver Oil internally (Wa). [See Bone.] Potassium Iodide, in syphilitic caries, 
holds the first place (Wa). Cod-liver Oil, to promote constructive metamor- 
phosis (R). Mechanical Contrivances, are necessary in most cases ; Sayre's 
plaster jacket, Agnew's jacket of leather and steel, Taylor's apparatus, etc., 
are used in spinal caries to separate the diseased bones, and extend the spinal 
column. [Compare Necrosis.] 



R. Cupri Sulphat., 

Zinci Sulphat , . aa partes xv. 
Liq. Plumbi Subacetat., p. xxx. 

Aceti, p. cc. 

( Villate's Solution ) 



R. Svrupi Calcii Lacto-phos- 

phatis (U. S. P.), . . 5 viij. 
Sig. — A dessertsp. to a tablespoonful 3 
or 4 times daily. 



Catalepsy. . 

Turpentine, in enemas, and embrocations along the spine, affords the best 
chance of stopping the paroxysms (Wa). Treatment must be essentially tonic 
and restorative (H) ; no constant line can be stated (A) ; external stimulation 
to arouse consciousness, by Ammonia, cold douches, Faradism, etc. Apomor- 
phine, gr. -^ to T ^-, in the paroxysm; with the onset of nausea, consciousness 
returns and spasm ceases ; in the intervals between the attacks the treatment" 
should be that of hysteria (Gowers). 



64O CATARACT CATARRH. 



Cataract. 

Phosphorus, with Oil, by frictions to the forehead, and instillation of the same 
into the eye, may cause absorption of the lens or capsule (Wa). Codeine, in 
diabetic cases (Br). Sodium Sulphate, a solution suggested as injection into 
anterior chamber, in hope to dissolve the nebula (Wa). Galvanism, has been 
successfully employed in incipient stage (Wa). Mydriatics, Atropine, Duboi- 
sine, etc., to secure full dilatation of pupil, as a means of ascertaining when 
the operation should be made, which is when the cataract is mature and there 
is no vision even with dilated pupil (Wa). Diet and Regimen, may do much to 
retard degeneration of the lens in cases due to diabetes, or to malassimilation 
in gouty or rheumatic persons (C). Iridectomy, made early and effectually may 
postpone the progress of lenticular opacity, if due to increased intraocular ten- 
sion (C) ; in partial cataracts which have become stationary, iridectomy for 
artificial pupil may be done to expose the clear portion of the lens (Roosa). 
Medicine, accomplishes nothing except to improve the general health and so 
delay the progress of the opacity. Removal may be performed by one of 
several operations (Roosa). 

Catarrh, Acute Nasal. 

Menthol, 1 or 2 parts dissolved in 20 of chloroform, of which a few drops 
in the hollow of the hand, the hands then rubbed together and placed before 
the face, the remedy being inhaled alternately through the nose and the 
mouth, will arrest the progress of a cold in its initial stage (Wunsche). Chlo- 
roform, by inhalation in small quantities, is an excellent nasal antiseptic, and 
is of great value in acute nasal catarrh. Sodium Salicylate, to abort a cold, 
gr. x bis die. Aconite, in severe coryza with much chilliness, aching limbs, 
hot and dry skin, and quick pulse ; also in catarrhs of children and that 
accompanying measles (R) ; in acute coryza (P); with Belladonna in ordinary 
colds with sore throat and high fever (B) ; in doses of m^ every % hour very 
useful for a commencing cold in the head (Smith). Belladonna, in acute 
nasal catarrh with profuse watery secretion, rr^v of tincture, then Try each 
hour (B). Nux Vomica, has great effect upon a dry cold in the head (P). 
Euphrasia, is of decided utility in coryza (P). Pulsatilla, a warm lotion, 3j-ij 
in ^iv aquae, syringed into the nasal passages in subacute coryza with muco- 
purulent secretion (P) ; acts similarly to Aconite, but is contraindicated if 
much gastric or intestinal irritation exists (B). Iodine, by inhalation in daily 
attacks with itching nose (R) ; gij of the tincture with £j of Carbolic Acid 
inhaled from sponge in the bottom of a wide-mouthed bottle placed in hot 
water (B). Iodides, are unquestionably serviceable, their action being local 
and substitutive ; Ammonium Iodide, gr. j every two hours, the best mode of 
using them (B). Sodium Iodide, gr. x ter die, with Pil. Ferri Iodidi in catarrhs 
of specific origin (B). Potassium Iodide, gr. x at bedtime at the onset, to'cut 
short an acute cold in the head; also useful in chronic colds (R). Arsenic 
Iodide is very efficient as a remedy for an acute cold, coryza, and similar 
affections, especially when accompanied by a sore throat resembling that of 
diphtheria ; gr. iij triturated with gr. xx of sugar of milk, one-half of which 
may be dissolved in Sjiv of water, and a teasp. given every hour or so. Ar- 
senic, when sneezing, itching of nostrils and frontal headache (R) ; as cigar- 
ettes (B). [See under Asthma, for formula.] Veratrum Viride, if Arsenic 
fails (R). Potassium Bichromate, in small doses, gr. -^ in trituration, is very 
efficient, especially when the nasal discharge is thick, stringy, and glutinous. 
Potassium Chlorate, in doses of eight or ten lozenges a day, will abort many 
a cold (R) ; a very good remedy in ordinary catarrh (P). Quinine, gr. x, with 
Morphine, gr. l /e, at incipiency, will often abort an acute coryza (B). Opium, 
at night, if taken early in the case, will often abort an attack of coryza ; a glass 
of hot grog assists its action (R) ; Dover's powder in a full dose at the onset may 



CATARRH. 



64I 



abort (B). Codeine, is useful in common colds, as a palliative (B). Ammonia, 
may be inhaled in the early stage (R). Camphor, as inhalation, the spirit in 
form of vapor (R) ; with Opium and Ammonium Carbonate as powder (see 
formula below), to break up or modify a cold (Beard). Tartar Emetic, gr. 
3^0 t0 tV m tne first stage (B) ; in acute catarrh of children often accompanied 
by vomiting and diarrhea (R). Ipecacuanha, for acute nasal and bronchial 
catarrh, and ordinary colds in children (B). Cimicifuga, when headache, stiff 
muscles, dull aches, bone-pains, etc. (R) ; an excellent expectorant (B) ; rheu- 
matic colds; neuralgic pains in jaw (P). Jaborandi, the fluid extract in doses 
of rr\,x to xxx, every half hour until profuse diaphoresis sets in, is one of the 
best modes of aborting a cold ; or Pilocarpine Hydrochlorate, gr. y$ in water at 
bed-time, will give prompt relief and cure in a few days (Wyss). Cocaine, a 4 
or 5 per cent, solution locally as spray, to empty the engorged venous sinuses 
of the nasal mucous membrane by their contraction, which it induces ; the fluid 
extract of Coca diluted with water is equally efficient if enough be used 
(Cohen). Resorcin, the best of all applications. [See Catarrh, Chronic] 
Chloral, 20 grains in 5J of Castor Oil, applied with a soft mop, when the 
Schneiderian membrane is very irritable, checks the secretion of mucus and 
lulls the irritation and the head pains (Brodnax). Ammonium Chloride or 
Cubeb, in the dry, congestive stage of a cold in the head ; Cubeb cigarettes 
may be smoked as a temporary palliative with great relief. Sulphurous Acid, 
in coryza, by inhalation, spray, or fumigation, is very efficient (R). Oil 
Inunctions, daily to the whole body, in cases of undue susceptibility to taking 
cold, will prevent the frequency of the attack (B). Baths, a warm foot-bath 
before going to bed ; Turkish bath, at onset in coryza, may prove abortive, 
also useful later on ; cold sponge-bath in cases of extreme susceptibility, sup- 
plemented by occasional Turkish baths (R). [Compare Cough, Hay-Fever, 
Influenza. 1 



R- . Quininae Sulpkatis, . . gr. xviij. 
Liq. Arsenicalis (B. P.), n\xij. 
Liq. Atropine (B. P.), . rrjj. 
Ext. Gentians, . . . . gr. xx. 
Pulv. Acacia;, . . . . q. s. 
Ft. pil. no. xij. Sig. — One every 3, 



or 6 hours, for acute colds. 



{Whalen. 



R- . Camphorae, gr. 1. 

JEtheris, q. s. 

Dissolve to creamy consistence, 
then add — 

Ammonii Carbonat., . . gr. xl. 

Pulv. Opii, gr. x. 

Divide into thirty papers. 
One or two powders, according to age, 
twice or thrice daily. [Beard. ) 



R. Tinct. Aconiti, . . . . Tt\x. 

Tinct. Belladonna;, . . gss. 

Syrupi Zingiberis, . ad ^ij. 
M. Sig. — Half to one teasp. according 
to age, every hour. 



R- . Acidi Carbolici, . . . . gr. Ixxx. 

Alcoholis, 5 ss. 

Aq. Ammonia;, .... TT^lxxx. 

Aquae, g ijss. 

M. Sig. — A few drops as an inhalation 
from a cone of blotting paper. ( Brand.} 



R. Morph. Acetatis. . . . gr. iv. 
Bism. Subnitrat. , 
Pulv. Talci, . . aa ^j. 
Ft. chartulas no. xxx. 
Sig. — Use as snuff in acute rhinitis. 
{Saj° 

R. 



'•) 



] J- 



Codeinae, . . . 

Syrupi Tolutani, 
Syr. Scillas Comp,, . aa ~j. 
M. Sig. — Teaspoonful occasionally for 
a common cold. (B.) 



R 



Morph. Hydrochlor. , 
Bismuthi Subnit. , 
Pulv. Acacia;, . . . 
M. Sig. — Use as snuff, 



3 V J- 



• 3'J- 



the 



above in 24 hours. {Farrier's Snuff.) 



Catarrh, Chronic Nasal. 

Sanguinaria, the tincture in 10-drop doses thrice daily or gr. y 1 - of the alka- 
loid internally, and the powder in small quantity locally to the mucous mem- 
brane, is successful treatment for chronic nasal catarrh (B). Glycozone, fre- 
41 



642 



CATARRH. 



quently applied, is of benefit (Edson). Hydrastis, is of value in chronic coryza, 
also in ulceration of the septum or any other part of the nasal fossae, gtt. v of 
the tincture thrice daily internally, and Z) to ^viij of water locally by syringe 
(P). Pulsatilla, is excellent in subacute inflammation of nasal passages, with 
offensive muco-purulent discharge, 3j-ij to ^iv of water, as wash (P). Potas- 
sium Bichromate, is an excellent local application in a solution of gr. j-x to ^iv 
water (B) ; small doses, gr. -j-j^- in trituration internally, a most efficient remedy, 
especially when the discharge is tough and stringy, and the nose tender. 
Cocaine, is much used, but is only of temporary benefit; many of the proprie- 
tary snuffs and powders for chronic catarrh contain this drug, their use fre- 
quently inducing the cocaine habit. Resorcin, the best of all applications, in 
acute and chronic catarrh ; after cleansing the nose with a Boracic Acid solu- 
tion, or Dobeli's, use a 2 to 10 per cent, ointment in Vaselin, also a spray every 
other day, of a 2 to 4 per cent, solution: it gives the same results as Cocaine, 
but is slower in action and more lasting, and does not suppress the normal 
function of the mucous membrane, as the latter does. Eucalyptus, has been 
employed with benefit (Wa). Bismuth, in powder with Acacia, as in Ferrier's 
snuff (see previous page), or with Tannin, Calomel, etc., used by insufflation 
daily (Robinson). Iodoform and Tannin, 1 of the former to 2 or 3 of the latter, 
carefully triturated and applied by an insufflator every other day only, is the 
very best of all applications (B). Sodium Chloride or Phosphate, a teasp. to 
the pint of warm water as cleansing solution, or the Bicarbonate, in the same 
proportion ; a sea-water gargle in the naso-pharyngeal space, has been used 
with success (Mosler) ; Wei de Meyer's Catarrh Cure is simple Sodium Bicar- 
bonate and a little pink coloring matter (Robinson). Potassium Permanga- 
nate, gr. j-x to the pint of warm water, as a deodorant solution when neces- 
sary. Ammonia, by inhalation, when painful inflammation of nasal mucous 
membrane and frontal bones (R). Carbolic Acid, a 1 per cent, solution as spray, 
or inhalations of the vapor with that of Iodine from a bottle in hot water, or 
vaporized by the warmth of the hand (B). Salicylic Acid, in weak solution, 1 
to 500 of water, as a disinfectant and astringent injection, used with a retro- 
pharyngeal syringe, and followed by applications of powdered Calomel 
through a speculum upon the ulcerated parts of the mucous membrane 
(Massei). Cubeb, finely powdered and blown into the nares by an insufflator 
(B) ; may be smoked, and administered internally in teasp. doses (Wa) ; in 
freshly ground powder as a confection, in follicular disease of the naso-pharyn- 
geal space (Robinson). Ammoniacum, in the same condition, small doses, gr. 
j-iij, with Ipecac or Ammonium Carbonate, will lessen the amount of secretion 
(Robinson). Aurum Chloride, in mercurialized and syphilitic subjects, with 
offensive discharge, depressed spirits, and soreness of the nasal bones. Iodides, 
of Iron and Sodium, in catarrh of specific origin (B). Silver Nitrate, in pow- 
der, as alterative application, gr. x-xv to the % of menstruum, is often a useful 
adjunct to treatment, used once every 4 or 5 days (Robinson). Cod-liver Oil 
should be used in. strumous subjects (R). Alum, in powder, dusted over the 
affected surface, is a useful application (B). Bromine, the vapor may greatly 
benefit, but must be used with caution (B). Senega, has been found service- 
able (Wa). Douche is dangerous, being likely to cause extension of the catarrh 
to the Eustachian tube and the middle ear; it has been very generally aban- 
doned. Sprays by hand-ball atomizers, or compressed air apparatus, of warm 
watery solutions, Vaselin, etc., are used with considerable success (Cohen); 
the Hank's atomizing tubes, with a 2-ball rubber syringe, are very serviceable 
for office use, and for the application of Rumbold's hot Vaselin spray. [See 
formula below.] Sulphur Waters, internally, of great benefit in follicular dis- 
ease (Robinson). [Compare Ozena.] 



R. Acidi Carbolici, .... TT\x. 

Glycerini, ^vj. 

Vaselini, ^ij. 

M. Sig. — Warm and use as a spray 
every 4 hours. {Rumbold.) 



R . Pulv. Argenti Nitrat., . gr. vij. 
Pulv. Acacias, . . . gj. 
Bismuthi Subnitrat. , . . ^iij. 
Triturat. Sig. — Apply with insufflator 
once in 4 or 5 days. {Robinson.) 



CEREBRAL ANEMIA CEREBRAL CONGESTION. 



643 



R . Acidi Carbolici, . . . TT\,xl. 
Sodii Boratis, 
Sodii Bicarbonat., aa ^ij. 

Glycerini, 3 vr j- 

Aquae, . . q. s. ad 3 viij. 
M. Sig. — Use daily as spray. 

{D obeli.) 

R. Bismuthi Subcarb., 

Pulv. Acacise, . . aa ^ss. 
Zinci Sulphat., . . . . gr. x. 
Morph. Sulphat., . . . gr. ij. 
M. Sig. — Snuff, to be used thrice daily. 
{Sajous.) 



R . Bismuthi Subcarb. , 

Morph. Muriatis, . 

Pulv. Amyli, . . 

Triturat. {Bumess : 

Ferrier 's Snuff.) 



■ - 3 V J- 

. gr. ij. 

• • 3 ij- . 

modification 



of 



& . Ext. Pini Canaden. , . . TT^xx. 

Glycerini, TTpcxx. 

Aquae q. s. ad Oj. 

M. Sig. — Use with post-nasal syringe. 



Sodii Boro-benzoatis, 
Ext. Hydrastis FL, . 

Glycerini, 

Ac. Carbolici, . . . 
Aquae Camphorae, . . 
Aquae, . . . . q. s. ad 



r^xx. 
"xij. 



M. Sig. — Use with syringe or atomizer 



thrice daily. 



{Chamberlain. 



gtt. xv. 



M 



Acidi Carbolici, . . 
Extr. Hydrastis FL, . 
Sodii Bicarb., 
Sodii Biborat., . . . . aa^j. 

Glycerini, Jj. 

Aquae Camphorae, q. s. ad J viij. 
Sig. — Use with posterior nasal 



sprayer. 



U . Sodii Salicylatis, . . £ij- 
Sodii Boratis, . . . . giij. 

Glycerini, ^ ss. 

Aquae, ... q. s. ad ^vj. 
M. Sig. — -A dessertspoonful into a pint 
of warm water ; snuff it from the hollow 
of the hand thrice daily. (Sajous.) 



Cerebral Anemia. 

Iron, the tincture of the Chloride, or mild chalybeate waters, in chronic 
cases from general anemia (B). Amyl Nitrite, in vaso-motor spasm ; affords 
relief in sudden attacks (B). Chloral, in small doses with stimulants and warm 
baths (Ros). Camphor, or other cerebral excitants, as Asafoetida, Valerian, 
Serpentaria (B) ; the Mono-bromide in one- to five-grain doses (Hammond). 
Glonoinum, rt\J of a 1 per cent, solution (P). Phosphorus, supplies the needed 
material for healthy brain action (B). Strychnine, stimulates the circulation 
generally ; with Iron preparations as a tonic. Galvanism, a mild current 
transversely through the head, gives excellent results in the confusion of mind, 
vertigo, etc., due to imperfect nutrition of the brain from atheroma of the cere- 
bral vessels (B). Arsenic, is highly efficient in some hypochondriacal cases 
(B). Aurum, is of great utility in vertigo, melancholia, etc., when due to or 
accompanied by cerebral anemia (B). [Compare Insomnia.] 

Cerebral Concussion. 

Arnica, when concussion is due to a fall, cannot be too highly spoken of (P). 
Warmth, to extremities, rest, expectant treatment, will suffice in mild cases 
(Ag). The indications are : (1) to recover from insensibility and collapse ; (2) to 
prevent inflammation ; (3) to restore impaired faculties (D). Stimulants or 
Venesection, cannot be too strongly reprobated (Ag). 



Cerebral Congestion. 

Aconite, in the active form, renders important service (B) ; is much the best 
remedy in this condition (P). Belladonna, one of the best remedies in all 
hyperemic conditions of the brain or spinal cord (P). Gelsemium, rr^v of the 
fluid extract every two hours, very useful (B). Bromides, are very useful (B) ; 
must be used in full doses. Colocynth, as a counter-irritant, appears to act well 
(P). Cathartics, lessen blood-pressure (B). Colchicum, in plethoric subjects 



644 CEREBRAL SOFTENING CHANCROID. 

(P). Galvanism, of the brain and cervical sympathetic (B). Chloral, when 
temperature high (B). Arsenic, sluggish venous circulation, torpor (B). Hy- 
drocyanic Acid, rtv.ij-v of Scheele's dilute acid (B). Venesection, will prevent 
injury to brain; not to be adopted as a matter of course; is contraindicated 
when anemia, aortic valvular disease, or in cases commencing with syncope 
(A). Water, cold douche to head, feet in warm water ; ice and hot water 
alternately to head and nape of neck, often more effective than ice alone (B) ; 
hot water to head on flannels, mustard and hot water packing for 20 to 30 
minutes around legs, when active congestion ; protect bowels well (R). Diet, 
should be low, but not too low, until all fear of relapse is past; full animal 
diet should be avoided, also undiluted wines (A). [Compare Apoplexy, 
Coma.] 

Cerebral Softening. 

Venesection, and antiphlogistic treatment generally, are most beneficial in 
red softening the result of inflammation ; require wise discretion, and should 
be used early ; not to be thought of in the yellow form, arising from want of 
nutrition, wherein restoratives and food are needed, perhaps wine (A). Phos- 
phorus, in threatened softening of the brain ; is the only drug which affects the 
nerve centers (W). 

Chancre. 

Mercury, small doses steadily, but ptyalism must not be induced ; Black- 
wash (Calomel gr. viij, Aq. Calcis %)), or yellow-wash (Hydr. Chlor. Corr. gr. j, 
Aq. Calcis ^j) on lint, to erosions and ulcerated indurations (B) ; Calomel 
alone as dry dressing: the internal use of Mercury is best postponed until sec- 
ondary symptoms appear (St). Carbolic Acid, as wet dressing, gr. ij of crys- 
tals in ^iv of water applied thrice daily (St). Iodoform, heads the list of dry 
dressings ; with Lycopodium, equal parts, or 1 to 2 of Zinc Oxide ; 2 to 1 of 
Calomel (St). Hydrogen Dioxide, said to destroy the specific character ; wash 
lesions thrice daily, and apply lint soaked in it (R). Caustics, should never be 
used unless chancre is attacked by phagedena (St). Caustic Alkalies, to hard 
edges (R). Bromine, Chromic Acid, are the best escharotics (B). Dressings, 
are effective as far as the local trouble is concerned in the majority of cases, 
sometimes a piece of lint on the erosion will suffice ; never cauterize an initial 
lesion unless it is attacked by phagedena (St). Cleanliness, of great impor- 
tance ; tepid water locally frequently suffices for the local treatment of infecting 
chancre. [Compare Chancroid, Syphilis.] 



Chancroid. 

Mercury, the Acid Nitrate one of the best caustics ; apply with a glass rod 
(B). Nitric Acid, fuming, as caustic (R) ; 3j to ^ viij aquas is an excellent 
dressing (St). Carbolic Acid, injected into sore (B) ; 2>ij-v to Oj aquas locally 
in phagedena (St). Ferri et Potassii Tartras, the born enemy of phagedena 
(Ricord) ; 3J to ^vj aquae, internally, teasp. doses thrice daily; also locally 
(St). Ferrous Iodide, in sloughing phagedena, or simple chancroid in debili- 
tated constitutions (B). Iodoform, powdered and dusted over the sore, allays 
pain, changes morbid action, and is antiseptic (R) ; 1 part to 2 of Lycopodium, 
or one of Tannic Acid ; as stimulant and alterative (St) ; does no good except 
to relieve pain (Gross). Potassium Chlorate, in impalpable powder, is better 
than Iodoform (B). Chloral, gr. iij ad ^j aquas, the best local application to 
relieve pain (Gross). Caustics, in severe cases, the white-hot iron, strong Sul- 
phuric Acid, pure Nitric Acid, pure Carbolic Acid, are effective in the order 
named (St). [Compare Bubo, Chancre.] 



CHAPPED HANDS AND LIPS CHLOROSIS. 645 



Chapped Hands and Lips. 

Sulphurous Acid, as solution or by fumigation, will speedily cure (R). 
Glycerin, diluted, or better still, Glycerite of Starch, or with yi the quantity of 
Eau de Cologne (R). Benzoin, the comp. tinct. 1 part to 4 of Glycerin ; an 
admirable application (P). Hydrastis, on compress as lotion (P). Collodion 
is usefully employed (P). Carbolic Acid, 1 to 2 of Glycerin, locally ; one appli- 
cation is generally sufficient. Unguentum Aquae Rosae alone, is often efficient ; 
may be combined with Zinc Oxide. Menthol, with Salol, etc. (see below), is 
said to alleviate the pain of chapped hands on the first application. 

R. Mentholi, gr. xv. R. Cetacei, gj. 

Saloli, gr. xxx. Glycerini, % ij. 

01. Olivse, 3 SS - Cerae Albae, gr. xv. 

Lanolini, . ... £Jss. 01. Amygd. Amarae, . . n\nj. 

M. Ft. unguentum. M. Ft. unguentum. 

Chest-pains. 

Belladonna, as ointment, when tenderness is in the skin (R). Iodine, as 
oint. when pain is in muscles (myalgia) of chest, they being tender on pressure, 
while the skin may be pinched without pain (R). Strychnine, affords relief in 
functional irritability of the nervous system, manifested by wandering neuralgic 
pains (B). Arnica, internally for a stitch in the side. Bryonia, when painful 
catching of breath. Cimicifuga, for intercostal rheumatism and pains under the 
breasts in women. [Compare Myalgia, Neuralgia, Pleuritis, Pleuro- 
dynia, Pneumonia.] 

Chilblains. 

Digitalis, internally and locally, to improve the circulation, and combat the 
arterial hypo-tension and peripheral vaso-dilatation which are always present in 
those subject to chilblains (Pilatte). Caffeine and Kola may sometimes be sub- 
stituted for Digitalis. Iodine, as ointment, the best application (R) ; the tincture 
lightly painted over the surface every 3 or 4 days, is particularly serviceable 
for the itching. Arnica, is a useful application (Wa). Carbolic Acid, with 
Iodine, as ointment, is a very efficient application for chilblains. Benzoin, the 
tincture in Glycerin, applied after thorough washing in soap and water and 
drying, the best application. Sulphurous Acid, an efficient application ; £j to 
S'nj each of water and glycerin (B) ; as solution or fumigation (D). Balsam of 
Peru, in ointment for broken chilblains (R). Capsicum, the tincture painted 
over unbroken chilblains (R). Cajuput Oil, applied locally (R). Turpentine, 
as wash, then apply Basilicon Ointment mixed with Turpentine (B). Ichthyol, 
as oint. has been of service. Thiol, the dry form, as a dusting powder, is 
used efficiently. Alcohol, as Eau de Cologne, or camphorated, with friction, 
after careful drying of the hands and feet. Vaselin and other fatty substances 
should never be applied (Pilatte). 

R. Tinct. Digitalis, .... £jss, R. Acidi Carbolici, .... £j. 

Tinctura Iodi, . . . . ,"ij. 

Acidi Tannici, %]. 

Cerati Simplicis, . . . . 5 iv. 
Misce bene, ft. unguentum. {Morrow.') 



Iron, combined with Arsenic or Strychnine, also occasional purgation and 
active exercise (R) ; the Iodide, when much torpor of the system, is often 
speedily efficacious ( Wa) ; Iron is not a specific in chlorosis, and acts best in 



. Tinct. Digitalis, . . 
Thymoli (cryst.), . . 
Alcoholis (70 C), 


. . gjss, 
. . gr. xlv. 


R. 


Glycerini, 

M. Sig. — For local use. 


aa g xv. 
{Pilatte.) 


Mis 




Chlo 


rosis. 



646 



CHOKING CHOLERA ASIATICA. 



the purest types (Tr). Manganese, the saccharated carbonate of iron and 
manganese (B) ; Pepto-mangan is a good preparation. Arsenic, if Iron fails 
or disagrees (B). Aurum Arsenate, has rendered good service. Ergot, in 
chlorotic amenorrhea (P). Nux Vomica, stimulates the blood-making organs, 
and may be combined with Iron ; a very generally useful preparation is the 
syrup or elixir of Iron, Quinine, and Strychnine (B). Cocculus Indicus, when 
amenorrhea and exhausting leucorrhea (P). Hypophosphites, of Calcium or 
Sodium (R). Benzoin, has been used with advantage (P). Pepsin, benefits, 
especially where digestive derangement (B). Sulphur, of great benefit in cases 
where Iron is of no effect ; also to prepare the system for benefit from Iron 
(Schulz). Bone Marrow, has been used with benefit. Thymus Extract, has 
apparently been of service. Nuclein, is employed with success in some cases. 
Purgation, is very important, to prevent auto-infection from putrid intestinal 
decomposition, which is the true cause of this disease (Duclos) ; absorption of 
such products tending to impoverish the blood, and produce a "fecal anemia" 
(Sir A. Clark). Oils and Fats, as inunctions, after baths, of great benefit (B). 
Galvanization, central, will aid the action of the remedies (B). [Compare 
Anemia, Amenorrhea.] 



R . Ferri Arsenatis, .... gr. ij. 
Extracti Cinchonse, . . gr. xij. 
Fiant pil. xij. Sig. — One pill after each 
meal. _^ (B.) 

R. Ferri Sulph. Exsiccat, . gr. xl. 
Quininaa Sulphatis, . . . gr. xx. 
Strychninae Sulphat, . gr. ss. 
Ft. pil. xx. Sig. — One thrice daily. 



R. Pulv. Aloes Socot., 

Ferri Sulph. Exsiccat. 

01. Tanaceti, vel 

01. Sabinae, .... 

Croci, 

Myrrhas, 

Cantharidis, .... 
Ft. pil. lx. Sig. — Two thrice daily, 
gradually increased to four. ( Wallace.} 



\\X. xxx. 



aa gr. xxx. 



Choking. 

Potassium Bromide, benefits a curious affection, sometimes found in children 
who from their birth can swallow solids with ease, but choke at drinks (B). Oil 
of Cajuput, in one case of persistent choking sensation in the throat, a few doses 
removed the symptom which had lasted several weeks (Hale). 



Cholera Asiatica. 

Camphor, a drop or two of the saturated tincture, orgtt. v-x of the spirit with 
a little Opium every half-hour (B) ; gtt. iv-vj of strong spirit every ten minutes 
until symptoms abate, then hourly (R) ; the combination of camphor, opium, 
etc., known as Squibb' s Cholera Mixture (see next page for formula) is an effi- 
cient remedy at the inception. Morphine, gr. Y% to y z hypodermically in the 
preliminary diarrhea (P) ; )/% to % g r - of the greatest value even in collapse 
(R) ; dangerous if kidney complications exist (P) : Morphine is the principal 
ingredient in Chlorodyne (see page 261), a remedy commonly used in India. 
Chloroform, a few drops frequently repeated, or 10 to 30 drops of chlorodyne, 
of great value (B). Chloral, with Morphine, by hypodermic injection, is the 
most effective treatment (see next page for formula) ; it causes pain and in- 
duration but not suppuration (B). Arsenic, in epidemic cholera ; some cases 
of arsenic poisoning are not distinguishable from cholera (B) ; for the vomiting 
and in collapse (R). Copper salts have been given (R). Turpentine, Ti^x-xx 
every two hours, promises to be a remedy of value (Wa). Lead, the Acetate 
in early stages (R). Carbolic Acid, with Iodine, has given good results (B). 
Salol, has done excellent service. Sulphuric Acid, the aromatic, with Opium, 
is very effective (B) ; two parts of the former with one of Laudanum, of this 5 
to 30 drops as per age, is one of the best prophylactics (McClellan). Strych- 
nine, as prophylactic during the preliminary diarrhea, and in epidemic form 



CHOLERA INFANTUM. 



647 



when nearing collapse (B). Alcohol, small doses of iced brandy for vomiting 
(B). Spinal Ice-bag, for cramps (R). Saline Injections, into the veins, have 
been successful in the collapse (B) ; Sodium Chloride, Sodium Carbonate, aa 
3j, Boiled Water quart j, makes a suitable injection, of which one to three 
quarts at ioo° F. may be slowly injected into a vein by gravitation, the efTect 
being carefully watched (Mn). Milk, by transfusion, in the collapse (B). Irri- 
gation of the intestines with hot water and soap, using 1 to 3 gallons at a time 
twice daily, also Hydrogen Peroxide with hot water to cleanse the stomach ; 
the method used by me in Russia and at Hamburg, during the epidemic of 
1892 (Elmer Lee). Treatment, the only treatment of any proved value is the 
purely symptomatic and expectant one (Mn). Absolute Rest, recumbent pos- 
ture, no food, ice ad libitum ; enemata of warm milk; fresh air, friction, and 
heat to abdomen, legs and feet ; stimulants are worse than useless. Cholera 
Toxin, as inoculated by Dr. Haff kine, has been highly efficient as a prophyl- 
actic in India. 



R 



M, 



Chloroformi, ..... gj. 
Tinct. Opii, 
Spt. Camphors, 
Tinct. Capsici, . . . aa ppij. 
Alcoholis, . . . q. s. ad ^ij. 
Sig. — 30 to 60 drops in water. 

(Squibbh Cholera Mixture.) 



gr. viij. 



i£ . Acidi Carbolici, .... 

Bismuthi Subnit., . . . 

Mucil. Acacise, 

Aquas Laurocerasi, aa ^j. 
M. Sig. — Teasp. every hour or 
for vomiting and diarrhea. 



two, 



R. 01. Menthae Piperitae, . . partem j. 

Tinct. Opii, partes iv. 

Ac. Hydrochlor. Dil., . partes ij. 
Quininse Hydrochlor., . partes iv. 
Tinct. Cinchonae Comp., 
Spt. ^Etheris Comp. , aa partes xv. 
M. Sig. — 15 drops every 2 hours. 

(Bothin's Cholera Drops. 



R. Chloralis Hydrat., . 

Morphinae Sulph., . 

Aquae Laurocerasi, 

M. Sig. — Fifteen to 

injection hypodermically. 



311J. 
. . gr. iv. 

• • Si- 
twenty drops as 
(B.) 



Cholera Infantum. 

Bismuth Subnitrate, in hourly doses of 3 to 6 grains, is regarded by many as 
almost a specific. Ipecacuanha, greenish stools with mucus and often blood 
(B). Arsenic, for vomiting and collapse (R). Mercury, gr. )/e of gray powder 
hourly of great service in infantile cholera with incessant sickness, profuse, 
almost continuous diarrhea, offensive and nearly colorless stools ; a Starch in- 
jection, with a minute quantity of Laudanum, assists the gray powder, and 
should be given in urgent cases (R). Zinc Oxide, with Bismuth and Pepsin, is 
very useful (B). Camphor, 3j of the spirit in ^iv of milk, very serviceable (B) ; 
an admirable remedy for summer and choleraic diarrhea (R). Opium is gen- 
erally necessary ; enemata of Starch and Laudanum [see above under Mer- 
cury], Morphine, hypodermically, in doses of gr. -^^ to g 1 ^ according to age, 
the latter dose for a child of one year, with 5 or 6 drops of Ether, to be repeated 
in an hour, the most efficient treatment (E. Smith). Copper Sulphate is often very 
successful (B). Carbolic Acid, with Bismuth, may arrest the disorder promptly 
(Br). Lead Acetate, is one of the most useful astringents in this complaint (Br). 
Potassium Bromide, when due to nervous irritation or cerebral congestion 
(B). Silver Nitrate, is beneficial after the acute symptoms have passed (B). 
Caffeine, when due to nervous irritation (R). Coto Bark, the tinct. gtt. j-iij, 
is highly recommended by Rohrer for choleraic diarrhea in children. Alco- 
hol, in grave cases, with tendency to collapse, gtt. x-xx of brandy with milk 
every 30 to 60 minutes. Diet, farinaceous food a common cause ; cow's milk 
O^f with sacch. lactis %] to 0}( aquae-bul., or cold milk with Lime-water (R) ; 
milk, animal broths ; no starches or fats (B). Drinks, as water, weak tea, etc., 
freely, to keep vessels filled and prevent paralysis of the heart (Meinert). Spice. 
Poultice, to abdomen, composed of Cloves, Ginger and Cinnamon, mixed with 



643 



CHOLERA SIMPLEX CHORDEE. 



brandy or whiskey. Mustard Bath, in stage of collapse, with mustard over 
the heart, and Ether hypodermically (Smith). Lactic Acid, a 2 per cent, solu- 
tion in drachm doses, 5 to 8 times in 24 hours, in epidemic diarrhea of infants 
with green discharges, also local antisepsis as to linen and diapers, on the 
theory of a bacillary origin for the disease (Hayem). Peptenzyme, is excellent 
in cholera infantum and the summer diarrhea of children. 



R . Cupri Sulphat. , . . . . gr. j. 

Tinct. Opii Deod., . . gtt. viij. 

Aquae Destil., . . . . ^iv. 
M. Sig. — Teasp. every 2, 3, or 4 hours 
for a child of one or two years. (B.) 



R 



Acidi Carbolici, . . 


. gr. xxiv. 


Spt. Vini Gallici, . . 


gtt. xxiv 


Aquae Menth. Pip., . 


fjss. 


Mucil. Acaciae, . . . 


3 V J- 


Syr. Papaveris, . . . 


3 V J- 


Tinct. Opii Deod., . . . 


gtt. X. 


Sig. — A teasp. every 


2 hours. 



M. 



R . Hydrarg. Chlor. Mitis, . gr. y L. 
Bismuthi Subnitrat, . . gr. ij-v. 
In powder every half hour for the vom- 
iting and purging. 



R 



. Acidi Carbolici, . . . 

Bismuthi Subnit., . . 

Mucil. Acaciae, . . . 

Aquae Menth. Pip., . 
M. Sig. — Teasp. every 2, 



R 



Plumbi Acetat., . . . 

Pulv. Opii, 

Pulv. Camphorae, . . 

Sacch. Lactis, . . . 

Triturat. et div. in chart. 



• 3*h 

3, or 4 hours. 
(B.) 



gr. xxiv. 
gr. xij. 

gss. 
q. s. 



Xlj. 



Sig. — One powder every hour. 



(B.) 



R 



Hydrarg. Chlor. Mitis, . gr. i. 
Plumb. Acetatis, . . . gr. ^. 

Pulv. Opii, gr. jL-i. 

Ft. pulv. no. j. Repeat every half-hour 
or hour for the acute gastric symptoms. 



Cholera Simplex. 

Camphor, an admirable remedy (R). Salol, is highly efficient. Salophen, 
is equally so. Veratrum Album, for the vomiting (R). Copper Salts, have 
been given (R). Arsenic, for vomiting; also for collapse in latter stages (R). 
Chloral, hypodermically with Morphine, is the most efficient treatment (B). 
[See C. Asiatica for formula] ; for the cramps Chloral %j in Linim. Saponis 
§iv to vj, applied to the abdomen with friction (Da C). Opium, gr. yi to }£ 
every 2, 4 or 6 hours, in the early stage (P). Morphine, gr. y% to y z hypoder- 
mically, is very useful (B). Carbolic Acid, with Bismuth (see under Cholera 
Infantum for formula) is very effective (B). Lead, the Acetate in the early 
stages (R). Calumba, as anti-emetic, of great value (P). Ipecacuanha, has 
been used with much advantage (Wa). Sumbul, said to have proved success- 
ful (P). Mustard, as an emetic in collapse, to stimulate a failing heart (P). 
Cajuput Oil, much used in India for choleraic affections (P). Alcohol, as 
iced brandy in small doses for vomiting (B) ; the value of stimulants is justly 
doubted ; if given, 'should be largely diluted (Wa). [Compare Cholera 
Asiatica and Infantum.] 



Chordee. 

Aconite, gtt. j of the tincture hourly, will relieve chordee (R). Belladonna, 
combined with Camphor or Opium, gives the best results of remedies adminis- 
tered internally (St). Camphor, £j doses of the spirit will relieve (R). Can- 
tharis, gtt. j of tinct. ter die, will prevent (R). Cannabis Indica or Cannabis 
Sativa (P). Lupulin, valuable (P) ; said to prevent (B). Morphine, hypoder- 
mically, the one sure remedy ; should be injected into the perineum at bed- 
time (St). Cocaine, a few drops of a 4 per cent, solution, locally to the 
glans ; or injected into the urethra, promptly relieves chordee. Diet, should 
be plain, even low, no stimulants ; copious draughts of barley-water, or lin- 
seed tea. 



CHOREA. 



649 



R . Liq. Morph. Magendie, %iv. 

Atropinse Sulphat., . . gr. j. 

Acidi Acetici, . . . q. s. 

Aquae Destillat., q. s. ad %]. 
M. Sig. — TT\^v— viij hypodermically at 
bedtime. [Sturgis.) 



R . Pulv. Opii, gr. xij. 

Pulv. Camphorae, . . . gr. xxiv. 

Sacch. Alb., q. s. 

Fiant capsulse xij. 

Sig. — One at bedtime, to be repeated in 
2 hours if required. [Sturgis.) 



Chorea. 

Antipyrin, is the only medicine from which cures may confidently be antici- 
pated (McCall Anderson) ; is successfully used to combat excitability of the 
motor nerve centres (W) ; may be given in 2 grain doses every 3 hours to very 
young children (Whitla). Acetanilid has been used with benefit, in both mild 
and grave forms of chorea (Id). Exalgin, with Citrate of Iron and Quinine 
after meals (Dana) ; is believed by many to have specific power over chorea, 
given in doses of 2 grains thrice daily and gradually increased to 3 grains five 
times a day. Arsenic, is one of the most certain remedies, but large doses are 
required and are well borne (B) ; Tr\^iij of Fowler's solution thrice daily for a 
child of 7 years, gradually increased to rt^x thrice daily, and may be continued 
for several weeks (Whitla) ; is very successful in uncomplicated cases (R). 
Zinc Sulphate, in doses of 2 or 3 grains gradually increased to 8 grains, is next 
in value to arsenic (Whitla) ; in large and increasing doses is very useful (R) ; 
has action similar to that of Arsenic, but is inferior (B). Hyoscyamine, -^fa 
grain thrice daily, gradually increased, has cured cases which resisted all other 
remedies (Da C). Duboisine is equally efficient ; the Solanacese are very suit- 
able for nervous, delicate children. Hyoscyamus may be tried. Quinine, as 
a stimulant to the inhibitory centre which controls motor discharge from the 
spinal cells, and which is weakened in chorea to a greater degree than the dis- 
charge power (W). Aurum Bromide, in daily doses of gr. ^ to ^, continued 
until its characteristic headache is produced (Goubert) : the Bromides in full 
doses have proved useful. Chloral, contributes to cure by inducing quiet sleep 
(R) ; in gradually increasing doses is of the greatest service, as it has an almost 
absolute power to suspend or control spasm during its deep hypnotic action 
(Gairdner). Chloralamid, may be pushed with greater safety, and excellent 
results have followed its use (Whitla). Physostigma, is recommended (R) ; is 
of doubtful benefit (B) ; cures the disease in 5 or 6 days with doses of -^ grain 
of Physostigmine twice daily hypodermically (Reiss). Calcium Chloride, has 
done good in strumous subjects (B). Cocaine, is of the highest value, and 
has cured cases repeatedly in which all the ordinary remedies had been used 
in vain (B) ; the whole amount given daily has rarely exceeded }4 grain (Id). 
Cimicifuga, is a very valuable remedy in cases due to menstrual derangement 
(P) ; when there is a rheumatic history (R). Strychnine, in doses gradually 
increasing to the toxic (Tr) ; minute doses, gr. ^ to -fa, have been highly use- 
ful when chorea is due to fright or commencing puberty (B). Cuprum Ammo- 
niatum, has been used successfully (B). Iron, large doses of the Subcarbonate 
in anemic cases, about the time of puberty (B). Chalybeate waters often re- 
lieve or cure. Arsenic generally better, unless anemia coexists (R). Vera- 
trum Viride, has been employed (R). Cocculus, or Picrotoxin, large doses (P). 
Conium, in large doses, to quiet muscular agitation (B) ; is only palliative (R) ; 
evidence contradictory as to its value (P). Valerian, said to restrain the move- 
ments (R) ; useful when from worms (P). Chloroform, inhalations often of 
great service in severe cases (R). Morphine, with Chloral, hypodermically in 
large doses for severe cases (Tr) ; when the movements prevent sleep (R). 
Musk, has been given (R). Cod-liver Oil, when nutrition is low (R). Water, 
by cold affusion to head and spine, and cold baths are important (B) ; tepid 
water first, cold should not be used if rheumatism or fever or pain in the joints 
(R). Electricity, static, is useful in some forms (B) ; the constant current used 
in 20 cases, all recovering (Benedict); a galvanic chain around the neck and. 
down the back, is reported serviceable. 



650 



CHOROIDITIS CLIMACTERIC DISORDERS. 



M 



Chloralis Hydratis, . 
Tinct. Hyoscyami, . 
Syr. Limonis, . . . 
Aquae Cinnamomi, . 
Sig. — A teasp. 3 or 



according to age. 



■ l'y 

■ 3 1V - 

4 times daily, 



rj« . Zinci Oxidi, gr. iij-vj. 

Sacchari Albi, . . . . gr. lxxv. 
M. et div. in pulv. no. vj. 
Sig. — One powder thrice daily. 

{Bamberger. ) 



R. Tinct. Ferri Chloridi, . gj 
Liq. Acidi Arsenosi, . . % ij. 
Syr. Limonis, . . . . Jjss. 
Aquae, . . . . q. s. #<■/ Sjviij. 
M. Sig. — A teasp. thrice daily after 

meals, gradually increased and effects 

watched. 



R . Acidi Arsenosi, . . . . gr. ^—^ 
Ferri Reducti, . . . . gr. j-iij. 
Quininae Sulph., . . . gr. ij-v. 
In pill or capsule, thrice daily. 

(Sacks.) 



Choroiditis. 

Mercury, as in iritis ; cannot be borne to the same extent as in the latter dis- 
ease (A). Opiates, necessary externally and internally to overcome pain (A). 
Treatment, is generally the same as in corresponding forms of iritis, but when 
atrophic spots appear on the choroid, no treatment can repair the damage 
(A) ; rest of eyes and protection from light by blue glasses ; in suppurative 
form (panophthalmitis) use Atropine, in strong solution, with ice compresses 
and leeches in early stage ; Paracentesis repeatedly to relieve tension and 
give exit to pus ; Canthoplasty of outer canthus to relieve the pressure of the 
lids (Roosa). 

Chyluria. 

Thymol, in doses of 1 grain, gradually increased to 5 grains, cured two cases 
of chyluria due to filarial in the blood (Laurie). Hypophosphites, the syrup in 
emulsion with Cod-liver Oil, caused the entire disappearance of chyluria in a 
woman who had been a life-long sufferer therefrom (Barnes). Sodium Benzo- 
ate, in doses of Z) thrice daily, gave promising results, but the after-history of 
the cases was not obtained (Mackenzie). Potassium Iodide, in large doses, 
has checked the discharge for a time in several cases (Lewis). Gallic Acid, in 
doses of 3j-ij, always affords some benefit (Id). Ferric Chloride, large doses 
of the tincture do some good (Id). Treatment, is unsatisfactory; no remedy 
appears to possess any constant effect (Whitla) ; drugs have no influence what- 
ever in stopping the lymphorrhagia, the best results are obtained by absolute 
rest in bed, elevating the pelvis, restricting the amount of food and fluid — espe- 
cially fatty food, and gentle purgation (Mn). 



Climacteric Disorders. 

Aconite, for nervous palpitations, and restlessness or " fidgets " ; gtt. j hourly 
(R). Cimicifuga, for distressing headache (R). Amyl Nitrite, in small doses 
when the "heats" predominate, followed by cold, clammy, pale skin (R). 
Ergot, for the flooding, gr. ij of Squibb's extract in fresh pill every hour until 
relieved ; Cannabis Indica may be well combined with it. Cannabis Indica, is 
used in the headaches of the menopause, with uniformly good results. [See 
Headache, for formula.] Iron, for flutterings of the heart, with fullness of 
head, heat and weight on the vertex, frequent flushings, and hot and cold per- 
spirations ; large doses of the Chloride thrice daily (R). Nux Vomica, Opium 
and Belladonna, when the symptoms described above under Iron are limited 
to the head and face (R). Ammonia, Raspail's sedative lotion to painful part 
of the head in climacteric headaches (R). Potassium Bromide, for the 
despondency, with sleeplessness and irritability, often also with heats, flush- 
ings, perspirations (R). Physostigma, the extract, gr. -^ every yi hour for 7 
or 8 doses, for flatulence and a sensation of fluttering at the pit of the stomach 



COCCYGODYNIA — COLIC. 



651 



(Smith). Camphor, for drowsiness and headache ; Eau-de-cologne, saturated 
with Camphor, rubbed on the head (R). Zinc Valerianate, hysterical symptoms 
(R). Change of air and scene, when other treatment only partially successful 
(R). Warm Bath, to promote free perspiration ; at 90 to 95 F. for an houi , 
once a week, will correct many of the symptoms (R). [Compare Metror- 
rhagia.] 

Coccygodynia. 

Chloroform, injected as deeply as possible about the seat of greatest pain (B). 
Electricity, has cured one severe case of 12 years' standing, and helped others. 
Surgical treatment the only resource in rebellious and painful cases (Ros). 
Nott extirpated the coccyx ; Simpson performed subcutaneous section of mus- 
cles and ligaments; Goodell removed the bone, after first treating the case as 
the local expression of a general neurosis. 

Coldness. 

Strychnine, for cold hands and feet (R). Cold Baths, with friction to the 
skin, nightly for cold feet (R). Chloral, in small doses daily, will counteract 
the coldness of the feet and hands in certain cases of anemia, hysteria, etc. 
(Cherchevsky). Spinal Ice-bag, is often efficiently employed in general cold- 
ness of the surface, and persistent coldness of the hands and feet (R). Co- 
caine or Atropine, will raise the body-temperature. (See page 38.) 



Colic, Intestinal. 

Nux Vomica, quickly subdues abdominal cramps and spasms (P). Bella- 
donna, especially in children (R). Chamomile Oil, n\iv-vj, in colicky attacks 
of hysterical women (P). Cocculus, of great value, especially during preg- 
nancy (P). Chloral, sometimes relieves (R). Chloroform, effective in flatu- 
lent colic ; also useful in hepatic and saturnine (B) ; often used combined with 
Opium (D).; Potassium Bromide, in a peculiar form of colic in young children 
(R) ; given in Anise- or Peppermint-water is of greater efficacy for the colic 
of infants than the opium preparations in general use, and perfectly safe (B). 
Asafcetida, no better remedy in flatulent colic of infants ; teasp. doses of the 
Emulsum Asafcetida (B). Dioscorea, is used successfully in so-called bilious 
colic, TTLxv-xxx of the fluid extract. Morphine, gr. yi-% hypodermically, 
repeated in 15 minutes, gives more relief than any other remedy in all forms 
of colic (B) ; frequent small doses (P). Arsenic, will cure in a surprising 
manner when enteralgia is idiopathic (B). Essential Oils, especially those of 
Cloves and Cinnamon (R) ; of Anise, Cardamom, etc. ; Oil of Rue in flatulent 
colic of children (P). Magnesium, the Carbonate with Opium and Asafcetida, 
as in Dewees's Carminative (see page 202), the dose being n^xx for an infant 
2 to 4 weeks old. Tobacco, as enema, is dangerous! (B); as clyster, or by 
stomach (R). Ammonia, in spasm of intestinal canal and in colic of children 
or infants from bad feeding (R). Lime Water, for young children who eject 
milk in lumpy masses, with colic and flatulence (R). Water, hot fomentations 
to ease pain (R) ; a copious enema of warm water often gives immediate 
relief. 



R . Spiritus Chloroformi, 

Tinct. Cardamomi Co., aa ^ ij. 
M. Sig. — Teasp. in water every y z 
hour. (B.) 

R . Atropine Sulphatis, . gr. j. 

Zinci Sulphatis, . . . gr. xxx. 

Aquae Destil., .... 3J. 
M. Sig. — 3 to 5 drops two or three 
times daily. (B.) 



R- . Ext. Gentianae, 

Pulv. Rhei, . . . . aa gj. 
Ft. pil. xx. Sig. — One or two 
thrice daily for tendency to colic. 



pills 



R 



Pulv. Camphorae, 
Pulv. Capsici, 

Pulv. Zingiberis, . . aa gr. ij. 
Ft. pil. xij. Sig. — One pill as required. 



652 



COLIC COLLAPSE. 



Colic, Lead. 

Alum, singularly, is the best remedy (B) ; gr. x hourly (R) ; converts the 
poisonous salt of lead in the system into a comparatively innocuous sulphate; 
3jss-ij daily with ir^xl-l Tinct. Opii, and an occasional dose of Castor or 
Croton Oil to procure one or two motions daily (Wa). Opium, gives more 
relief than any other remedy, gr. ]/% to % of Morphine hypodermically (B) ; 
gr. ij-iv of Opium, with a moderate dose of Castor Oil (P). Sulphuric Acid, 
diluted well, as a prophylactic, and is useful in the treatment of the disease (B) ; 
considered remarkably efficient when used in association with repeated Sulphur 
baths (Wa). Calomel, a full dose, with or without Opium, followed in a few 
hours by Castor Oil and a Turpentine enema, often affords speedy and marked 
relief (Wa). Tobacco, may control, but is dangerous (B). Croton Oil, in half- 
drop doses, with sufficient Opium to relieve the pain, repeated every 3 or 4 hours 
until free evacuations are produced ; proves effectual when other remedies fail 
(Wa). Magnesium Sulphate, for the constipation, and to remove the poison 
from the system ; should be combined with Potassium Iodide, 3j of the former 
thrice daily and about two hours after having given gr. v-x of the Iodide ; 
this treatment dissolves the lead in the tissues, causes its elimination by the 
intestinal mucus, renders it insoluble after it has entered the intestinal canal, 
and quickly removes it from the body (Br). Atropine, gr. y^, with Potassium 
Iodide, gr. v, gives excellent results in the treatment of lead-poisoning, the 
former relieving the colic and pain in the head in the most rapid manner, 
keeping the bowels open freely, assisting in the return of the bodily powers, 
and aiding in the removal of the lead by the Iodide (Humphreys). [Compare 
Poisoning by Lead.] 



R. Aluminis, ^ij. 

Ac. Sulphurici Dil., . . ^j. 

Syr. Limonis, . . . . %]. 

Aquae, rfiij. 

M. Sig. — Tablesp. every hour or two 
for lead colic. (B.) 



R. 






Magnesii Sulphatis, 

Ac. Sulphurici Dil. 

Aquae, 

M. Sig. — Tablesp. every 3 hours (B) ; 
or thrice daily, each time preceded by a 5- 
to io-grain dose of Potassium Iodide. (Br.) 



Colic, Renal and Hepatic. 

Ether, inhaled in paroxysms of hepatic colic (R). Chloroform, by inhalation 
in renal and biliary colic, inferior only to Morphine injection, superior to 
Opium, warm baths, etc. ; two or three administrations will be required (R). 
[See also Colic, Intestinal.] Counter-irritation, flying blisters for renal 
colic (R). Opium, small doses with Spt. Chloroformi every five or ten minutes 
until the pain gives way, or Morphine hypodermically (R). Turpentine, has 
been given with benefit in biliary colic (R). Olive Oil, in full dose during an 
attack of colic, frequently gives relief (Brockbank) ; stops the spasm of the 
ureters, and acts in nephritic colic precisely as it does in hepatic colic (Aussil- 
loux). Glycerin, in doses of gv-vij i n hepatic colic brings the attacks to an 
end; doses of 3j-iv daily, in a little alkaline water, prevented recurrences 
(Ferrand). Water, warm baths to ease the pain (R). Aliment, withhold 
all starches and fats ; Alkaline mineral waters are useful (B). [Compare 
Calculi.] 

Collapse. 

Camphor, 3] of a 10 per cent, solution in oil, hypodermically into each fore- 
arm, in the collapse of pneumonia (Schilling) ; hypodermic injections of cam- 
phor are used for purposes of excitation in collapse. Ether, by mouth, inhala- 
tion, or hypodermically, is of great service. Ammonia, the liquor diluted, by 
intravenous injection, in cases of fracture and laceration accompanied with 



COMA CONJUNCTIVITIS. 653 

collapse (P) ; in desperate cases when the hypodermic method is the only avail- 
able route (Whitla). Brandy, or other alcoholic stimulant, by mouth if the 
patient can swallow, if not then by the bowel or hypodermically (Id). Digitalis, 
the tincture as a cardiac stimulant, but being slow of action it should be pre- 
ceded by Ammonia or Alcohol. Strychnine, or Nux Vomica, for impending 
cardiac failure, is very efficient. [Compare the articles on Heart Affections 
and Syncope.] Electricity to the phrenic nerve, or an interrupted current 
through the upper extremities (Whitla). Beef Extract, Liebig's in large doses 
with hot water, is a rapidly acting stimulant (Id). Transfusion, or a warm 
saline solution by subcutaneous injection, when collapse is associated with 
extensive hemorrhage ; or an Esmarch bandage to the limbs, or the tourniquet 
to the femoral artery, to keep the blood out of the lower extremities (Id). Heat 
to the surface and over the cardiac region. Counter-irritation, by mustard to 
the spine, nape of the neck, and calves of the legs. Affusion, of cold water 
alternating with hot (P). [Compare Exhaustion, Shock, Syncope.] 

Coma. 

Croton Oil, as a purgative, n^X or Vi every hour, mixed with a little butter 
or lard and conveyed to the back of the tongue (R). Oxygen, by inhalation, 
is generally applicable in coma. Potassium Bitartrate, free purging therewith, 
often removes coma, convulsions, and other symptoms due to poisoned blood 
(R). Blisters, in the comatose condition, large blisters or mustard poultices 
should be applied in quick succession to different parts of the body — chest, 
abdomen, thighs, and calves ; often very valuable in the critical condition near 
the end of an acute illness (R). Cold Douche, for stupor of drunkenness or of 
opium poisoning ; may have to be repeated if relapses occur ; it should be kept 
up for a long time if pulse and breathing improve or are no worse (R). Mus- 
tard, as poultice to the feet and ankles in the coma of narcotic poisoning (P). 
Exercise, in coma from poisoning the patient should be persistently walked 
about. [Compare Cerebral Congestion, Uremia, and Poisoning by Nar- 
cotics.] 



Condylomata. 

Nitric Acid, !§j in Oj aquae, as wash, frequently used (R). Thuja, locally a 
strong tincture, also tt\,v internally, night and morning, for warts with narrow 
base and pendulous body ; warts about anus or pudenda of either sex, whether 
syphilitic or not, are often rapidly cured by Thuja (P) ; in non-syphilitic warts 
of penis or vulva, I have employed it with satisfaction (Pf ). Mercury, Calomel 
dusted over, after washing with a solution of Chlorinated Soda (Ricord) ; the 
Nitrate locally, or a 20 per cent, oleate (R). Zinc, the Chloride, Iodide or 
Nitrate as local applications (R). Arsenous Acid, as a caustic (R). Carbolic 
Acid, as a mild escharotic (B). Chromic Acid, gr. c. in ^j aquae dest. ; a good 
local application (B). [Compare Syphilis, Warts.] 

Conjunctivitis, Catarrhal. 

Zinc, a weak solution of the sulphate or acetate as astringent collyrium (B) ; 
gr. j-ij in ^j aquas destil. as mild astringent lotion every few hours, with ice 
locally in the earlier stage (Roosa). Sodium Borate, gr. v in ^j aquae dest. a 
good and mild astringent for ordinary cases. Boric Acid, gr. vj in gj each of 
aquae camph. and aq. destil., as collyrium (Fox). Boro-glyceride, in dilute 
solution, 3ss to the j§, is an efficient application. Mercury, Calomel finely levi- 
gated and dusted from a camel's-hair brush over the palpebral conjunctiva in 
severe cases (B) ; is a most efficient application in the conjunctivitis of children . 
showing minute ulcers ; the Oleate of Mercury and Morphine applied to the 



654 



CONJUNCTIVITIS. 



outside of the lids in palpebral conjunctivitis (R) ; the Red Oxide as ointment, 
10 grains to the ^ of Vaselin (Bader) ; the Yellow Oxide, 8 to 10 grains to the 
^ of Vaselin (Seely) ; }i grain in Z\) of Vaselin is strong enough. Carbolic 
Acid, a 5 per cent, solution applied every two hours by spray of steam atomizer, 
which dilutes it one-half, an extremely efficient application, relieving the pain 
and contracting the vessels. Cocaine, the Hydrochlorate, in 3 to 5 per cent, 
solution or oleate, applied to the palpebral conjunctiva, is a very efficient pal- 
liative, especially where much pain and photophobia (Roller). Alum, Potassa 
Alum after acute symptoms subside (Br) ; gr. iij-v ad ^ij aq. destil. brushed 
over the conjunctiva twice daily. Pulsatilla, 3j-ij of tincture to ^iv aquae, as 
wash several times daily, also TT\j-x internally every 3 or 4 hours (P). Opium, 
the wine dropped into the eye relieves pain and improves the condition of the 
conjunctiva (R) ; Morphine, gr. j-ij ad ^j, is often used in collyria with Zinc 
Salts or Alum, but is irritant. Cadmium, as collyrium, gr. ij of the sulphate to 
^j aquae rosae (B). Tannin, in Glycerin, £>j ad ^j, every second day in chronic 
catarrhal conjunctivitis, presenting diffused injection of vessels with edema 
(Hansell). Silver Nitrate, solutions of gr. j-iv to the ^, applied by physician 
to conjunctiva (R); should not be given to patient ; Zinc and Copper Salts are 
preferred (B). Copper, the Sulphate crystal in chronic cases where great swell- 
ing or hypertrophy of the papillary layer; is too irritating to be entrusted to 
the patient. Lead salts should never be used lest deposits occur in slight abra- 
sions or ulcerations of the cornea. Sulphates, of Zinc, Copper, and Iron, with 
Alum aa, gr. j to ^j of aq. destil. as collyria, extremely efficient ; in severe 
cases may be used in saturated solution by the physician (Holmes). Castor 
Oil, a drop placed in the eye often allays the pain and photophobia caused by 
an irritant (R). Belladonna, locally and internally (B). Atropine in strong 
solution, gr. iv to the ^, is one of the best local applications where mydriasis 
is not objectionable. Euphrasia, as a mild astringent (P). Blisters, behind 
the ears in bad cases (R). Ergot, the fluid extract locally gives excellent re- 
sults in acute conjunctivitis (B). Staphisagria, especially in tarsal ophthalmia 
(P). Colchicum, when gouty diathesis (A). Spigelia, in rheumatic form (P). 



R 



M 



Zinci Sulphatis, 

Morphinse Sulph., . aa . gr.j. 

Atropinae Sulph., . . . gr. ss. 

Aquae Rosae, §j. 

Sig. — Eye- water. 



rjt . Liq. Plumbi Subacetat., gj. 
Aquae Destillatae, . . . 3 iij . 
M. Sig. — For local use. To be brushed 
over conjunctiva of everted lids by the sur- 
geon and washed off with water. (Bulle?-. ) 



R- . Hydrarg. Oxidi Rub., . gr. x. 

Atropinae Sulph., . . gr. j. 

Vaselini, # 1j. 

M. Sig. — A minute portion as an oint- 
ment for the eye. [Bader.) 



R- . Ung. Hydrarg. Nitrat., . gr. xx. 

Cocainae Hydrochlorat. , gr. v. 

Vaselini Albi, . . . . gij. 
Use a fresh ointment, triturate thor- 
oughly, and label " Ointment for the eye." 



Conjunctivitis, Diphtheritic. 



Atropine, locally throughout the disease ; not very effectual (Roosa) ; is, for 
severe cases, powerless ; cornea sure to be attacked and liable to slough 
(Noyes). Boric Acid, a 4 per cent, solution, as antiseptic, the best application, 
with Quinine internally in full doses (Noyes). Iron, the Pyrophosphate for 
children, 3] in ^iij of simple syrup, of which a teasp. thrice daily after meals, 
with Quinine in 1- to 3-grain doses thrice daily and good food (Derby). Cold 
by compresses as in purulent ophthalmia, in early stages. Silver Nitrate, in 
10 grains to the % solution locally, or the mitigated stick in the second stage. 
Tannin, gr. xx to the % of Glycerin, later on, applied every day, with hot water 
lotions if corneal complications are present. 



CONJUNCTIVITIS. 655 



Conjunctivitis, Gonorrheal. 

Zinc Chloride, gr. j-ij ad sjj aquae, as collyrium, used with marked benefit 
(Wa). Silver Nitrate, a 2-grain to the ^ solution, after syringing out the eye 
with warm water, followed by ice compresses, in hope to abort the attack, if seen 
early (Roosa). Cold, by ice or wet compresses, essential in the early stages 
(C). Atropine, may be used from the beginning, as corneal complications 
begin very early. Treatment, is generally the same as for Purulent Conjunc- 
tivitis ; isolation and cleanliness are of prime importance. 



Conjunctivitis, Granular. 

Silver Nitrate, the diluted stick applied lightly and quickly (C) ; strong solu- 
tions to granular lids, gr. xx to the S5 cautiously when corneal ulcers exist (B) ; 
mild solutions better, gr. v to the ^ daily in the papillary form ; in miliary tra- 
choma it should not be stronger than gr. ij to the ^ (Noyes) ; applications lose 
their effect after a time, and should be changed (Roosa). Copper Sulphate, 
the solid crystal lightly touched to the membrane once a day, the favorite 
astringent and caustic in all forms of trachoma (Roosa) ; when the membrane 
is torpid to other stimulation and when lymphoid substance is predominant ; as 
ointment gr. v-x to the % of Vaselin, when for use by patient (Noyes). Alum, 
a smooth crystal is a useful daily application (Noyes). Tannin, gr. x-xxxtothe 
^ of Glycerin, an application to change to from others (Roosa). Bismuth is one 
of the numerous applications in chronic conjunctivitis and granular lids (B). 
Phytolacca internally, is undoubtedly efficient in granular conjunctivitis (W). 
Jequirity, to excite substitutive inflammation (see page 75). Atropine, gr. ij to 
the :§, thrice daily, is often advisable, when moderate irritation and haziness 
of the cornea (Noyes). Hygienic Measures, are of great value; protection by 
blue or smoked glasses ; rest of eyes, best secured by using Atropine collyria ; 
hot or cold water as local bath frequently. Tobacco, must be avoided, also all 
locations contaminated by impure air. Canthoplasty, of outer commissure 
when the lids press on the globe. 



Conjunctivitis, Phlyctenular. 

Mercury, Calomel finely levigated and dusted from a camel's-hair pencil 
over the membrane in phlyctenular ophthalmia, an excellent application, but 
should never be used when Iodine is being taken ; in more obstinate cases a 
small bit the size of a pin-head of Pagenstecker's ointment (Hydrarg. Oxidi 
Flav. gr. j-iij, Vaselini 3j), placed between the lids (Noyes). Ergot, the fluid 
extract applied undiluted gives excellent results in the phlyctenular ophthalmia 
of children (B). Antimony, Tartar Emetic gr. ^ to ^3 or 4 times daily in 
strumous ophthalmia, with sharp purgation at the outset (R). Belladonna, or 
Atropine, locally in strumous ophthalmia, of great service in relieving pain ; 
constitutional treatment also required (Wa). Arsenic, invaluable in inveterate 
cases of strumous ophthalmia, especially when complicated with cutaneous 
eruptions (Wa). Tannin, finely powdered and dusted over the everted lid, 
gives remarkably good results in this and other forms of conjunctivitis, causing 
very little pain and no inflammatory reaction (B). Carbonic Acid Gas, applied 
to the eye is said to relieve the pain and photophobia of strumous ophthalmia 
(R). Hydrastis, as lotion, is serviceable when Meibomian follicles are impli- 
cated, causing adhesion of lids in the morning (P). Physostigmine, locally, 
to reduce the pupil and shut out the light (P). Iodine, is employed locally in 
strumous ophthalmia, for its alterative stimulation (W). Zinc Chloride, gr. 
ij-iv to the ^, as collyrium, has succeeded admirably in pustular ophthalmia 
(Wa). Zinc Sulphate, gr. j-iv to the ^, is very serviceable ; the addition of. 
Liquor Plumbi improves its efficacy (Wa). Rhubarb, the Mistura Rhei et Sodas 



656 CONJUNCTIVITIS — CONSTIPATION. 

when much disturbance of digestion present. Tonics, may be given later, as 
preparations of Cinchona and Iron. Cod-liver Oil, in strumous subjects, tends 
to remove the manifestations of the disease (R). 



Conjunctivitis, Purulent. 

Alum, gr. ij ad ^j aquae, a sufficient astringent application in ophthalmia 
neonatorum (Roosa); gr. viij ad ^j aquas, applied every % or x / z hour in the 
purulent ophthalmia of children, its success depending on the frequency of the 
application (R). Copper Sulphate, gr. j ad %') aquas camph. as collyrium in 
purulent ophthalmia of infants (Wa). Silver Nitrate, gr. iij-x ad ,^j aquae 
destil., rarely so strong as gr. x to the ^, applied by brush once daily to 
everted lids in purulent ophthalmia of infants (Noyes) ; solution gr. ^ to the g 
twice daily under lids (Meigs) ; by many considered needless and injurious 
(Roosa). Boric Acid, a 4 per cent, solution, as antiseptic, is all that is neces- 
sary in mild cases ; in others it is the proper fluid for cleansing the eye 
(Noyes). Atropine, when the cornea becomes invaded and shows haziness, a 
solution gr. ij to the ^ must be instilled every 3 hours (R). Cold, by ice or wet 
compresses, essential in the early stages of acute purulent ophthalmia (C). 
Cleanliness, of great importance ; as the discharge is infectious the patient 
should be isolated and care taken to prevent inoculation of the other eye. 

R- . Sodii Boratis, gr. xij. R- . Sodii Boratis, gr. iij. 

Zinci Sulphatis, . . . . gr. j. Aquae Rosse, Aquae, aa ^j. 

Aquae Camph. , .... gj. M. Sig. — Apply beneath lids three or 

Aquae Destillat., . . . £)• four times daily after cleansing. 

M. Sig. — Apply to lids 2 or 3 times 

daily in ophthalmia neonatorum, with solu- R- . Atropinae Sulph., . gr. j. 

tion of Silver Nitrate, gr. ^/ to the 3 in- Glycerini, ^ss. Aquae, g ij. 

jected under lids twice daily. (Meigs.) M. Sig. — Two drops into the eye. 



Constipation. 

Nux Vomica, gtt. j-ij of tincture, twice or thrice daily (R) ; gtt. v-x in a glass 
of cold water before breakfast and dinner, often overcomes the most obstinate 
constipation (P) ; especially useful when great fecal accumulations from torpor 
of bowel (B). Sulphur, gr. x with Confectio Sennas, often succeeds after other 
remedies fail (R) ; sulphurous mineral waters (B) ; or Sulphates in purgative 
waters ; frequent small doses (R). Podophyllum, the most generally used 
cathartic when secretion deficient (B) ; gr. T ^ to ^ night and morning when 
constipation with nervous and bilious headaches (P). Senna, as in the Pulvis 
Glycyrrhizas Compos., which may be taken in doses of a teasp. to a tablesp. as 
required, and kept up for months (Goodell). Mercury, Calomel or gray pow- 
der as a cathartic (R-). Hydrastis, very valuable, when constipation is refer- 
able to a sluggish liver (P). Magnesium, the Bicarbonate, a useful and mild 
aperient (R). Alum, a cheap and serviceable laxative (B). Aloes, in minute 
doses, in pill with Ferrous Sulphate, as the official Pil. Aloes et Ferri, is one of 
the best agents in the management of chronic cases ; purgation should not be 
aimed at. Chloral, is an efficient laxative in rebellious chronic constipation, 
particularly that of neuropathic cases (De Holstein). Ipecacuanha, gr. j every 
morning, fasting, when great torpor of bowel (R). Cocculus, flatus, hard 
lumpy motions (P). Turpentine, in purely atonic constipation, with gaseous 
distention of colon, has triumphed when all other remedies failed (P). Physos- 
tigma, very effective in intestinal torpor (B). Stillingia, rt^x of fluid extract 
in habitual constipation (B). Castor Oil, a mild efficient cathartic (B). Am- 
monium Chloride, in the so-called bilious state with constipation (B). Arsenic, 
nyj of Fowler's solution often overcome constipation (R). Belladonna, gr. l /z 
of the extract at night, in habitual constipation (B) ; gr. l /6-% once a day, espe- 



CONVALESCENCE. 



657 



cially when dyspepsia (R) ; acts directly on the bowel as a stimulant (P). 
Croton Oil, the most efficient cathartic, when simple impaction without inflam- 
mation ; gtt. j-ij (B) ; when evacuations of blackened feces (R). Cascara Sagrada, 
the fluid extract in doses of 3j, produces large, soft evacuations without grip- 
ing, and leaves behind it a laxative influence. Frangula, in similar doses, is 
equally efficient, but if from a fresh bark may produce griping. Cathartics, 
especially Confectio Sennse, Pil. Rhei Compos., Pil. Aloes, the Comp. Cathar- 
tic Pill, as well as those above (B) ; purgation as usually practiced was de- 
nounced by the editor of the Lancet, October 1, 1870. Saline Waters, are use- 
ful (B) ; Pullna, Friedrichschall, or Hunyadi, the first two with milk, are good 
for children (R). Enemata, of soap-suds and salt, or a pint of cold water (B) ; 
or Turpentine, Castor Oil, aa ^ss to Oss-j of gruel (P) ; the habitual use of 
warm enemata increases torpor of the bowels (R). Tamar-Indien, a favorite 
mild aperient, is proprietary, and supposed to contain Cocculus, Glauber's salt, 
etc. Aliment, important in habitual constipation ; corn bread, cracked wheat, 
oatmeal, bread of unbolted flour, fruits, green corn, tomatoes, and celery ; ^ 
dozen each of almonds and raisins daily. Water, 3. glass of cold water before 
breakfast may overcome habitual constipation (B) ; drinking largely of water 
is a most beneficial measure in cases of chronic constipation. Smoking a 
cigar or a pipe after breakfast (R) ; tobacco smokers rarely suffer from consti- 
pation. [Compare Intestinal Obstruction.] 



R. Ext. Colocynth Co., . . gr. xij. 
Ext. Belladonna, . . . gr. ij. 
Ext. Gentianae, . . . . gr. vj. 

Olei Cari, gtt. iij. 

Ft. pil. vj. Sig. — One pill at bedtime. 



R- . Podophylli Resinse, . . gr. ij. 

Quininae Sulphatis, 

Ext. Aloes, . . . aa gr. viij. 

Fellis Bovini, gr. xvj. 

Ft. pil. no. xvj. Sig. — One or two at 
bedtime. ( Goodell. ) 



R. Ext. Rhamn. Pursh., Fl., gj. 
Ext. Belladonna Fl., . . %'}. 
Tinct. Nucis Vom., . . 5pj. 

Syrupi et Aquae, . z&ad giv. 
M. Sig. — Teasp. thrice daily, in obsti- 
nate constipation. {Clarke.) 



Castor Oil Emulsion. 



R 



01. Ricini, 
Glycerini, .... aa 5jj. 
Tinct. Aurantii, .... m^xx. 
Tinct. Senegre, .... TT\v. 
Aq. Cinnamomi, q. s. ad £ ss. 
M. ft. emulsum. Sig. — One dose, 
be taken in the morning. 



M 



Artificial Hunyadi Water. 

Magnesii Sulphatis, 

Sodii Sulphatis, . . 

Potas. Sulphatis, 

Sodii Bicarbonatis, 

Sodii Chloridi, . . 

Aquae, . . . . q. s. ad 3 viij. 

Sig. — A winegl. before breakfast. 



a 5 ss. 

• g r - ij- 

• gr- viij. 

. PT. XX. 



Convalescence. 

Lime, as Lime-water, or the Carbonate, in convalescence from serious dis- 
ease (R). Quinine or Hydrastine, to promote digestion and appetite (B). 
Fats, especially Cod-liver Oil (R). Alcohol, before or during meals (R). 
Koumiss, possesses great value (B). Bitters, especially Gentian and Calumba 
(B) ; the latter especially when stomach weak (R). Eucalyptus, a serviceable 
tonic (B). Coca, 3ss-ij of the fluid extract at a dose (B). Guarana, gr. xv-3j 
may be given (B). Opium, as Laudanum, injected per rectum, for insomnia of 
convalescents (R). Sea-Baths, valuable in many cases (R). Nuclein, is used 
with benefit. Orchitic Extract, has been employed with good results. Bone 
Marrow, gives great satisfaction in anemic cases. Diet, requires the most 
careful attention ; the prevalent error of giving food difficult of digestion too 
early must be guarded against, especially in intestinal and gastric disorders ; 
the strictest moderation should be enjoined. The symptoms must be watched 
closely, and combated by appropriate medication. [Compare Adynamia for 
Tonic Prescriptions, also Anemia.] 
42 



658 



CONVULSIONS — CORNEAL OPACITIES. 



Convulsions. 

General Directions. — In all cases a horizontal posture, fresh air, clothing 
loose ; a plug of soft wood or a cork between the teeth, to prevent biting the 
tongue ; sprinkle the face and chest with cold water. Epileptic. — The general 
directions above will usually suffice. Hysterical. — The diagnostic peculiarities 
are : pupils not dilated but are sensitive to light, no wounding of tongue, 
face not livid, pulse usually normal. Infantile. — Administer some anti- 
spasmodic as Ether, alone or combined with Musk or Belladonna; then search 
for any mechanical cause, as a pin in a dress, etc. ; lance the gums if dentition 
the cause (A). Solanum Carolinense, has a good reputation in the southern 
states for epilepsy and other convulsive affections, and has rendered excellent 
service in my hands (Napier) ; a tincture is prepared by bruising the berries 
and steeping them in whiskey, of which the dose is Z), repeated until drowsi- 
ness is produced. [Compare Albuminuria, Epilepsy, Hysteria, Puerperal 
Convulsions, Uremia.] 



Convulsions, Infantile. 

Belladonna is of the highest value in certain congestive forms, as in fits due 
to the irritation of teething, or those referable to whooping-cough (P). Ignatia, 
is efficient in convulsions of children from intestinal irritation, no cerebral con- 
gestion being present (P). Valerian, has been successfully used in convulsions 
from the worms to which it is fatal (P). Potassium Bromide, in all forms of 
convulsions in children (R) ; children bear it in large doses, gr. v thrice dailv 
or oftener for a child a year old, in convulsions from teething (Br). Chloral, 
in large doses, gr. v, by mouth or rectum (Br) ; best used as a suppository rather 
than by liquid injection, and is often very useful (R) ; it gives better results 
than any other agent. Chloroform inhalations are of great service (R) ; useful 
in all forms (B); should be used to arrest the convulsion and prevent recurrence 
(Smith). Alcohol, has remarkable power in arresting convulsions of dentition ; 
small doses of wine or brandy (W). Asafcetida, in the convulsions of teething, 
a small portion in an enema, appears to mitigate them (Wa). Opium, efficient 
but dangerous in young children. Veratrum Viride has been employed suc- 
cessfully (R). Amyl Nitrite, gtt. v, with gr. % of Morphine, was used in one 
case as a last resort after five hours' convulsions in a child of 18 months, 
and resulted in producing quiet sleep (Engel). Hot Baths, are important, 
with cold affusions or ice to the head (B). Spinal Ice-bag, may be very 
efficient (R). 



Jc. Chloralis Hydratis, . . gr. v. 
Lactis, ........ %]. 

M. Sig. — As rectal injection. Or the 
dose may be made into a suppository 
with cacao-butter and inserted well up into 
the rectum. 



R . Sodii Bromidi, 

Chloralis Hydratis, 

Sodii Bicarb., . . . aa gr. viij. 

A q u3e * %')■ 

M. Sig. — A teaspoon ful every hour to 
a child under four months old. 



Corneal Opacities. 

Cadmium, is said to promote their absorption ; gr. ij of the Sulphate to 5jj of 
rose-water, as collyrium (R, Wa). Mercury, Calomel by insufflation, or the red 
Iodide gr. ij, Cerate gr. xl, Olive Oil gtt. xx, as ointment, successfully used 
(Wa) ; weak solutions of the Bichloride, or ointments of the Oxides, gr. ^f to 
the %, as remedies among others to hasten absorption in recent cases (Arlt). 
Oils, Eel-liver and Cod-liver Oils, Ox-gall, Juniper Oil, Oil of Turpentine com- 
bined with Olive Oil, and others, dropped into the eye once or twice daily for 
the same purpose (Arlt). Opium, the wine at first, then insufflations of Calomel 



CORNS COUGH. 659 

and Red Precipitate or Yellow Oxide ointment, frequently used in recent cases 
(Arlt). Potassium Iodide, as ointment with Potassium Carbonate after Cod- 
liver Oil or Oil of Turpentine with Olive Od, in cases of longer standing (Arlt). 
Silver Nitrate, gr. v-x ad ^j aquae, as lotion (C). Iodine, internally and as 
collyria, has been efficacious, especially in strumous cases (Wa). Sodium 
Chloride, gr. x ad %] aquas destil., of which TCLv-x injected subconjunctivally, 
to hasten disappearance of turbidity (C). Operative Measures, only in case of 
incrustations (as of lead and lime) situated superficially, by removal of epithe- 
lium and anterior elastic layer ; deeper interference may lead to suppurative 
keratitis. Excision of opaque cornea and transplanting of one from an ani- 
mal's or a recently enucleated human eye (keratoplasty), has always failed. 
Artificial pupil by iridectomy, for central opacities which are unremovable. 
Tattooing to relieve deformity of disfiguring leucomata (Arlt). Pannus and 
leucoma are best let alone (D) Stenopaic Spectacles, for semi-transparent 
opacities in pupillary region (Donders). [Compare Keratitis.] 



Corns. 

Salicylic Acid, in strong solution, removes excess of epidermis, warts and 
corns; is the essential ingredient of all corn-cures. Silver Nitrate, solid, after 
soaking and paring (Wa) ; the best application for soft corns and very irritable 
ones (D). Acetic Acid, strong, to remove corns (Wa). Mercury, Corrosive 
Sublimate in alcoholic solution locally to remove corns (Wa). Iodine, gr. xl ad 
^j Alcoholis, locally (Wa). Poultices, are useful ; or a plaster of soft material 
with hole in centre (D). Water, hot and cold, alternately applied to inflamed 
corns. Keep a corn thin by frequent washing and paring ; in performing the 
latter the knife should work downwards to the apex of the corn, so as to remove 
the central pressure on the subjacent tissue. 



& . Acidi Salicylici, . . . . gr. xv. 
Extr. Cannabis Ind., . . gr. vijss. 
Alcoholis, 90 , .... rP L xv. 

yEtheris, 62 , n^xxxvij. 

Collodii Flexilis, . . . TT^lxxv. 



Mix, and keep in closely-corked vial. 
Paint the corn every other day for a week, 
then it can be easily squeezed out. 

( Vigier.) 



Cough. 

Opium, in some form, is much used in cough-mixtures; Morphine and Gly- 
cerin applied to fauces (B) ; moderate doses are useful in irritative affections 
of the air-passages to allay irritation and hypersecretion, but it may do even 
fatal mischief in cases where secretion is copious and expulsory power feeble 
(P) ; opiates inadmissible when with copious expectoration there is any indica- 
tion of bronchial congestion (Wa) ; very useful in violent and frequent cough 
with little rhonchus and no signs of obstructed oxidation ; also, when cough is 
due to red, inflamed and ulcerated throat ; Opium or Morphine given so as to 
cling for some time in contact with the pharyngeal structures (R). Codeine, is 
often efficient in cough (Br) ; of particular value in ^-gr. doses ; is slightly 
expectorant, also laxative, does not nauseate or cause vomiting, or affect the 
appetite ; is far the best agent for the cough of phthisis when morphine is not 
well borne (Kobler). Peronin, is intermediate in its effects between morphine 
and codeine, and has a very quieting action on the paroxysmal cough of 
phthisis (Schroder) ; gr. yi-Yz thrice daily, the latter dose giving a quiet night's 
sleep, even in cases where morphine and codeine were ineffective (Munk). 
Nux Vomica, in laryngeal cough of neurotic origin, drop doses of the tincture 
every five minutes ; is promptly efficient (Macfarlan) ; has specific action on 
the pneumogastric, and is one of the most efficient remedies in cough of any 
kind, whether from bronchitis, pneumonia, phthisis or emphysema, but espe- 
cially in nervous coughs and periodic coughs which come on in the evening 



660 COUGH. 

and stay all night {Jour, de Med.). Pulsatilla, as Anemonine, *4, gr. and gr. 
doses, very useful in irritative cough, asthma, whooping-cough (P). Iodine, by 
inhalation for children in hoarse, hollow cough, wheezing (R) ; the tincture, 
5-10 drops, inhaled from boiling water for five minutes at bedtime, often gives 
most signal relief in the irritating cough of phthisis. Apomorphine Hydro- 
chlorate, very valuable in cough where there is persistent hacking without 
expectoration, or with difficult expectoration ; the dose is only gr. -fa to -^ in 
the 24 hours ; solution rapidly alters unless a few drops of Hydrochloric Acid 
are added (Stocquardt). Terpin Hydrate, in bronchial cough, and night-cough 
from habit, is very efficient in a 2-grain dose at bedtime, repeated early in the 
morning (Boyland). [See under Bronchitis, Chronic, for formula.] Aconite, 
irritable, tickling throat-cough ; short, dry cough of asthmatics, with anxious 
look and full, strong pulse (P). Belladonna, often useful; no indications (R) ; 
internally and externally as plaster to the chest, very serviceable in spasmodic 
and nervous coughs (Wa). Hyoscyamus, very useful in spasmodic tickling 
night coughs (P). 

Hydrocyanic Acid, for nervous, irritable cough and cough of phthisis, also 
mother's sympathetic cough (B) ; no more certain palliative for simple, ner- 
vous cough due to irritable state of the system (S) ; a valuable adjunct to ordi- 
nary remedies in cough of phthisis (Wa). Potassium Cyanide, is equally 
useful, gr. iij with §j each of Ext. Grindelise FL, Syr. Scillae and Syr. Tolutan., 
makes a good non-opiate cough mixture, of which the dose is 3) every 4 hours 
(Waugh). Prunus Virginiana, has some influence, due to its Hydrocyanic 
Acid ; is much used in cough mixtures (P). Laurocerasus, used as a substi- 
tute for Hydrocyanic Acid in spasmodic coughs (B). Conium, supposed to be 
useful (R) ; is very useful in spasmodic cough (Wa). Ipecacuanha, the Ad. 
extr. for troublesome night-cough (B) ; in obstinate winter-cough, with wheez- 
ing, the wine as spray to fauces, efficacious (R) ; in coughs of childhood Ipecac 
is one of the most generally serviceable expectorants we can use (Wa). 
Lobelia, dry cough, continued tickling sensation, even in sleep (P). San- 
guinaria, combined with Hyoscyamus, in nervous, spasmodic cough (P). 
Senega, as a stimulant expectorant in the cough of chronic bronchitis and 
subacute chest affections. Gelsemium, excessive irritability of the respiratory 
centre (R) ; often remarkably relieves convulsive or spasmodic, reflex and ner- 
vous coughs (B). Alum, internally in spasmodic cough; gr. x to !§j aquas as 
spray, in chronic cough also (R). Drosera, the fluid extr. in }4 teasp. dose to 
an adult every 2 or 3 hours, of high value when spasm predominates. [See 
page 306.] Potassium Bromide, serviceable in various reflex coughs (uterine, 
renal, etc.), and in cough of phthisis it is occasionally ameliorative as a gargle 
(B). Cubeb, 3ss-j of the tinct. in half-glass of Linseed tea thrice daily, often 
cures like a charm the coughs of chronic catarrh, of emphysema, or acute 
catarrh, or following an attack of influenza (R). Asafcetida, its value due to 
the sulphur in it (Garrod) ; very serviceable in after-cough from habit, and in 
mother's sympathetic whooping-cough (B). Carbolic Acid, as spray, a 5 per 
cent, solution in a steam atomizer will often prevent as well as cure a cough from 
cold. Valerian, in asthmatical and hysterical coughs (P). Chloroform, with 
Morphine and molasses in paroxysmal dry cough; may be painted on throat 
also (R) ; in irritable reflex cough, the vapor of a teaspoonful of the spirit may 
be inhaled from the surface of hot water, and repeated every five minutes for 
four or five times (B) ; the inhalation of small quantities of chloroform gives 
the greatest possible. relief in the irritable cough of phthisis (Spencer Wells). 
Chloral, in convulsive coughs, ameliorates symptoms after hypnotic effect 
(Wa). Camphor, equal parts of Camphor and Chloral triturated together are 
said to allay spasmodic cough when painted over larynx (B). Glycerite of 
Tannin, applied to throat when chronically inflamed and so producing cough ; 
often the case with children (R). Grindelia, used in cough of habit and spas- 
modic cough (B). Squill, in catarrhal cough, should not be employed until 
active inflammation has subsided (Wa) ; the syrup or vinegar of Squill is the 
best preparation for cough with tickling in the throat (P). Cod-liver Oil, in 



COXALGIA — CROUP, CATARRHAL. 



66 1 



chronic coughs (R). Lactucarium, the syrup as vehicle in cough-mixtures (B). 
Chamomile Oil, gtt. ij-viij, in coughs due to heightened reflex irritability, 
especially in hysterical women (P). Pix, Tar-water in winter cough, especially 
when paroxysmal (R) ; allays the cough of bronchitis and phthisis (P) ; the 
Plaster as rubefacient and counter-irritant in chronic coughs (Wa). The fre- 
quency and violence of nervous coughs may be controlled by a determined 
effort of the patient's will. [Compare Bronchitis, Pertussis, Phthisis.] 



Prescriptions for Cough Mixtures. 



R. Spiritus ^Etheris Nitrosi, j^ij. 

Vini Ipecac, ^ ss. 

Tinct. Opii Deodorat., . gj. 

Syrupi Tolutani, q. s. ad ^ij. 
M. Sig. — A teaspoonful twice or thrice 
daily. [Bozvditch.) 

&. Liq. Morph. Magendie, 

Spt. Limonis, . . . . aa gj. 

Syr. Ipecac, 

Spt. Lavand. Comp. , . aa giv. 

Syr. Scillae Comp., 

Syr. Tolutani, . . . . aa J|j. 

Syr. Pruni Virgin., q.s. ad % vj. 

M. Sig. — A teasp. as required. 

Each dose has of Morph. Sulph. gr. ^L. 



R . Codeinae, gr. v. 

Alcoholis, . . q. s. ad so\v. 
Potassii Cyanidi, . . . . gr. v. 

Syr. Scillae, • %'}• 

Aquae, . . . q. s. ad ^ iv. 
M. Sig. — A teasp. every 2 or 3 hours 
for irritable cough. [Potter.) 



R-. Mist. Glycyrrh. Co., . . |ij. 
Syr. Pruni Virginianae, 
Syr. Tolutani, . . . . aa3J. 
M. Sig. — Half teaspoonful 3 or 4 times 
daily for infants, teaspoonful doses at I to 
2 years, larger doses for older children. 



&. 


Tinct. Opii Deodorat., 








Vini Antimonii, . . . 


aa 3 ss. 






Ext. Valerianae Fl. , 








Syr. Simplicis, . . . 


aa 3ij. 






Aquae, 


• SJ 5S - 




M 


Sig. — A teaspoonful 


every hour 


or 


two 


until cough controlled. 


For those of 


4 


years and upwards. {Me 


igs &* Pepper 


•) 


K. 


Tinct. Sanguinarise, 






Tinct. Lobeliae, . . . 


aa 3Jss. 






Vini Ipecac , . . . . 


ziii. 






Tinct. Opii Camphorat 


"J* 

• > 






Syr. Scillae, . . . . 


aa ,^jss. 






Aquae Cinnamomi, . . 


ad%x). 





M. 

cough of bronchitis. 



the 

{Potter.) 



Coxalgia. 

Barium Chloride, in considerable doses (gr. j-ij) persevered in for a month, 
is thought to be most valuable in scrofulous diseases of the joints (Wa). Sul- 
phuric Acid, o] ad 3J Adipis, as ointment, persevered in, has resulted in great 
benefit ; a powerful irritant (Wa). Counter-irritation, by blisters around the 
hip, with perfect rest in the straight posture, Cod-liver Oil, etc. (D). Ferrous 
Iodide, in scrofulous disease of the joints, with Cod-liver Oil and nutritious 
diet (Wa). Iodoform, very successfully used by many continental practition- 
ers in scrofulous diseases of the joints (Wa). Cod-liver Oil, the remedy on 
which most reliance is to be placed (R). [Compare Abscess, Caries, Suppu- 
ration, Synovitis.] 



Croup, Catarrhal. 

Aconite, valuable (R) ; has been employed with the best results (P) ; gtt. % 
to j every half hour, until an impression is made on the fever movement, 
then every hour or two (B). Hot Water, applications beneath the chin and 
along the whole course of the larynx (Wa). Hot fomentations or turpentine 
stupe to throat (El) ; hot bath (95°-io2°) in the paroxysm, a good method 
(M & P). Potassium Bromide, locally, a solution by atomization, has proved 
highly efficient in spasmodic croup (Wa). Lobelia, has been used with occa-- 
sional success (P). Ipecacuanha, the syrup or fluid extract as an emetic at the 



662 



CROUP, MEMBRANOUS. 



outset (El) ; is a slower emetic than Tartar Emetic (P) ; the syrup to vomiting 
during the paroxysm, and tt\,v-x every 2 or 3 hours next day (M & P). [Com- 
pare Laryngismus Stridulus.] 



R. Potassii Citratis, . . . . 5jj. 

Syr. Ipecac, gij. 

Tr. Opii Deodorat., . . gtt. xij. 

Syr. Siraplicis, . . . . ^ij. 

Aqua, ^jss. 

M. Sig. — Teaspoonful every two hours 
at 2 years of age. In severe form of spas- 
modic laryngitis. (M. <$r» P.) 



B.. Tinct. Belladon., . . . gtt. iv. 

Tinct. Opii Camph., . . gtt. 1. 

Pulv. Aluminis, . . . . gr. vj. 

Syr. Acacise, f ss. 

Aquae, . . ... 3Jss. 

M. Sig. — Teaspoonful every 2 or 3 
hours at 6 months old when cough fre- 
quent and harassing. (M. &* P.) 



Croup, Membranous — Laryngeal Diphtheria. 

Mercury, a remedy of established value, gr. ss-j of Calomel, with gr. yi-%. 
of Ipecac, according to age every 2 hours, with local and other general meas- 
ures, especially the use of a hot (7o°-75°) and moist atmosphere (Wa) ; the 
Sub-sulphate, given early, is the best emetic, gr. iij-v ; Calomel is strongly 
urged as a laryngeal sedative and aplastic agent, allaying laryngeal spasm and 
preventing formation of membrane (B). Alum, one of the best emetics in this 
disease, a teasp. in honey or syrup, repeated every ten or fifteen minutes until 
it operates (M & P) ; a very useful and non-depressant emetic (B). Sanguinaria, 
by many considered specific, is undoubtedly the best emetic for this disease 
(P) ; is too harsh and too uncertain in action (B). Tartar Emetic, as an 
emetic, has established value in croup (W) ; is injurious, too depressant (B). 
Potassium Chlorate, as alkali, after emetics, the most reliable internal remedy, 
gr. ij-iij every 2 hours to a child of 4 years (M & P). Ferric Chloride, may be 
combined with the preceding, in doses of 3-5 drops of the tincture at the 
same age (M & P). Emetics, besides the above, are : Copper Sulphate, in 
small frequent doses (R) ; Ipecacuanha, inferior to Mercury (B) ; in severe 
cases vomiting should be caused 2 or 3 times a day, and should be commenced 
early (R) ; Apomorphine, effective, but highly dangerous (B). Senega, is con- 
sidered a valuable auxiliary (P) ; has been employed (R). Quinine, in full doses 
is highly useful (B). Sulphurous Acid, as spray, hourly or more frequently 
(R). Tannin, a 5 per cent, spray, several times a day for 15 or 20 minutes 
at a time (R). Hydrogen Dioxide, the solution, 1 in 4 of water, copiously 
sprayed over the nose, throat, mouth, etc., to destroy the membranes and pre- 
vent their reproduction ; then Glycozone, a teasp. in a winegl. of water thrice 
daily internally, prevents any disturbance of the stomach and regulates the 
bowels (Edson). Lactic Acid, as solvent of membrane (B). Iodine, the tinc- 
ture externally, affords great relief and tends to prevent formation of false 
membrane (Wa). Water, warm bath, hot fomentations or compresses to the 
throat ; watery vapor in room. Steam inhalations, with a few drops of Iodine 
or Bromine. Diet, water only in small quantities during attack; supporting 
diet may be required afterward. Lime-water, by vaporization, or inhalations 
of the vapor of slaking lime for a few minutes in every hour, or some other 
alkaline solution during the whole treatment (M & P). Tracheotomy, fully 
justifiable, 21 1 / 2 per cent, recovered out of 1024 operations; should be done 
when paroxysms become very frequent, and dyspnea is rather persistent than 
paroxysmal (M & P). [Compare Laryngitis, Diphtheria.] 



R. Pulv. San guinarise, 
Pulv. Ipecac, . 
Syr. Ipecac, if ij. 



M. Sig. — A teasp. every 



hour until 



emesis, then ^ teasp. every hour. [P. 



R: . Acidi Lactici, ^iijss. 

Aq. Destillat., . . . . J x. 
M. Sig. — To be used as a spray, or ap- 
plied by a mop. 

[London Throat Hospital.} 



CYANOSIS CYSTITIS. 663 



Cyanosis. 

Amyl Nitrite, by inhalation, often gives marked relief (P). Quebracho, in 
that from asthmatic attacks of consumptives, lessened the cyanosis or entirely 
relieved it (Rohrer). Oxygen, by inhalation in the cyanosis of asphyxia from 
toxic gases or due to opium and chloroform narcosis. Leeching is of service, 
in a manner not easily understood (P). Treatment must depend on the natuie 
of the lesion or disease giving rise to the cyanotic condition (A). [Compare 
Asphyxia, Asthma, Dyspnea, Heart Affections.] 

Cystitis, Acute. 

Belladonna, is a good remedy in almost every form of vesical irritation (G) ; 
when the vesical mucous membrane is irritable (B) ; very useful in recent 
catarrh from chill, with pain (P). Cantharis, in large doses causes inflamma- 
tion of the urinary tract, but gtt. j of the tincture every hour will often relieve 
vesical catarrh (Smith) ; in small doses continued very efficient (B) ; gtt. j-v 
of the tincture thrice daily, when bladder is irritable, its sphincter weak, and 
pain along the urethra (P) ; may be employed in cystitis with benefit (R) ; in 
small doses the best remedy for acute cystitis. Aconite, for febrile symptoms 
(P). Quinine, often useful for acute symptoms (B). Iodoform, in suppository 
for painful cystitis (R). Opium, a rectal injection of Starch and Laudanum 
will subdue pain and prevent the frequent micturition (R) ; dangerous if the 
kidneys are diseased (P). Alkalies, the Citrates and Bicarbonates if urine is 
highly acid; stop when it becomes alkaline (R) ; Liquor Potassae in barley- 
water or in a decoction of Triticum repens, preferred to all other alkalies; urine 
must be maintained at a neutral or very slightly acid reaction (Thompson). 
Cannabis Indica, an excellent anodyne in all bladder cases, having specific 
effect on that organ. Rest in horizontal posture, mucilaginous drinks, hot 
fomentations and hip-baths, laxatives for the bowels, light food. Milk-diet often 
necessary, especially in children. | Compare Bladder Irritable, Calculus, 
Dysuria, Enuresis, Hematuria.] 

R . Atropine Sulphatis, . . gr. j. R. Pulv. Opii, gr. xij. 

Acidi Acetici, .... gtt. xx. Camphorce, gr. xxx. 

Alcoholis, Ext. Belladonnas, . . . gr. iij. 

Aquae, . . . . . . aa^ss. 01. Theobrom., . . . . q. s. 

M. Sig. — Four drops in a winegl. of INI. et div. in supposit. no. vj. 

water before each meal. (£.) Sig. — One to be used at bed-time. 

Cystitis, Chronic. 

Benzoic Acid, and the Benzoates, in chronic cystitis from any cause, when 
urine is alkaline (B) ; has some balsamic character, and is useful in some cases 
of chronic cystitis ; gr. xxiv in the day at least, in pills made with Glycerin 
(Thompson). Sodii Benzoas, £j in Tinct. Gelsemii 3ij-hj, and water to gvj, 
makes an excellent wash for painful cystitis of old men with enlarged prostate ; 
a fluidounce should be warmed and injected and retained 20 to 30 minutes 
(Copeland). Alkalies, when urine is acid; the Liquor Potassae, with Hyoscya- 
mus as an anodyne, preferred notwithstanding its chemical incompatibility, to 
control painful and frequent micturition (Thompson) ; Bicarbonates or Citrates 
better, as the strong reaction of liq. potassae unfits it to be given in doses suffi- 
ciently large to affect in any great degree the reaction of the urine (R). 
Triticum, is very efficient as an internal remedy, ^ij-iv of the rhizome boiled 
in a quart of water until reduced to a pint, this strained to be taken in four doses 
in the 24 hours (Thompson) ; a very useful remedy (Pancoast). Buchu, is 
probably the most efficient of the urino-genital remedies, the fluid extract in 
doses of "n\,x-3j (B); the best drug in chronic cystitis, especially when the- 



66 4 



CYSTITIS, CHRONIC. 



catarrh implicates the ureters or the kidneys themselves, producing consider- 
able muco-purulent discharge (P). Uva Ursi, is decidedly effective (P) ; is less 
so than Buchu (B). Stigmata Maydis, an infusion, ^ij to the pint, a wine- 
glassful every 3 or 4 hours, has been used internally with considerable success 
(Dessein). Pareira, considered superior to Uva Ursi (Brodie) ; often very suc- 
cessful (P). Chirnaphila, is often very efficient, but is more actively diuretic 
than the above-named remedies (B) ; by many practitioners it is considered 
the best remedy for chronic cystitis. Copaiba, is very useful by virtue of its 
local action on the mucous membrane, but objectionable for its nauseous taste 
and resulting gastric disturbance (B). Cubeb, is often useful from its stimu- 
lating effect (P). Turpentine, has been useful in many cases (R) ; when cys- 
titis is due to urethral inflammation or prostatic disease (B). Juniper, the oil 
is indicated under the same conditions as is Turpentine (B). Eucalyptus, there 
is no more efficient remedy in chronic cystitis than this (B) ; the oxygenated oil 
of Merck is best, in doses of 3 drops on sugar every 6 or 8 hours. Myrtol, has 
been used with excellent results in the Paris Hospital. Salicylic Acid, in large 
doses, either internally or by injection into the bladder, is most efficient (B) ; 
the acid or Salicylates often useful to prevent decomposition (P). Salol, proves 
an efficient disinfectant, as its constituents are excreted with the urine ; solu- 
tions of 5 to 10 per cent, in Retinol gave gratifying results in subacute cases 
of obstinate character, where other agents were of no avail; this solution 
remains in the bladder, in diminishing quantity of course, after 6 or 8 urina- 
tions (Desnos). Camphoric Acid, in ^ to 3 per cent, solution in hot water, as 
injection, has cured several cases. Carbolic Acid and Sulpho-carbolates, to 
preserve the urine sweet (R). Sulphites will accomplish the same object (B). 
Silver Nitrate, by intra-vesical injection, gr. j in ^iv to begin with, increased 
gradually to gr. ^/ to the ^ at most (Thompson) ; stronger solutions are advo- 
cated by Professor Richardson of New Orleans, and Professor Gardiner of 
McGill College, Montreal ; in the writer's experience a solution of gr. v to the 
^ used as a vesical wash, has been promptly efficient in curing many cases 
which resisted other treatment for months, — it sometimes produces serious 
symptoms, and it is therefore well to have a neutralizing solution of Sodium 
Chloride on hand for use if required. Other Injections, which may be used to 
wash out the bladder are — Lead Acetate, gr. j to 3iv of warm water, once 
daily ; Nitric Acid, dilute, rt\j — ij to £j of water ; Tannic Acid, gr. j to ^j ; 
Borax, ^j in ^ij of glycerin and ^ij of water, of which ^ss in %W of warm 
water for one injection ; Quinine, gr. j-ij to ^j of water, with a drop of 
Acetic Acid. All injections must be used with great care, not more than ^ij 
forced in at once and that very slowly ; use flexible catheter, warm solutions, 
and a rubber injecting-bottle with a long nozzle and stop-cock (Thompson) ; 
washing the bladder is of great value (R). Evacuation of the urine, some of 
which is often retained in the bladder, is a matter of great importance. Ergotin, 
hypodermically, increases the contractile power of the bladder, and enables 
it to empty itself more perfectly (Langenbeck). Pichi, the fluid extract, rr\,xx 
to xxx four times daily, gave excellent results in bad cases of long standing, 
urine being alkaline, 'ammoniacal, ropy and purulent (Delamere). [Compare 
Bladder Irritable, Calculus, Dysuria, Enuresis, Hematuria.] 

$ . Quininae Sulphatis, . . . gss. 

Acaciae, gij. 

Morphinae Sulphatis, . . gr. jss. 

Aquae, . . . . q. s. ad ^iij. 
M. Sig. — A tablesp. to 2>% ounces of 
warm water, which inject in 3 parts, daily. 



R . Uvae Ursi Fol. , 

Pareirae Radicis, . . aa ^j-ij. 
Sig. — Boil in 3 pints of water until re- 
duced to a quart, then strain, and take I or 
2 wineglassfuls 3 or 4 times daily. 

( Thompson.) 



R 



Ext. Tritici Repentis Fluidi, 
Syr. Amygdalae, . . aa !§ij. 
M. Sig. — A dessertsp. in water 5 or 
times daily. (Pancoast.) 



R 



%)■ 



Sodii Boratis, . . . 
Glycerini, 

Aquae, aa ^ij. 

M. Sig. — Tablesp. in four ounces of 
warm water as an injection. 



CYSTS DEAFNESS DELIRIUM.' 66K 



& . Argenti Nitratis, . . . . gr. vij. 
Aquae Destillat., .... ^iijss. 
M. Sig. — Injection every third or 
fourth day after washing the bladder out 
with warm water. (Ricord.) 



ft. 01. Terebinth., . . : . ^ss. 

Camphorae, gr. xv. 

Extr. Hyoscyami, . . . gr. ss. 
Fiat massa. Sig. — Take a piece the size 
of a cherry-stone morning and evening. 
(Chauvel.) 



Cysts. 

Iodine, by injection very effective in cysts of the neck, and sometimes in 
unilocular ovarian cysts (B) ; after tapping (R). Silver Nitrate, gtt. v-x of a 
strong solution (gr. xx ad 5>ij), as injection into cystic tumors (wens), after 
allowing the contents to escape, will cure by setting up adhesive inflammation 
(B). Galvano -puncture will permanently occlude cysts of the neck (B). Aurum 
Chloride, may sometimes cure ovarian dropsy (B). Remedies, internally, have 
all proved worthless (E). [Compare Ovaritis.] 



Deafness. 

Quinine, cures some forms, and often causes deafness (Brown-Sequard). 
Glycerin, for dryness of meatus ; also to form a film to ruptured tympanum 
(R) ; either alone or in combination with Olive Oil (P) ; effects are temporary 
(Wa). Tannin, the glycerite as application for throat deafness (R). Gelse- 
mium, the tincture, n^xv-xx, repeated 2 or 3 times a day, is often useful in the 
treatment of nervous deafness, and seems to have an influence on the organ 
of hearing similar to that of Nux Vomica on the organ of sight. Colchicum, 
when from gout in ear (A). Cantharides, as ointment; gr. xxx ad ^j Adipis, 
below and behind the ear bis die, with alterative mercurial treatment, in deaf- 
ness from thickened tympanum (Wa). Collodion, contractile, applied to the 
membrana tympani, in deafness from relaxation of the membrane, has exerted 
a permanently beneficial influence, even in cases of long standing (Wa). 
Turpentine, gtt. xl in ^ss Glycerin, a few drops into the meatus in deafness 
depending on deficient secretion of cerumen, results in much benefit (Wa). 
Morphine, gr. ss, sprinkled on surface behind the ear denuded by a small blis- 
ter, has proved curative in chronic deafness, after all other remedies had failed 
(Wa). Gargles, in throat-deafness are of great value; of Potassium Nitrate, 
Borax, etc., in sthenic cases ; tincture of Capsicum added in nervous forms ; 
of Hydrargyrum Bichloride when from secondary syphilis (Wa). Water, 
washing in warm water, in deafness from general debility (Toynbee). Faradi- 
zation of the ear in nervous deafness, in which slight results only to be expected 
from the treatment (R) ; demands the utmost caution (Wa). inflation, by the 
Politzer bag, or Eustachian catheter, in throat deafness. Remove wax from the 
external canal. 

Delirium. 

Belladonna, in delirium of typhus and other fevers (R) ; in severe forms of 
delirium (P). Hyoscyamus, in delirium of typhus; for the mild, less inflamma- 
tory form, with hallucinations, nervous excitement, little cerebral congestion 
(P). Stramonium, in wild and furious delirium of puerperal mania, with gen- 
eral restlessness and suicidal or destructive tendency (Wa) ; no drug deserv- 
ing of more confidence in the greater number of maniacal cases (Cullen). 
Opium, in traumatic delirium, as a rectal injection, combined with Tartar 
Emetic in fevers ; or better still Morphine hypodermically ; Laudanum in low, 
muttering delirium (R) ; is regarded with suspicion (P). Cannabis Indica, the 
extract in doses of gr. Y~Y in nocturnal delirium occurring in softening of the 
brain (Wa). Potassium Bromide, in delirium resembling delirium tremens 
(R). Camphor Monobromide, useful in rambling delirium (Wa). Camphor, in 



666 DELIRIUM TREMENS. 

20-grain doses, every 2 or 3 hours, especially in low, muttering delirium (R). 
Chloral, in violent delirium of fevers (R). Antimony, in delirium of fevers (R). 
[See Fever.] Water, the cold douche in maniacal delirium ; place patient 
in warm bath during application (R). [Compare Cerebral Congestion, 
Fever, Mania.] 



Delirium Tremens. 

Chloral, at outset (R) ; very successful, but dangerous to old drunkards or 
when heart disease exists (B); the experience of inebriate asylum physicians 
does not bear out the teaching that chloral is dangerous to old alcoholic 
cases, being by them commonly given in 30-grain doses every 3 or 4 hours 
until sleep is induced, without apparent danger. Belladonna, of proven effi- 
cacy when congestion of the brain (P) ; useful for the insomnia when coma 
vigil, cold surface, cyanosis (B). Stramonium can do all that Belladonna can 
do, and is more powerful (Tr). Hyoscyamus, in some forms admirable (P). 
Hyoscine, is a useful drug in delirium tremens, and in other affections in which 
tremor is a marked symptom (Weatherly). Duboisine, is even more sedative 
and hypnotic than Hyoscine. Opium, cautiously, if at all (B) ; as rectal injection, 
hypodermically or with spirits; if patient strong, delirium boisterous, and pulse 
full, add Tartar Emetic or Aconite (R). Bromides in the " horrors " preceding 
the delirium, 3j every 4 to 6 hours ; are of less value in the delirium, and in 
subsequent attacks (R) ; Ammonium Bromide has been used with very good 
results (Wa). Chloroform, inhalations to procure sleep (R) ; anesthetics are 
dangerous (B). Cannabis Indica, gr. ss-j of extract, one of the least dangerous 
and most useful hypnotics (P). Tartar Emetic, as hypnotic (B) ; combined 
with Opium to control mania and insomnia (R). Capsicum, to induce sleep in 
early stages, gr. xx-xxx in a bolus with honey, repeated after three hours (R) ; 
in 20-30 gr. doses has remarkable success (P) ; the tincture in gss doses every 
three hours of great benefit (Wa). Nux Vomica, or Strychnine, should be 
more freely used than it is in alcoholism, and in delirium tremens may be 
used hypodermically almost to the commencement of tetanic action (Luton). 
Arnica, the tincture is exceptionally serviceable in cases where there is depres- 
sion (B). Coffee, often exceedingly useful (P). Digitalis, gss of tincture re- 
peated in 4 to 6 hours (R) ; a tablesp. of the infusion every 4 hours in pale 
subjects, where anemia of brain, with effusion and edema (B) ; has cured 
many cases promptly without producing any unfavorable symptoms ; its safety 
and efficacy are alike questionable (Wa). Cimicifuga, an excellent tonic for 
the nervous system, is very successful (P). Quinine, with a mineral acid to 
restore digestion, in the " horrors," and in adynamic states (B) ; gr. j two or 
three times daily as a tonic, the best agent to produce nervous tranquillity 
(Anstie). Sumbul, very efficient for insomnia (P). Zinc Phosphide, gr. jss 
daily, in divided doses, for many weeks, is used with decided benefit. Zinc 
Oxide, is of essential benefit as a nerve tonic and sedative, gr. ij-viij, twice 
daily, gradually increased to the higher dose named (Wa). Lupulin, the tinc- 
ture or oleo-resin, useful in mild cases as stomachic tonic and cerebral sedative 
(B). Ammonium Carbonate, when anemia of brain and feeble heart-action 
(B). Conium, combined with Opium, is useful (P). Alcohol, of undoubted use 
where failure of stomach to appropriate food (B) ; is best omitted entirely from 
the treatment, the experience in inebriate asylums showing that cases recover 
more rapidly and surely without alcohol. Water, about 6o° with ice to head, to 
reduce temperature in the hyperpyrexia (R). Treatment, should tend to nour- 
ishment and establishing of digestion ; concentrated liquid food with moderate 
use of stimulants (H). Diet and Hygiene, the immediate source of danger is 
exhaustion, hence animalized and nutritious, digestible diet should be used in 
fluid form, small quantities frequently repeated ; beef-tea, soups, yolk of eggs, 
warm milk, cocoa, cayenne pepper or stimulants in soups; coffee, to still ner- 
vous excitement ; hot baths and wet pack to eliminate the poison ; a quiet, 



DEMENTIA PARALYTICA DENGUE — DENTITION. 



667 



dark room ; sleep a necessity, often induced by Belladonna. [Compare Alco- 
holism ; also page 138, for Treatment of Delirium Tremens.] 



R . Tinct. Capsici, 

Ext. LupuliniFL, . . aa.^j. 

Mucil. Acacise, . . . . Jss. 

Aquae Cinnamomi, . . 3Jss. 
M. Sig. — Dessertsp. as required for the 
wakefulness and excitement which pre- 
cede an attack of delirium tremens. 



R . Chloralis Hydratis, . . ^vj. 
Ext. Conii FL, . . . . spij. 
Ext. Hyoscyami Fl., . . giv. 
Mucil. Acacise, . . . . ^ij. 
Aquae Menth. Virid. , ad ^ ij. 
M. Sig. — Teaspoonful in water 



after 



each meal, to prevent delirium tremens. 



Dementia Paralytica. 

Physostigma, has seemed to retard the progress of the disease in some few 
cases (B). Paraldehyde, in one or two drachm doses as a calmative and hyp- 
notic, is as efficient as Chloral and without danger (B). Tonics, may be used, 
though treatment is only palliative ; Calcium Lacto-Phosphate, Cod-liver Oil, 
etc. ; no remedies have hitherto been of any avail (B). 



Dengue. 

Emetics and Purgatives are indicated at the outset, also free diaphoresis. 
Quinine, in five-grain doses every four or five hours for the fever (Da C) ; 
should be given more for its tonic than for its antiperiodic effect (Fayrer). 
Opium, in some form for the pains and nocturnal restlessness. Salicylic Acid 
or Salicylates, for the pains in joints and muscles. Carbolic Acid, as lotion, a 
4 per cent, solution for the itching, or Camphorated Oil. Belladonna, confers 
great relief, rtix-xv of the tincture may be given every hour for two or three 
doses (Fayrer). Aconite, with salines and Nitrous Ether, during the pyrexia, 
which may be so high that cold sponging or the cold bath may be required. 
Bitter Tonics, as Gentian or Calumba, with Quinine and a mineral acid or 
Strychnine during convalescence. Treatment, is entirely symptomatic. 



Dentition. 

Belladonna, in convulsions of dentition, rarely fails to relieve (P). Hyoscy- 
amus, to alleviate pain and subdue irritation ; better than Opium for children 
(P). Chamomilla, rr\j of the tincture every ^ hour, an excellent sedative for 
children (A.A.Smith). Potassium Bromide, for irritability and convulsions in 
teething (R). Dulcamara, the infusion, in the diarrhea of dentition, quickly 
checks symptoms ( P). Calumba, excellent for the accompanying vomiting and 
diarrhea (P). Hypophosphites, of Calcium or Sodium, as a general tonic, are 
highly recommended (R). Rhubarb, with Soda, internally for the aphthae, 
with perfect cleanliness of the mouth and a wash of Borax or Potassium Chlo- 
rate in Glycerin, gr. x to the £ (E. Smith). Castor Oil, for the diarrhea of den- 
tition to clear out the bowels, then a mixture of Chalk and Catechu, or Zinc 
Oxide gr. j to the dose, with gtt. j of Laudanum if required to reduce peristalsis 
(Id). Lancing the Gums to relieve tension when gum is actually swollen ; 
should not be indulged in indiscriminately. 



R . Potassii Bromidi, . . . ^j. 

Olei Anisi, mjj. 

Mucil. Acaciae, 
Aq. Menth. Pip., . . aa gj. 
M. Sig. — Teasp. every half-hour until 



the child is relieved, 



(B. 



R. Sodii Bromidi, Sodii Bicarb., 

Chloralis, aa gr. xx. 

Aq. Menth. Viridis, . . Sjss. 
Syr. Zingiberis, . . . . 3 ss. 
M. Sig. — Half-teasp. to a dessertsp. 

according to age. 



668 



DHOBIE ITCH DIABETES INSIPIDUS. 



Dhobie Itch. 

Chrysarobin, gr. xx to the ^ of vaselin, rubbed in twice daily, is almost inva- 
riably successful ; stains the clothing, must not be applied to the face, and 
should be stopped when it causes an erythematous ring at the edge of the dis- 
eased patch (Mn). Silver Nitrate, a 4 per cent, solution in alcohol, painted 
over the surface daily, has given satisfaction in many cases. Salicylic Acid, 
in collodion, has many advocates [see formula below]. Calcium Sulphide, as 
in Vleminck 's Solution [see formula below], applied every night for 3 or 4 times, 
after a thorough use of soap and water, generally brings about a rapid cure 
(Mn). Cassia Alata, a tincture of the leaves painted on, or the crushed leaves 
themselves well rubbed in, are successful (Id). Iodine, the liniment freely 
applied and of double strength, is the best remedy for the ringworms of the 
thick-skinned natives (Id). Zinc Oxide, with Boric Acid and Starch, equal 
parts of each, as a dusting powder to the crutch and axillae after the daily 
bath, to prevent infection of the skin (Id). Dhobie Itch is a term used in the 
far East for any itching, ringworm-like affection of any part of the skin, but 
most commonly refers to some form of epiphytic disease of the crutch or 
axilla. The chief parasites attacking these localities are — (1) the trichophytons 
or ordinary body ringworms, (2) microsporon mimitissiinum of erythrasma, and 
(3) the diplococcus of pemphigus contagiosus (Mn). 

R. Quick-lime, ^j. 

Precipitated Sulphur, . ;fij. 

Water, ^ xv. 

Boil in an earthenware vessel until re- 
duced to ^x; after subsidence decant the 
sherry-colored fluid. 

( Vleminck' 's Solution. ) 



R-. Ac. Salicylici, . 
Chrysarobini, . . 
Traumaticini, 




. gr. xx. 
. gr. xxx. 


M. Sig. — Apply as 
affected area. 


a 


paint to the 
(Morrow.) 


R . Tinct. Iodi, 






Ichthyoli, . . . . 
M. Sig.— For local 


use 


aa partes seq. 



Diabetes Insipidus. 

Opium, large doses necessary, gr. vj-xij a day (B) ; combined with Gallic 
Acid, the most generally useful remedy ( W). Ergot has cured many cases, 
the fluid extract in doses of 3ss-j thrice daily (Da C) ; one of the most efficient 
remedies (B) ; is the most useful remedy (R) ; but if used in large doses or 
long continued symptoms of ergotism appear and the drug has to be stopped 
(Ralfe). Nitroglycerin, has been employed with good results (Id). Arsenic, im- 
proves the general condition and given with other special remedies it greatly 
increases their power (Id). Iron and Strychnine are very useful for tonic' 
effects (Da C). Valerian, in large, increasing doses (R) ; restrains the flow of 
urine but does not cure (B). Sodium Salicylate, in small doses, very effective 
in some cases. Muscarine has been used with apparent success (R). Potas- 
sium Iodide is curative in many cases of syphilitic origin (B). Alum has pro- 
duced good results (B). Jaborandi, is used successfully to reduce the quantity 
of urine (B). Krameria lessens the quantity of urine (P). Galvanism, the 
constant current over the upper part of the spinal cord ; or one pole to the loin 
and the other to the hypochondrium on the same side for a few minutes, then 
on the opposite side ; or the anode to the nape of the neck and the cathode 
first to the loins and then to the epigastrium (Kiilz). Diet, a dry diet beneficial 
(B), but is very difficult to carry out. 



Diabetes Mellitus. 

Phosphoric Acid, largely diluted, assuages the inordinate thirst ; in one case 
it seemed to act as a curative agent (Wa). Arsenic, when from faulty assimi- 



DIABETES MELLITUS. 669 

lation, in diabetes oi hepatic origin, and in thin subjects (B) ; the Bromide is 
credited with several cures [see Aurum below] : the Lithiated Arsenical Water 
was used in 70 cases, with cure of 96 per cent. (Martineau) ; [see i?ifra for 
formula.] Morphine, is very efficient in reducing sugar when used by mouth, 
but is of no value when employed subcutaneously, even in the same case 
(Bruce). Opium in large doses, gr. vj-xij a day, ameliorative. Codeine, is 
especially serviceable (B) ; abates thirst and controls appetite (R) ; its value 
much disputed (P) ; is of great value in many cases (W) ; is one of the best 
remedies in doses of gr. %-% (Da C). Jambul, has given favorable results 
after abandoning all the usual remedies (Lawrence) ; in 2 severe cases, in 
which 7 and 3 per cent, of glucose were excreted, the urine was brought back 
to normal by preparations of the bark, and kept so for two years (Vix) ; should 
be given after meals, in water or wine sweetened with Saccharin. Sodium 
Salicylate has cured when all other drugs have failed (R) ; gr. x-xv in com- 
pound spirit of Lavender and water, thrice daily, is my favorite remedy (Da C). 
Ergot, is one of the useful drugs (Da C) ; decreases the quantity of sugar and 
the volume of urine. Potassium Bromide, gr. xx ter die, cured two cases in six 
weeks (Begbie) ; useless (Da C). Krameria lessens the quantity of urine (P). 
Phosphates, to avert failure of nutrition (B). Aurum, the Chloride is one of the 
promising remedies (B) ; the Bromide of Gold and Arsenic caused so much im- 
provement in one case that he was accepted as a good risk by one of the fore- 
most life insurance companies (E. A. Wood). Iodoform, in doses of gr. j-ij, 
rapidly reduced the sugar and caused its disappearance in 4 or 5 days in five 
cases, without any change in diet being made (Moleschott) ; the amount of testi- 
mony for its value in this disease is quite considerable (B). Iodol, can be ad- 
vantageously substituted for Iodoform in all the diseases to which the latter is 
applicable (B). Uranium Nitrate, gr. i-iij, thrice daily has caused decided im- 
provement in several cases (Hughes). Aloin, for the accompanying constipa- 
tion (Da C). Nux Vomica, or Strychnine, is generally beneficial. Calcium 
Lactophosphate benefits the thin, nervous type of diabetic remarkably (B). 
Antipyrin, affects secretion, and has been used with benefit. Methylene Blue, 
has given satisfaction in two cases (Estay). Orchitic and Adrenal Extracts 
have been given with reported success. Alkalies are used on theoretical 
grounds, but have not produced much benefit ; one case apparently cured by 
the diligent use of Ammonium Carbonate (B) ; are serviceable (Da C) ; alka- 
line mineral waters for diabetes of hepatic origin and in obese subjects, are 
extremely useful (B). Alkaline Waters, when of hepatic origin and in obese 
subjects; tepid drinks for the intense thirst (B). Salines, a warm solution of 
the Phosphate and Chloride of Sodium, by intravenous injection in diabetic 
coma, produced astonishing results in one case (B). Oxygen as oxygenated 
water, instead of carbonated water, has been successfully used (Le Blond). 
Glycerin has produced good results (B) ; used in place of sugar (\Y). Diet and 
Hygiene are of the utmost importance; avoid amylaceous food and everything 
containing sugar, especially ordinary bread ; use fresh, nutritious animal food, 
with bread of bran or almonds; warm baths, warm climate, flannel under- 
clothing. Professor Lupo of Naples maintains that some cases may be cured 
by an exclusive vegetable diet, including all sorts of vegetables, and gives two 
cases in which this treatment proved successful. Professor Saundby permits 
the ingestion of the maximum amount of carbohydrates which the patient can 
assimilate. Peanuts, are an excellent article of food for diabetics, being rich 
in albumin, of which they contain 47 per cent., together with 19 per cent. 
of fat and non-nitrogenous extractive matters- (Furbringer). Milk-cure, by 
skimmed milk, very successful, 6 to 10 pints daily; give no other food for six 
weeks, then animal food; — Caution! the urine of patients taking Salicylic 
Acid gives the reaction of sugar with Trommer's test (R). Saccharin, as a sub- 
stitute for sugar, does well for sweetening purposes, but is not a nutrient and has 
no influence on the disease. Dulcin, is sweeter than saccharin, and is harm- 
less in reasonable doses, up to 24 grains in the day (Kobert). Levulose, is a 
saccharine food which can be taken freely and without any injury by diabetic 



670 



DIARRHEA. 



patients; it most nearly approaches the ideal carbohydrate food indicated in 
diabetes (Hebra) ; it is assimilated well and nearly all oxidized by diabetics, 
who are able to partake freely of it in comparatively large quantity (Ebstein) ; 
sugar and sugar-forming food constitute more than half the nourishment needed 
by a healthy person, and it is the imperative duty of the physician to furnish 
a diabetic with a moderate amount thereof, to prevent death from inanition, 
and to lessen the danger of diabetic coma which is induced by a diet of meat 
alone (Leyden) ; Levulose, formerly very high in price, is now sold at a reason- 
able rate under the name Diabeti7i. 



& . Liq. Potassii Arsenitis, . gjss. 
Tinct. Opii Deodorati, . 3 v. 
Syrupi Zingiberis, , . . t ^j. 
Aquae Cinnamomi, . ad %iv. 
M. Sig. — Teasp. thrice daily. 



vnj. 



M 

dose 



Codeinae, , 

Alcoholis, q. s. ad solv. 

Sy ru pi> |y- 

Aquae, . . . q.s. ad ^iv. 

Sig. — A teasp. thrice daily, the 
to be gradually increased up to a 



tablesp. (Pavy.) 



R . Lithii Carbonatis, . -. . gr. xl. 

Sodii Arsenatis, . . . . gr. j. 

Ext. Gentianae, . . . . gr. xx. 
Ft. pil. r,o. xxv. Sig. — One night and 
morning until sugar disappears. ( Vigier. ) 



R. Sodii Arsenatis, . . . . gr. iij. 

Aquae, Oj. 

A tablesp. of this with Lithii Carbonat. 
gr. iij, into a quart siphon filled with car- 
bonated water, which is to be taken freely, 
as daily beverage. (Martiueau.) 



Diarrhea. 

Mercury, in diarrhea of children with bad digestion, flatulent distention and 
clay-colored, pasty, stinking motions, gr. j of the Bichloride to 3 viij of water 
in doses of 3j every hour ; or still better Hydrarg. cum Creta, gr. y z every hour 
or two, will restore the natural bilious color and limit the number of the stools (R); 
Calomel in minute doses, gr. -^ to ^ every half hour, is useful in the diarrhea 
and dysentery (ileo-colitis) of children, when there is much irritability of the 
stomach (B) ; in the acute or chronic diarrhea of children, characterized by 
slimy stools mixed with blood and accompanied by pain and straining, gr. j of 
the Bichloride to ^x of water, in doses of 3j\ is very efficient, curing with re- 
markable speed and certainty (R) ; in mucous diarrhea, gr. j of the Bichloride 
to a quart of water, in doses of Z] every hour (A. A. Smith). Antipyrin, in 
doses of gr. l / 2 to 1 x / 2 , has rendered signal service in the diarrhea of infants and 
children. Aconite, in diarrhea from chill, with high fever and cutting pains in 
the abdomen (P). Camphor, in summer diarrhea and the preliminary diar- 
rhea of Asiatic cholera (B) ; when from effluvia of drains or exposure to cold 
(R) ; useful in many forms (P). Opium, is commonly used, but is best when 
evacuations are very watery, combined with mineral Acids or with Lead Acetate 
(B) ; with Starch as an injection in severe cases (R). Codeine, gr. ss-j answers 
most satisfactorily in the milder forms of diarrhea and leaves no unpleasant 
after-effects (Braithwaite). Ipecacuanha, in summer diarrhea and dysentery 
of children with greenish stools (B) ; hourly drop-doses of the wine, especially 
if vomiting (R) ; when from nervous irritation, especially in young children 
(P) Dulcamara, in diarrhea of children from damp or with dentition (P). 
Pulsatilla, dyspeptic diarrhea, mucous discharges, active piles (P). Quinine, 
in periodic diarrhea, with dysentery and jaundice (B). Veratrum Album, in 
the vomiting and purging of summer diarrhea (R). Podophyllum, in chronic, 
with high-colored motions and cutting pains, also in morning diarrhea (R) ; 
gr. ^ to j^q, with occasional doses of Aconite, for vomiting and diarrhea of 
gastro-enteritis and prolapse of rectum (P). Chamomile, an infusion in sum- 
mer diarrhea of adults, or in that of dentition (R) ; the Oil in diarrhea of chil- 
dren, especially from worms (P). Arsenic, for evacuation of undigested food 



DIARRHEA. 6/1 

(B) ; gtt. j of Liq. Arsenicalis before meals when diarrhea excited by food ; also 
in chronic and membranous forms (R). Nux Vomica, a very useful adjunct 
to other remedies (B) ; often of much service in epidemic diarrhea (P). Sul- 
phuric Acid, in summer and choleraic diarrhea ; small doses in the chronic 
form and in the straining diarrhea of children (R). Peptenzyme, is excellent 
in cholera infantum and the summer diarrhea of children. Balsam of Peru, 
is excellent in diarrhea, with or without tenesmus (Tr). Kola, is useful in 
atonic diarrhea. Zinc Salts, are very efficient in the summer diarrhea of 
children (B). Haematoxylon, is devoid of irritating qualities and is well adapted 
to the diarrheas of young children. Calumba, in diarrhea due to relaxation 
of the mucous membrane and not dependent on inflammation (B). Catechu, 
in atonic diarrhea and in that following withdrawal of morphine or opium from 
habitues, also in the diarrhea of children ; in the latter the tincture with Chalk- 
mixture is very serviceable. Kino, in atonic diarrhea ; the tincture in doses of 
3j for the diarrhea resulting from the disuse of opium or morphine. Coto, the 
fluid extract, or Cotoin, is one of the new remedies for atonic diarrhea. Tan- 
nic Acid, is very useful in profuse and chronic diarrhea (B) ; with milk diet in 
chronic diarrhea and dysentery (S). Potassium Bichromate, in doses of gr. ss 
in trituration, for chronic diarrhea due to intestinal ulceration. 

Castor Oil, in cathartic dose for diarrhea due to irritating material in the 
intestinal canal, as undigested food or irritant secretions, no remedy more 
useful (B) ; makes a good preparatory treatment for other medication. Bis- 
muth Subgallate, gr. xx-xxx every 2 or 3 hours, does good service. Bismuth 
Subnitrate, is effective, requires large doses, gr. xxx-lx every 3 or 4 hours; is 
especially indicated when desire for stool is felt immediately after eating (B) ; 
gr. j hourly with milk, sometimes with gr. ^ of gray powder in various forms of 
infantile diarrhea (R). Bismuth and Ammonium Citrate, in diarrhea without 
irritation but rather relaxation of the intestinal mucous membrane. Bismuth 
Salicylate, is highly praised in the diarrhea of phthisis and in that of typhoid. 
Salol, is very efficient in acute diarrhea due to action of microbes. Resorcin, 
gives very marked satisfaction in the diarrhea of children. Thymol, gr. xx to 
3ij in 24 hours in divided doses for adults, is a very efficient internal antiseptic 
in all cases of diarrhea, especially that of phthisis, teething children, chronic 
diarrhea, etc. (Martini) : avoid alcohol in any form with or after thymol, lest 
poisoning result. Carbolic Acid, very useful in fermentative diarrheas, espe- 
cially combined with Bismuth in cholera nostras and cholera infantum (B). 
Mineral Acids, in painless, watery stools, light color and alkaline (B). Alkalies, 
Mistura Cretae in sour-smelling stools (B) ; Sodium, Potassium or Magnesium 
Bicarbonates when acid canal (R). Calcium Carbonate, as Chalk-mixture, in 
the later stages, also in the diarrhea of typhoid or phthisis (R) ; may be com- 
bined with Opium and with vegetable astringents. Lead Acetate, with Opium 
as an injection (R) ; is excellent in all forms (B). Rhubarb, in early stages to 
get rid of irritant, afterward to check the diarrhea (R) ; when torrefied it has no 
purgative power, but its astringency is retained. Rumex, in morning diarrhea 
(R). Arnica, checks exhausting diarrhea with great certainty (P). Silver 
Nitrate, in diarrhea of children, with white, pasty, and offensive stools ; com- 
bined with Opium the most effective remedy for that of phthisis and typhoid 
(B). Saline Purgatives, a teaspoon ful of Epsom salts (Magnes. Sulph.) in a 
wineglass of water every three hours when intestinal inflammation (B). Cop- 
per Sulphate, the most effective astringent in chronic diarrhea and that of 
phthisis (B). Ergot, in persistent, chronic diarrhea (B). Iodine, one or two 
drops of tincture in diarrhea from atony of mucous membrane (B). Diet, 
should be cool or cold, light bland food ; gruel, rice, arrowroot, whey, barley- 
water, in recent cases ; in chronic cases the most digestible but nutritious food, 
as fresh fish, game, raw eggs, rice, mucilaginous drinks ; Milk and Lime-water 
or Soda-water very useful; also raw meat pulp; avoid beef, pork, veal, and 
much starchy food. In most forms of diarrhea in children it is wise to cut 
off milk and substitute some artificial food (R). [Compare Dysentery,- 
Cholera.] 



6j2 



DIPHTHERIA. 



R. Bismuthi Subnit., . . . 3J-ij. 
Pepsini Saccharat., . . gss. 

Zinci Oxidi, gr. vj-xij. 

Trit. et div. in chartulas xij. 
Sig. — One every four hours in summer 
diarrhea of children. 



R. Ac. Nitrici Diluti, . . gij. 
Tinct. Camphorae, 
Tinct. Opii, . . . aa %], 
Syr. Zingiberis, . . . . giv. 
Aq. MenthaePip., q.s. ad !|vj. 
M. Sig. — Tablesp. doses to be used 
after a cathartic. (Hope's Mixture as modi- 
fied by Thompson.) 



R. Tinct. Opii Deodorat. , . Tr^x. 

Bismuthi Subcarb., . . £Jss. 

Syrupi Zingiberis, . . . gvj. 

Mist. Crete, . . q.s. ad ^iv. 
M. et fiat emulsum. Sig. — A teaspoon- 
ful every 2 or 3 hours, for a child of one 
year old, when the stools are acid and 
green. • (Goodhart.) 



R 



Plumbi Acetat. , . . . 

Pulv. Opii, 

Fiat massa, et div. in pil. x. 
Sig. — One twice daily. 



gr. xx. 
gr. x. 



R . Spiritus zEtheris Co. , 

Tinct. Opii Camph., . aa^j. 
Syr. Simplicis, . . . . 25 ij. 
M. Sig. — A dessertspoonful after each 

movement. 



R • Zinci Sulphatis, 

Pulv. Opii, 

Pulv. Ipecac, . . . aa gr. xij. 
M. Fiant pil. no. xij. Sig. — One 3 or 
4 times daily in chronic diarrhea of adults. 



R. Tinct. Opii Camph., 

Tinct. Catechu, . . aa giij. 

Mist. Cretae, gx. 

M. Sig. — A teaspoonful four or 
times daily for children. 



R. Tinct. Opii Deodorati, . ^j. 
Tinct. Calumbae, q. s. ad £i]. 
M. Sig. — Teasp. in winegl. of water 
before meals. 



R. Zinci Oxidi, gr. 

Sodii Bicarb. , . . . . gr. 
M. et div. in chartulas iv. 
Sig. — One every 6 hours. 



xvij. 
viij. 



3 SS - 



R . Sodii Brornidi, . . 

Mucil. Acaciae, 

Aquae Purse, . aa q. s. ad £ ij. 
M. Sig. — Teaspoonful every three 
hours in the diarrhea of dentition, for child 
less than a year old. (A. A. Smith.) 



R . Tinct. Opii Camph., 

Syr. Rhei Aromat. , . aa 5; ss. 

Aquae Calcis, . q. s. ad ^ij. 

M. Sig. — A teasp. for children. 



Diphtheria. 

Antitoxin is eminently successful, particularly when the treatment is com- 
menced early in the case. (See page 177.) Mercury, the Corrosive Chloride 
internally, with Ichthyol rubbed into the glands of the neck, employed with 
marvellous success (Davison) ; doses for 24 hours are gr. % m E w °f water for 
young children, gr. y 2 in §vj for children of 6 or 7 years, gr. ^ in ^viij for 
adults, with Ichthyol (as above) and Antipyrin by enema if m uch fever (Dale) ; 
the Bichloride has given me most success, with a gargle of Thymol or Boric 
Acid (Da C) ; gr. jss.in ^iv of glycerin and water, of which 3j every y 2 hour 
for 6 doses, then every hour night and day, to a child of 4 years (Grant-Bey) ; 
locally very efficient, gr. ij to Oj of water, applied on a cotton swab, which 
should be burned after one using ; this hourly night and day (Oatman). 
Hydrargyrum Cyanide, in solution of gr. ^ to the ^, of which a teasp. every 
]/ 2 hour day and night to older children and adults, with a gargle of the same 
solution (Sellden) ; gr. ^§— jg-, according to age, every hour or two (Erichsen) ; 
gr. \ in ^iv of water, of which 3j to iv as per age every hour (Schultz) ; used 
by homeopaths in Berlin almost entirely, sometimes alternated with Apis, but 
most efficacious alone; table of 484 cases so treated, with 28 deaths. {Brit. 
Jour. Homasop., 1884, p. 382.) Calomel is next in importance to Quinine and 
Iron, has proved successful in cases where other means failed, gr. y,-% every 






DIPHTHERIA. 673 

3 hours, with a little Dover's powder (Da C) ; checks plastic exudation, its use 
limited to children of good constitution with sthenic symptoms ; gr. y z to j every 
2 or 3 hours, with or without Dover's powder (gr. j) or Ipecac (gr. j) till bowels 
become relaxed with greenish stools (Wa) ; gr. v repeated boldly every hour up 
to 5>iv, for a child of 3 years, until the stools appear like polyps in water-troughs, 
gelatinous and of a bright, dark-green hue, — then a dose of Castor Oil if sali- 
vation is feared (Reiter) ; the safest and most efficient germicide with which we 
can saturate the system ; nothing like it in diphtheria, gr. yi-]A, every hour, 
even gr. j every 2 hours has no bad effects, no salivation (Fowler). 

Belladonna, an excellent remedy ; if given early will abort the exudation and 
later is useful to sustain the heart (B) ; especially when throat and tonsils 
acutely inflamed and much swollen (R). Pilocarpine, used in 80 cases without 
a single death ; produces free salivary discharge, but is depressant to the heart 
(Guttmann) ; many opinions for and against it ; is decidedly injurious in ady- 
namic cases (B). Quinine, in tonic doses recommended from my experience 
(Da C) ; when headache with high temperature, vomiting, and symptoms of 
septic poisoning, then in full doses (Wa) ; is most useful after serious symptoms 
have abated, then with Iron and a mineral acid (Mackenzie). Arsenic, in 
medicinal doses for malignant cases, or when sloughing of throat (R) ; the 
Iodide, in doses of gr. -fa every hour or so, (see under Throat, Sore), an ex- 
cellent remedy for the so-called diphtheritic sore throat. Calcium Chlorate, in 
solution locally as lotion for the mouth ; considered almost specific by some ; 
its chief utility is in removing fetor ; may influence germs (R). Potassium 
Chlorate, grain-doses every %, hour (Smith) ; is more largely used than any 
remedy, both internally and locally (B) ; in full doses with Liq. Cinchonas, 
seems to be of service in some cases (Wa). Carbolic Acid, as spray, a 5 per 
cent, solution in the atomizer cup ; locally to the fauces, to remove fetor and 
destroy disease-germs (B) ; the strong acid in Glycerin as caustic on a mop or 
brush (W) ; with Iodine internally to prevent systemic infection (B). Sodium 
Sulpho-carbolate, internally, has been found useful in lieu of Carbolic Acid 
(Wa). Salicylic Acid, locally, and internally gr. x, has produced good re- 
sults (B). Sulphurous Acid, the gas recommended by a royal commission in 
Victoria, as a means of arresting the disease ; crude sulphur burned in the 
room, all apertures being closed (R) ; the official acid in full and frequent doses, 
causes rapid disappearance of the exudation, and improvement in the general 
condition ; £j every y z hour to an adult in severe cases, in ordinary ones every 
two hours; an 8-ounce mixture should have 2 or 3 ounces of syrup and 
be given in milk to young children (Snow). Sodium Sulphite, £>j to jfj aquae, 
locally, an easily managed application (B); an injection for nares in nasal 
diphtheria (Da C). [See formula below.] Sodium Hyposulphite, in solution 
of 3j to ^ij of water, of which hourly doses of 3j, to be retained in throat 
several minutes before being swallowed, an excellent local and constitutional 
remedy, which may also be used bv a brush or spray to the throat, and by a 
syringe to the nares (Fruitnight). Sodium Benzoate, is highly efficient, 75 to 
100 grains daily, according to age, also used locally (B). Myrrh, the tincture 

4 parts, Glycerin 8 and Distilled Water to 200, of which Z] to giv as per age 
every hour or half-hour, used in nearly 300 cases with strikingly good success 
(Stroll). [See under Myrrha, ante, page 385.] Strychnine, hypodermically, 
for the subsequent paralyses, which may be any form of motor paralysis. 

Lime-water, dissolves false membrane ; the vapor of slaking lime inhaled ; 
or, better, Lime-water by atomizer to back of fauces while patient inspires 
deeply (W). Ferric Chloride, as solution painted on or applied by spray to 
the throat (R) ; of no advantage locally, internally may serve by supporting 
the organism (B) ; the tincture, gtt. xx every 2 or 3 hours ; or better the Per- 
chloride, gr. ]/ 2 to j every 2 hours in syrup and water, is easier to take and 
doesn't hurt the throat (Da C) ; the solution is an ingredient of Loeffler s Solu- 
tion (see formula below) for local use. Thymol, Z) in Glycerin £j and Water 
|[iij, is the best agent for use as a gargle (Da C). Toluene, with Menthol, 
Creolin, etc., as in Loeffler s Solution, which is applied on a swab of cotton 

43 



674 DIPHTHERIA. 

every 3 hours for 4 or 5 days, after cleansing the surface ; is highly efficient for 
destroying the bacilli and preventing absorption of toxin (Loefner). Hydrogen 
Dioxide, the solution, as spray or gargle, is a very useful application, and may 
be diluted with 3 or 4 parts of water ; is much more powerful against young 
bacilli of diphtheria than against those of two days old, and hence its 
value is especially available at the very outset of the disease, and as a 
prophylactic during epidemics thereof (Traugott). Glycozone internally, a 
tablesp. in a winegl. of water every 3 hours, has an excellent effect (Edson). 
Tartaric Acid locally, converts membrane into a gelatinous mass, easily ex- 
pelled (Vidal). Chloral, a dilute solution in glycerin and water makes an excel- 
lent local application for the throat ; internally may be used as a symptomatic 
remedy in the early stages, but not when the heart is weak. Papain, by atom- 
ized inhalation, is used to destroy the membrane. Pineapple Juice and Papaya 
Juice, used by sipping and swallowing the juice after chewing the pulp, highly 
efficient in India (Chambers) ; see page 41 5. Boracic Acid, in solution as gargle, 
ranks next best after Thymol (Da C). Sulphur and Alum, equal parts, pow- 
dered and blown into the throat at the moment of deep inspiration, as often as 
asphyxia is threatened, are efficient (Jones) ; Sulphur is a very old and efficient 
local remedy in diphtheria, the flowers (sublimed sulphur) rubbed up with water 
as a gargle, or blown upon the throat through a quill, was the method of Dr. 
Field, who had a great reputation in England a few years ago for curing this 
disease {Lancet). Trypsin, is a good solvent of the false membrane; of all 
remedies used with the spray-atomizer it has given me the largest percentage 
of recoveries (Fruitnight). Chinolin, a 5 per cent, solution painted over the 
affected parts with great advantage (Seifert) ; the tartrate in 10-grain doses in- 
ternally (B). Bromine, the vapor by inhalation, is useful (Wa) ; a y-^ solution 
in distilled water, of which gtt. j-iij every y, hour in a teasp. of sweetened 
water, using a glass spoon ; and a saucer full of Bromine Water in the room, 
renewed every 12 hours, has seemed to be extremely efficient in a number of 
cases. Iodine as inhalation frequently ; with use the solution may be increased 
to §ss at each inhalation (R). Potassium Permanganate, gr. y z in distilled 
water internally and also used locally, is of undoubted benefit (B) ; is credited 
with brilliant results even in malignant cases. Sanguinaria, the best emetic, 
and by many is considered specific in this disease (P). Lactic Acid, ^iijss to 
%x of distilled water, as gargle, on mop or by spray, to dissolve membrane (B). 
Tannin, a 5 per cent, solution as spray (R). Cubeb, very efficient in the catar- 
rhal forms of diphtheria (Robinson) ; the freshly ground berries in large doses 
in early stages of the disease, a very successful treatment (Trideau). Turpen- 
tine, Z) °f the °il thrice daily, with rr^iv of Spiritus yEtheris as a corrective, at 
the same time using ice-bags and a gargle of Potassium Chlorate solution, and 
internally J^-ounce doses every 2 hours of a 2 per cent, solution of Sodium 
Salicylate (Roesse, Baruch). Tar and Turpentine vapor, made by burning in 
the room Coal-tar 7 parts to Oleum Terebinthinas 3 (Delthil). Methylene Blue, 
was used with success after losing cases by other treatment ; even in simple 
non-diphtheritic ulceration of the throat, patients would, after one or two appli- 
cations of the solution, express themselves with delight as being cured (Rose). 
Chlorine-water, tablesp. doses internally and as a gargle, highly efficient ; a 
mixture of Chlorine-water 2 parts and Distilled Water 1, of which Z\ internally 
every 2 or 3 hours, is by far the best treatment of this disease ; no water should 
be given after the mixture (Schubert) ; as a prophylactic the same may be 
given 2 or 3 times daily (Id). Nuclein, has been used with benefit (see page 
161). Alcohol, is probably as good a local antiseptic as any; diluted with 
equal parts of water, by hand-ball atomizer every y z hour; is the prince of 
antiseptics, and the most perfect and reliable medicine in diphtheria of which 
we have any knowledge (Hills). Stimulation, freely, the essential part of the 
treatment; infants are not injuriously affected by teasp. doses of whiskey every 
y. hour ; stimulate for effect and not by dose ; those cases do best which are 
stimulated freely and early (Da C) ; there is more danger from giving too little 
alcohol than from too much ; a three-year-old child can comfortably take jfj- 



DROPSY. 



675 



^v of Cognac, or gr. xv of Musk or Camphor, or gr. xv-^j of Ammonium 
Carbonate in 24 hours; in the septic form especially, the intoxicating action of 
Alcohol is not experienced, and young children with general sepsis began to 
improve when their ^iv of brandy were increased to ^xvj daily (Jacobi). 
Water, as ice in the mouth and the wet pack to the throat, is extremely ser- 
viceable (B) ; Ice sucked, especially at commencement, and continued until 
the disease declines (R) ; Ice packed in bladders or thin india-rubber bags, to 
the throat (W). Aliment, good foods, wines or brandy, necessary from the 
start to maintain the patient's strength (R) ; a teasp. of glycerin every 3 or 4 
hours, plenty of good soup and wine, nutritive enemata, are necessary to sus- 
tain the system. Moist inhalations. Temp, of room 68° Fah. Removal from 
the house wherein attacked is advisable. Tracheotomy, only in extremis (R) ; 
is not successful in diphtheria, though very much so in membranous croup 
(Da C). Intubation of the Larynx, as an alternative to tracheotomy, is enthu- 
siastically advocated by many operators. [Compare Croup membranous.] 



R- . Hydrarg. Chlor. Corros., gr. jss. 

Glycerini, sfj. 

Aquae Destillatae, . . :§iij. 
M. Sig. — A teasp. every ]/ z hour for 6 
doses, then every hour night and day to a 
child of four years. Also, — 

R. Ung. Iodoformi (1 in 10), rubbed in 
over swollen glands every 3 hours. 

[Grant-Bey.') 



rJL . Sodii Sulphitis, 
Glycerini, . . 
Aquae, 



s. ad 






M. Sig. — Nasal injection. [Da Costa.) 



R. Tinct. Ferri Chloridi, . ^j. 
Syrupi Tolutani, 
Liq. Potassii Citratis, . aa^ijss. 
M. Sig. — Teasp. to dessertsp. accord- 
ing to age, every 3 hours; 3J=TTLx of 
the tincture. [Anderson.) 

R- . Hydrarg. Chlor. Corros., gr. j, may 
be added to the above formula, which 
should then be given in teasp. doses. 



R. Mentholi, ioGm. 

Toluene, . . . q. s. ad 36 Cc. 
Dein adde — 

Creolin, 2 Cc. 

Liq. Ferri Chloridi, . . 4 Cc. 
Alcoholis, . . q. s. ad 100 Cc. 
Sig. — To be applied by cotton swab 
every 3 hours for 4 or 5 days. 

[Loeffler's Solution.) 



R 



. Ac. Tartarici, ^j. 

Glycerini, . ... jfjss. 

Aquae Menth. Pip., q.s. ad$ iv. 
M. Sig. — Gargle frequently. ( Vidal.) 



R. Tinct. Ferri Chloridi, . 5j. 
Potassii Chloratis, . . . gss. 
Misce et adde — 

Aquae, . . . . q. s. ad ^viij. 
Sig. — Gargle. [Jacobi.) 

For the chemistry of this combination 
see under Chlorum, ante, page 267. Gly- 
cerin should not be added, as in Dr. Ja- 
cobi's original R , wdiich makes a mixture 
that may explode. 



Dropsy. 

Arsenic, in dropsy from feebleness of heart, and in old age (B) ; swelled feet 
from debility (R). Aurum, has an ancient reputation in several forms of 
dropsy (seepage 209). Digitalis, one of the best remedies, especially in renal 
dropsy from acute desquamative nephritis; the infusion in doses of ^ss (B) ; 
the fresh infusion best for that of heart disease, especially when tricuspid re- 
gurgitation (R) ; induces striking effects in cardiac dropsy, when scanty urine 
and venous engorgement ; has high rank as a diuretic (P). Apocynum Can- 
nabinum, actively diuretic (P). Diuretin has been employed with marked 
benefit in both cardiac and renal dropsy, in hepatic cirrhosis, and in various 
diseases of the heart and kidneys accompanied by edema : gr. xv several 
times daily, in aqueous solution, avoiding acids or acid vegetable juices. 
Caffeine, the Citrate in 5-grain doses is eminently diuretic ; for objections to its 
use see page 232. Cactus, has long had a high reputation in dropsy among 
the natives of its habitat ; is probably of service in cardiac dropsy. Hydrargy- 
rum, a classical pill in dropsy with dyspnea from cardiac disease is the combi- 



676 



DROPSY. 



nation of Dr. Baillie, containing Mercury, Digitalis, and Squill (see formula 
below) ; Calomel in doses of gr. ss-ij is eminently diuretic, especially in car- 
diac dropsy, but by many it is thought to act by aiding the action of other 
diuretics. Bryonia, as a drastic purgative and diuretic ; care necessary, as it 
depresses the heart; the infusion best (P). Hellebore, the tincture, in doses of 
gtt. v-xv, every 2 or 3 hours, very successful in dropsical effusions, especially 
in general anasarca after scarlatina (P). Senega, as a diuretic when dropsy is 
dependent on kidney disease ; has been praised (P). Chimaphila, is useful as 
a diuretic in renal dropsy especially when loss of appetite and debility (P) ; 
may be substituted for Scoparius (B). Juniper, largely used as a diuretic in 
cardiac and renal dropsy (B) ; esteemed in post-scarlatinal dropsy (R). Iron, 
purgative chalybeate waters (B) : the Liquor Ferri et Ammonii Acetatis (Ba- 
sham's Mixture), in anemic dropsy (Da C). Pilocarpus, very valuable in renal 
dropsy when secretion of urine is much reduced or suppressed (B). Jalap, the 
compound Jalap powder, gr. xv-xx, with giij of Potas. Bitart. and a little Ginger, 
early in the morning, 2 or 3 times a week ; no hydragogue superior in dropsy 
from Bright's disease (Wa). Turpentine, controls dropsy with albuminous 
urine, from non-desquamative renal disease ; gtt. ss every 2 to 4 hours (P). 
Colchicum, as a hydragogue in hepatic and cardiac dropsy when patient is 
vigorous, also in post-scarlatinal dropsy (B). Scoparius, esteemed by English 
physicians (B) ; is most useful in cardiac dropsy ; Cullen found it the most cer- 
tain diuretic : diluents should be freely used with it (P). Squill, in cardiac 
dropsy ; cautiously if from kidney disease ; if anemic add Iron (R). Taraxa- 
cum, is occasionally used as a diuretic, with limited utility (B). Copaiba, gives 
good results, especially in ascites, which see for formula (B). Potassium Bitar- 
trate and Acetate, are very certain as diuretics when largely diluted with water, 
as cream-of-tartar lemonade; indicated in desquamative nephritis, and in 
general dropsy from valvular disease of the heart (R). Elaterium, of unques- 
tionable value as a derivative in many passive forms of dropsy, though many 
fear it (P). Acupuncture, or better still, incisions from ^ to an inch long, one 
over each external malleolus generally sufficient ; a hot sponge, moistened 
with weak carbolic acid solution kept to incisions (R). Aliment, dry diet is of 
advantage in dropsy of serous cavities (B) ; should be light in acute dropsies ; 
nourishing in chronic. Water not injurious but beneficial as drink. Warm 
baths, Holland gin in small doses, tapping for alleviation in incurable cases. 
A moderately warm, dry atmosphere. Skim-milk diet said to be of great value 
in renal dropsy. [Compare Ascites, Hydrocele, Hydrocephalus, Hydro- 
thorax, etc. 1 



R. Pulv. Scillse, 

Pulv. Digitalis, . . aa % ss. 

Potassii Nitratis, . . . gj. 
M. Fiat massa et div. in pil. xxx. 
Sig. — One pill thrice daily. 



R. 



Potassii Acetatis, . . . £vss. 
Spt. ^Etheris Nitrosi, . gij. 
Aquae, . . . . q. s. ad ^viij. 
M. Sig. — Tablesp. every 3 or 4 hours. 



5J- 



R. Potassii Bitartrat., 

Ext. Taraxaci, . . 

Decocti Taxaraci, . . §viij. 
M. Sig. — y 2 wineglassful twice or 
thrice daily. 



R 



r. j-jss. 
r. j. 



Ft. 

Sig 



Pulv. Digitalis, .... 
Pulv. Scillse, .... 
Hydrarg. cum Creta vel 
Pil. Hydrargyri, . . . gr. j-iij 
pil. no. j. Mitte tales xxiv. 
. — One pill thrice daily. 



R . Liq. Ferri et Ammonii 

Acetatis (U. S. P.), . gvj. 
Sig. — Dessertsp. or two, three or four 
times daily. (Bashavi 's Mixture.') 



R 



. Aceti Scillae, ^ ss. 

Infusi Digitalis, q. s. ad Jiv. 
M. Sig. — A tablesp. 2 or 3 times daily. 



R. Elaterini, gr. j. 

Spt. ^Etheris Nitrosi, . ^ij. 

Tinct. Scillse, 

Tinct. Colchici, . . aa ^ ss. 

Syr. Simplicis, . . . . ^j. 
M. Sig. — A teaspoonful 3 or 4 times 
daily, for hepatic and cardiac dropsy in 
sthenic subjects. 



Tinct. Digitalis, . . 


• Rj-ij. 


Tinct. Scillae, . . . 


• S-iJ- 


Spt. Juniperi Comp., . 


• 3 1V ~ V J 


Potassii Acetatis, . . 


• 7> iv. 


Vini Albi, . . . q. s. 


ad%v). 



DUODENAL CATARRH DYSENTERY. 6jJ 

R. Vini Colchici Seminis, . ^ ss. R. 

Liq. Ammonii Acetat., . ,^ijss. 

Infusi Petroselini, . . . !| v. 
M. Sig. — Teasp. every 4 hours. An 
excellent diuretic, especially adapted to 
the dropsy of scarlatina. (B.) M. Sig. — A tablesp. 3 or 4 times daily. 



Duodenal Catarrh. 

Salol, is the most efficient remedy. Sodium Phosphate, Z) four times daily, 
extremely efficient in catarrhal conditions of the duodenum and bile-ducts, 
resulting in jaundice, hepatic colic, etc. (B). Vichy Water, in similar condi- 
tions, probably owes its efficacy to the Sodium Phosphate contained in it (B). 
Potassium Bichromate, in doses of gr. -^-\ t two or three times a day, is an 
excellent remedy in so-called duodenal dyspepsia, manifested by a bitter taste, 
coated tongue, pale stools, vomiting of glairy fluid and dull pain in right hypo- 
chondrium. Arsenic, has been used with success in jaundice from catarrh of 
bile-ducts after duodenal catarrh (B). Aurum salts will often remove duodenal 
catarrh and that of the bile-ducts, also the jaundice therefrom (B). Podophyl- 
lum, in catarrhal and malarial duodenitis. Nitro-muriatic Acid, internally in 
mucous duodenitis ; also as bath to right hypochondrium (£iij to gall, j), temp, 
of bath 96 (B). Aliment, no starches or fats ; milk, eggs, oysters, beef-broth, 
broiled or raw beefsteak, white-fish (B) ; the diet should be exclusively animal, 
in order to let the stomach deal with it. [Compare Jaundice, Biliousness.] 



Dysentery. 

Ipecacuanha, is par excellence the remedy for acute dysentery of the ordi- 
nary type ; large doses ; gr. xxv-xxx (P) ; gr. xv in milk (B) ; valuable in acute 
or epidemic forms, also in summer dysentery of children, with greenish stools, 
mucus and blood, gr. ij-v every 2 hours in milk (B) ; in dysenteric diarrhea 
of children, especially with vomiting, which will often yield to hourly drop doses 
of Ipecac wine (R). [See under Ipecacuanha, in Part I for the method of 
administration.] Castor Oil, as a mild cathartic, is very valuable in appro- 
priate cases (Wa); gtt. v every hour, in water with sugar and gum, is excellent 
for dysenteric diarrhea of children (Smith): %] of the oil, guarded by 10 to 20 
drops of laudanum, the best preliminary treatment for all cases of catarrhal 
dysentery. Saline Purgatives, Epsom salts the best treatment for acute dysen- 
tery, especially when fever, pain, tenesmus and stools of mucus and blood (B). 
Potassium Bitartrate, in acute dysentery with scorbutic symptoms, as seen in 
miners, sailors, etc.; a full cathartic dose, ^ss or more, has acted most bene- 
ficially as a preliminary to other treatment, and in many cases has proven to 
be the only remedy required. Opium, as enema, with starch and milk, after 
canal is emptied by salines; indispensable in chronic dysentery (B) ; for the 
purging (R); a remedy of great value, and applicable to every stage and every 
form of the disease, allaying pain and vascular excitement, moderating peri- 
stalsis, promoting the cutaneous secretion ; is inferior to Ipecac in acute dysen- 
tery, and is most valuable in the chronic form (Wa). Silver Nitrate, in pill, 
gr. %-], with Opium, in acute dysentery after subsidence of acute symptoms; 
also as enema beyond the sigmoid flexure (gr. x-xx ad Oj aquae); also as 
escharotic through speculum to ulcer of rectum (B) ; a solution of 1 in 1000 as 
antiseptic wash daily, up to 60 washes in series, entirely successful in many 
cases of the recurrent form of tropical dysentery, having lasted from 1 to 5 
years (Gallay, Surgeon-Major for French Colonies). Balsam of Peru, 3 grains, 
with alcohol Z), syrup of lemons 5iv and water ^iij, excellent for dysentery 
(Tr). Bismuth Subnitrate, in doses of 15 to 20 grains every hour or so, is 
highly efficient ; may also be used in suspension with Starch or Chalk-mixture, 
as a rectal injection. Arnica, is highly extolled for cases where the vital 



678 



DYSENTERY. 



powers are depressed (Wa). Salol, is highly efficient as an intestinal antisep- 
tic. Mercury, in minute closes for the ileo-colitis of children; gr. ^ to y 1 ^ of 
Calomel or Hydrargyrum cum Creta every half hour (B) ; gr. ^q of the Bi- 
chloride hourly or every 2 hours, in acute or chronic dysentery if stools are 
slimy or 'bloody (R). Hamamelis, when the discharges contain much blood 
(R). Aconite, when fever and cutting pains (P). Nux Vomica, in epidemic 
dysentery (P) ;. prune-juice stools, much gas, vital depression (B). Arsenic, 
Fowler's solution gtt. ij with gtt. v of Opium often benefits (B). Quinine, when 
periodic (B) ; in malarial subjects is as successful as Ipecacuanha in dysentery 
of the ordinary type (P) ; in warm solutions, 1 in 1000 to 1 in 5000, as rectal 
injections for amebic dysentery, the amebae being rapidly destroyed thereby 
(Ty). Ailanthus Glandulosa, as infusion, sometimes succeeds where other 
measures have failed, and seems to be especially serviceable when the case 
has become subacute or chronic (Mn). Monsonia Ovata, a tincture gave 
wonderful results in chronic cases and in acute ones which had resisted the 
ordinary remedies (Maberly). Methylene Blue, may be of use in amebic dys- 
entery, on account of its being partially excreted by the feces (Armstrong). 
Cinnamon, sometimes does good in chronic dysentery, may be combined with 
Ailanthus (Mn). Iron, weak solutions of the tincture of the Chloride for irriga- 
tion of the bowel have been used in bad cases with great benefit. Gamboge, gr. 
^ internally in the 24 hours, exceedingly valuable in young persons (P). Matico, 
the infusion by mouth and rectum was found serviceable in the malignant 
hemorrhagic dysentery occurring in Trinidad. Glycerin, with infusion of Lin- 
seed, 1 to 4, to allay tenesmus (B). Lead Acetate, as enemata, in acute and 
chronic dysentery to allay tenesmus (B) ; with Ipecac and Opium in pill, for acute 
form (Da C). Sulphuric Acid, with saline purgatives (B). Copper Sulphate, 
useful in acute dysentery ; in chronic the most valuable astringent (B) ; gr. x- 
xx ad Oj aquae (R). Ergot, in chronic after acute, and also in the acute form 
(R). Grape-cure, is used successfully in the chronic form (P). Iron Pernitrate, 
sometimes in chronic (army) dysentery (B). Calumba, is of great value in 
chronic dysentery with ulceration of colon (P). Chekan, is used with benefit. 
Injections of mucilaginous enemata (as Linseed) are of great value (R). 
Diet is of prime importance (B) ; avoid animal food and stimulants, liquid 
foods best, all to be cold (R) ; milk diet alone during exacerbations. Boiled and 
peptonized milk, light animal broths and beef-juice, not beef teas; barley or 
rice may be added to such broths, but should be thoroughly cooked (Ty). 
[Compare Diarrhea, Enteritis, Sprue.] 



R. Magnesii Sulphatis, . . . ,^viij. 

Ac. Sulphurici Dil., . . . jfss. 

Aquae, 3 v i i j . 

M. Sig. — Tablesp. in a winegl. of water 
every hour or two until it operates.. (B.) 



R. Ergotini, . . . . 

Ext. Nucis Vom., . 

Ext. Opii, .... 
Fiant pil. no. xx. Sig. 
6 hours. 


. . . gr. xx. 
. . . gr. v. 
. . . gr. x. 
— One pill every 
{King.) 


R . Liq. Ferri Nitratis, 
Ac. Nitrici Dil., . 
Syr. Zingiberis, . . 
Aquae, . . . . q. 
M. Sig. — A teasp. th 

child of 2 years. Tonics 

tive treatment. 


aa g ss. 
. . . %]. 
s. ad ^iij. 
rice daily for a 
to follow pallia- 
(Starr.) 



R. Morphinae Sulph., . . . . gr. ij. 

Strychninae Sulph., . . . gr. %. 

Ac. Sulphurici Dil., . . . Jf ss. 

Aquae Camphorae, . . . giijss. 
M. Sig. — A teasp. well diluted every 
hour or two. In epidemic dysentery with 
prune-juice stools and marked depression. 



gr. xxiv. 



R . Plumbi Acetatis, . . 

Ipecacuanhae, 

Pulv. Opii, aa gr. iij. 

Fiant pil. no. xij. Sig. — One pill every 
2 hours until blood ceases, then at longer 
intervals. {Da Costa.) 



Ext. Ergotae Fl., . . . ^ iijss. 
Tinct. Opii Deodorati, . . 5SS. 
M. Sig. — A teasp. thrice daily. 

{Andrew^ 



DYSMENORRHEA. 



6/9 



R . Plunibi Acetatis, . . . . gr. iv. 
Morph. Acetatis, . . . . gr. ss. 

Aquae Fervid., t ^j. 

M. Sig. — Enema to allay tenesmus. 



R . Ferri Sulphatis, ..... gr. xl. 

Pulv. Opii, gr. xx. 

Fiantpil. no. xx. Sig. — One pill thrice 
daily, in chronic dysentery. 



R. 



M. Sig. — A dessertsp. to child over 
one year, tablesp. or more to an adult ; 
every 2 or 3 hours, after emptying the 
bowels. 



Bismuthi Subnit. , . . . 


• SU- 


Spt. Amnion. Aromat. , 


• Si- 


Tinct. Opii, 


. gtt. xvj 


Syrupi Simplicis, . . . 


• 3 SS - 


Misturse Cretse, . . . . 


• 5J 5S - 



Dysmenorrhea. 

Ammonia, the Aromatic Spirit in doses of £j every 4 hours or oftener, a 
thoroughly trustworthy remedy, and should be used in place of the alcoholic 
stimulants generally prescribed (Illingworth). Ammonium Acetate, has re- 
markable power over many forms of dysmenorrhea ; the Liq. Ammonii 
Acetatis, in gss doses, with gr. yj, of Ipecac, every 2 or 3 hours, to keep up the 
action of the skin until the flow is well established (E). Antipyrin, as an anal- 
gesic, is efficient. Acetanilid, is equally efficient for the pain. Cimicifuga, 
relieves pain in the congestive variety and is decidedly useful (P) ; is said to 
be very efficient (R) ; is valuable (Wa). Opium, necessary when pain is very 
severe ; one hypodermic of Morphine at each period is often sufficient (Wa). 
Codeine, when Morphine is not well borne, has given very complete satisfaction 
in several cases ; gr. % to % morning and evening (Oliver). Gelsemium, 
relieves pain in the neuralgic form, rr^v-x of the fluid extract every 2 hours (B). 
Chloroform, as the liniment on a flannel wrung out of hot water, or by inhala- 
tion as an anesthetic when pains very severe ; sometimes exerts a permanent 
influence (Wa). Ergot, given when the molimen begins, is useful in the con- 
gestive form (B). Amyl Nitrite, may be inhaled with benefit in the neuralgic 
variety, especially in chlorotic girls (Wa). Sodium Borate, in the membranous 
form, has been used with great benefit combined with Ext. Belladonnas (Wa). 
Camphor, is my favorite remedy, gr. x in mucilage and Cinnamon-water ; 
repeat the dose in an hour or two if necessary (Dewees). Guaiacum, is very 
useful (P) ; drachm doses of the ammoniated tincture in the neuralgic or rheu- 
matic forms (B). Caulophyllum, is by many considered the best curative 
remedy for spasmodic dysmenorrhea, if given in the intervals. Viburnum 
Opulus, the fluid extract, in half-drachm doses, has considerable reputation in 
some sections for uterine pains of various kinds, and is useful in the spasmodic 
variety of this affection ; may be used in combination with Cannabis Indica 
(Thomas). Arsenic, gtt. iij-x of Fowler's sol. with gtt. x of Tinct. Digitalis, ter 
die between the periods, gives excellent results (Athill) ; indicated when copious 
membranous discharge from bowels and uterus (R). Cannabis Indica, is very 
useful as a palliative in painful menstruation (B) ; gr. ss-j thrice daily to relieve 
the pain (R). Nux Vomica, in neuralgic form; Syrup or Elixir of Iron, Qui- 
nine and Strychnine (B). Apiol, neuralgic form (B) ; as emmenagogue, night 
and morning, for several days near the period (Wa). Pulsatilla, in the func- 
tional form ; is of much benefit when discharge is scanty or profuse, black and 
clotted ; should be persevered in for two months or more (P) ; gtt. ij every hour 
is most effective when the affection is not of membranous, obstructive, or 
neuralgic character (Smith). Hydrastinine, has been used with benefit. [See 
under Menorrhagia.] Chloralamid, in one dose of gr. xxx, to prevent an 
impending attack, has been of service. Belladonna, in neuralgic or spasmodic 
forms, dark and fetid discharge, crampy pains; and cold chills ; a suppository 
or mild injection together with internal administration, will relieve (P) ; in 
neuralgic dysmenorrhea it will permanently relieve (B). Aconite, a valuable 
remedy when commenced early (P) ; for the congestive form in plethoric sub- 
jects (B). Aletris, is advertised as a highly efficient agent. Carbonic Acid, 
injected into the vagina (see page 93). Electricity: in neuralgic, a galvanic 
current ; in congestive, the inverse current (B). Croton-chloral, in neuralgic ' 



68o 



DYSPEPSIA. 



form (R). Iron, if depending on anemia (B). [See Amenorrhea for formula.] 
Cajuput Oil, said to relieve the pains (R). Rue and Sumbul, are reported use- 
ful (P), Emetic of Ipecac, with warm covering in bed, feet in hot water, hot 
ginger tea, Liquor Ammonii Acetatis ; if pain very severe, a suppository of 
Morphine and Belladonna per rectum ; best to avoid anodynes (E). Acces- 
sories, spinal ice-bag, when scanty discharge ; when menorrhagic, hot water 
spinal-bag ; sitz-baths, either hot or cold, or cold alone, during intervals. 



R . Ext. Cimicifugas Fl., . . . 
Ext. Pulsatilla FL, . . . 
Ext. Eriodyctii Fl. , . . . 
Syr. Aurantii, . . q. s. ad 



5 iv. 

3Jss. 

5iv. 



M. 
hours, 



Sig. — One or two teasp. every two 
for six doses. 



gr. iv. 



R . Ext. Belladonnae, . . 

Ext. Stramonii, 

Ext. Hyoscyami, . . . aa gr. v. 

Quininae Sulphatis, . . . gr. xl. 
Fiant pil. no. xx. Sig. — One pill thrice 
daily, in neuralgic dysmenorrhea. 



R. 



Ext. Viburni Prunifol. Fl., ^ij. 

Ext. Senec. Aurei, . . . ^ij. 

Tinct. Guaiaci Volat., . . ^xij. 
M. Sig. — A teasp. in new milk, thrice 
daily, between attacks, %) every hour dur- 
ing attack, and a hot sitz-bath. 



R. Ext. Ergotae Fl. , . . . . gvij. 

Tinct. Gelsemii, .... ^j. 

Tinct. Aconiti, WLxyj- 

M. Sig. — Teasp. every 2, 3, or 4 hours. 
In congestive dysmenorrhea. 



. gr. v. 



R . Ext. Opii, .... 

Ext. Cannabis Ind. 

Ext. Hyoscyami, . . aa gr. x. 

Camphorae, gr. xxv. 

M. Fiant. pil.no. x. Sig. — One pill two 
or three times daily. (McLane.) 



R. 



Ext. Cannabis Ind. FL, . gjss. 
Ext. Viburni Op. FL, . . gvj. 

Mucil. Acacias, ^iij. 

Aq. Cinnamomi, . q. s. ad ^ iv. 
M. Sig. — Dessertsp. every 4 to 6 hours. 



Dyspepsia. 

Pepsin, is very beneficial; Scheffer's or Beale's saccharated pepsin with 
diluted HC1 acid (B) : is especially adapted to gastric indigestion. Pancreatin, 
for intestinal indigestion ; Liquor Pancreaticus to peptonize milk, gruel, soups, 
etc., before administration, in cases of great digestive debility. Peptenzyme, 
is said to be very efficient. Papain (Papoid), acts equally well in gastric and 
intestinal indigestion, and hence is particularly indicated in cases of difficult 
diagnosis as to the location of the trouble ; is used in the various forms of dys- 
pepsia and indigestion with most excellent results : has marked proteolytic 
action in acid, alkaline and neutral solutions, and in the presence of many 
chemicals, antiseptics and therapeutic agents (Chittenden). Ingluvin, also 
promotes digestion (B). Pineapple Juice has the power ,of digesting proteids 
(Marcano) ; the fresh juice is a very constant and powerful digestant of albu- 
minous matters, its ferment being decidedly active in the presence of either 
acids or alkaline carbonates, but most energetic in neutral solution and be- 
tween 122 and 140 F. (Chittenden). Mineral Acids, Hydrochloric or Lactic 
with Pepsin after meals in atonic dyspepsia ; Hydrochloric after meals for acid 
pyrosis; Nitro-muriatic for dyspepsia with mental despondency, oxalates in 
urine, offensive gas, sallow complexion (R) ; Phosphoric, dilute, very efficient 
before meals (DaC). Sulphurous Acid, tt^v— ^j , well diluted, for acid pyrosis 
(B). Alkaline Mineral Waters, before meals in atonic dyspepsia, and highly 
useful in the dyspepsia of obese subjects (B). Alkalies, shortly before a meal 
increase the gastric juice, and are usually better than acids in atonic dyspepsia ; 
Sodium Bicarbonate is the best (R) ; a full dose (gr. xl-lx) in dyspeptic attacks, 
with flatulence, etc., usually affords speedy relief (Wa) ; Limewater is often 
efficient. Chloroform, gtt. xv-xx in sweetened water, when rapid fermentation 
of food and evolution of gas soon after eating ; is promptly efficient in giving 
relief (Willis) ; a highly efficient remedy in acute dyspepsia. Chloral, is a very 
good remedy in doses of 5 to 10 grains in 5J of cinnamon water; acts as a 



DYSPEPSIA. 68 1 

gastric antiseptic and sedative, and is efficient in the nervous dyspepsia of 
neurotic subjects, with severe gastric pain. Arsenic, drop doses of Fowler's 
solution before meals in irritative dyspepsia (B) ; also when diarrhea is excited 
by food (R). Bryonia, in dyspepsia of liver origin, and bilious headache with 
vomiting (P). Charcoal, when flatulence ; Nux Vomica in 5 tt\_, doses before 
meals, better (R). Mercury, Gray powder, gr. j 3 or 4 times a day, when 
dyspepsia during chronic disease or convalescence; if constipated, Calomel, 
gr. ss, with Ext. Hyoscyami, gr. iij, in pill for 3 nights (R) ; the Yellow Oxide, 
in doses of gr. 6b~3o > f° r dyspepsia septica and kindred disorders of the ali- 
mentary canal ; remarkably efficient in Austrian navy (Schaffer). Ipecacuanha, 
rr^v-x of the wine most valuable in atonic and chronic catarrhal dyspepsia 
(P) ; constipation, depression, food like a heavy weight (R). Hydrastis, gtt. v- 
xv of the tincture before meals, a good stomachic tonic (B) ; in chronic dys- 
pepsia, sluggish liver (P). Pulsatilla, a good remedy when depression with 
fear of death, white-coated tongue, little or greasy taste, nausea, flatulency, 
heartburn ; gtt. v in water every 4 hours (P). Cannabis Indica, often renders 
good service in indigestion. 

Nux Vomica, gtt. v-x ter in die before meals as stomachic tonic (B) ; when 
flatulence, weight on head, and heartburn (R) ; often of the highest possible 
value in simple atonic form, or in the dyspepsia of drunkards (P). Cinchona, 
with mineral acids in atonic dyspepsia (P). Quinine, especially for town- 
dwellers and elderly people ; checks excessive fermentation in alimentary 
canal (R). Chamomile, rr^ij of oil, very useful in atonic dyspepsia (P). Igna- 
tia, useful in nervous dyspepsia (P). Taraxacum, certainly does good in sim- 
ple atonic dyspepsia (P). Belladonna, gr. l /e to % of the extract, once a day 
when there is constipation (R). Bismuth, mixed with vegetable Charcoal in 
flatulent dyspepsia (R) ; gr. x with same quantity of Calcined Magnesia, in 
chronic gastric catarrh where diet cannot be regulated (Rose) ; the Subgallate 
(Dermatol) is said to be an efficient remedy. Aurum, the Chloride is useful in 
nervous dyspepsia (see page 209). Manganese, gr. x-xv of the Black Oxide 
in gastrodynia and pyrosis (B). Sanguinaria, gtt. ij-v of tincture or gr. -^ of 
alkaloid, in atonic dyspepsia promotes secretion and increases the appetite 
(B). Silver Oxide, ^-grain doses with same quantity of Ext. Hyoscyami be- 
fore meals in nervous dyspepsia (B). Xanthoxylum, as stomachic tonic, Z] of 
the fl. ext. in atonic dyspepsia (B). Simple Bitters, Calumba is the best ; 
Quassia or Gentian or infusions of them as vehicles for acids and alkalies (B) ; 
Calumba is easily tolerated when the stomach is weak (R) ; Gentian as sto- 
machic and tonic, very useful in atonic dyspepsia and that of gouty subjects ; the 
tinct. in some aromatic water, or in combination with alkalies and sedatives 
(Wa) ; Chirata is particularly serviceable in the dyspepsia of gouty subjects. 
Rhamnus Purshiana, in all cases of dyspepsia associated with a torpid liver 
and constipation ; small doses at first, gradually increased (Wa). Salophen, 
is used with decided benefit in intestinal dyspepsia with flatulence. Strontium 
Bromide, is excellent in dyspepsia, also in acetic and lactic fermentations. 
Glycozone, is an excellent remedy for atonic and acid dyspepsias, in which it 
gives very gratifying results (Edson). Aloes, combined with other agents, 
where habitual constipation accompanies dyspepsia (R) ; especially indicated 
in duodenal dyspepsia, gr. ij-iv with Ipecac gr. j-ij, two or three times a week 
(Wa). Water, a dry diet will entirely relieve the ice-water dyspepsia, or that 
due to excessive beer-drinking (B) ; half a tumbler of cold water ]/ 2 hour be- 
fore breakfast acts to some people as a purgative and removes many dyspeptic 
symptoms, but flatulent dyspepsia is often traceable to excessive water drink- 
ing at meals, especially that of iced beverages (R). Hot Water, x /z a pint to a 
pint at iio°-I5o° F. an hour before each meal and }i an hour before going to 
bed, each draught sipped slowly during 15-30 minutes; as a cure for dyspep- 
sia this is an old and efficient practice (Wa). Milk-cure, has succeeded ad- 
mirably (B) ; fresh Buttermilk a most excellent article for dyspeptics, as also is 
Kumyss. Alcohol, in any form, especially good wines, is useful in the atonic 
dyspepsia of sedentary livers (B) ; when loss of appetite and of digestive power 



682 



DYSPHAGIA. 



from fatigue, a glass of wine or brandy-and-water before eating is very appro- 
priate ; useful also in indigestion of town-dwellers, or during convalescence 
from acute disease (R). Diet, avoid tea and hot beverages, over-cooked food, 
over-feeding and iced-water; masticate all food well, eat slowly, small quan- 
tities and frequently. Active out-of-door habits should be cultivated, and all 
articles of food known to disagree should be strictly avoided. [Compare 
Acidity, Biliousness, Flatulence, Gastralgia, Pyrosis.] 



R . Acidi Hydrochlor. Diluti, 

Glycerini, 

Syr. Rubi Idaei, .... 
Liq. Pepsini (Fairchild), 
Spt. Chloroformi, . . . 
Vini Albiz/^/Xerici, q. s. ad £x\]. 
Sig. — 3 ss thrice daily after meals. 



R. Ac. Hydrochlorici Dil., . 5jj. 

Tinct. Capsici, 7, ss. 

Tinct. Calumbae, .... ,^jss. 

Vini Pepsini, . . q. s. ad !| iv. 
M. Sig. — Dessertsp. after meals, 
atonic dyspepsia. {Pancoast. 



In 



$. Tinct. Capsici, TH,xvj. 

Tinct. Nucis Vom., . . . gij. 

Tinct. Gentianse Co., q. s. ad^'\]. 
M. Sig. — A teasp. in water thrice daily, 
with gr. i of Aloin at bedtime, avoiding 
a starchy diet. For aggravated dyspepsia 
with constipation. [Da Costa.) 



R. Chloralis Hydratis, . . . gss-j. 

Sodii Hyposulphitis, . . . £j. 

Aquae Menthse Pip., . . ad^'n). 
M. Sig. — A teaspoonful in water after 
meals in nervous dyspepsia with severe 
gastric pain. 



rnvnj. 



R . Creosoti, 

Bismuthi Subcarb. , . 

Glycerini, 

Aq. Menth. Pip., . . . aa^j. 
M. Sig. — To be well shaken. A teasp. 
every 3, 4 or 6 hours, for pain in stomach 
and wind. (B.) 



rjt . Pepsini (Jensen), .... ^iijss. 

Ac. Tartarici, gr. v. 

Glycerini, 3J SS - 

Vini Xerici, . . q. s. ad gviij. 
M. Sig. — Teasp. or two after meals. 



JJ . Tinct. Nucis Vom., . . . ^iij. 

Ac. Hydrochlorici Dil., . gv. 

Glycerini, t ^ij. 

Aquae Lauro-cerasi, . . . ^j. 
M. Sig. — Dessertsp. before meals, 
improve appetite and digestion. 



Bi. Bismuthi Subnitratis, . . . 3Jss. 

Pepsini, . _ £j. 

Strych. Sulphatis, . . . . gr. j. 

Tinct. Cardam. Co., q. s. ad£ iv. 
M. Sig. — Teasp. thrice daily in water. 
For bilious dyspepsia. 



R- . Sodii Bicarb., gij. 

Spt. Ammon. Aromat., . . gij. 

Tinct. Zingib., '. . . . . !|j. 

Infusi Gentianse Co., . . ad gviij. 
M. Sig. — Teasp. or two thrice daily. 
For acid dyspepsia. 



Fx. 



Rhei, Gentianae, et Carda- 

momi, contus., . . . aa^ij. 
Spt. Vini Gallici, . . . . ^ij. 

A q u£e > o v J- 

Macera per horas 48, cola et adde- 
Tinct. Nucis Vomicae, 



Potassii Carbonatis, 



M. Sig. — Tablesp. in water thrice daily, 
before meals. 



Dysphagia. 

Cocaine, the Hydrochlorate in solution, 20 per cent., as spray or by swab, re- 
lieves the dysphagia of phthisical laryngitis (P). Cajuput Oil, in nervous dys- 
phagia, used in India with considerable success (P). Potassium Bromide, for 
congenital dysphagia of liquids in children, when no diphtheria or malforma- 
tion (R) ; in hysterical dysphagia (Wa) ; benefits a curious affection sometimes 
seen in children, who from their birth can swallow solids with ease but choke at 
liquids (R). Sprays of Ammonium Bromide, Chlorine-water, or other sedative 
agents in warm solution, for the dysphagia depending on specific disease of the 



DYSPNEA DYSURIA. 



68 3 



larynx (Muirhead). Galvanism, in the vicinity of the esophagus will speedily 
remove hysterical dysphagia (Muirhead). Tonics, as Strychnine, Iron and 
Quinine, for post-diphtheritic dysphagia. Iced Fluids, slowly swallowed, will 
often remove spasmodic dysphagia (Wa). 



Dyspnea. 

Morphine, hypodermically, the most efficient agent in relieving dyspnea 
from cardiac disease, or any other form ; but if albumin in the urine it must be 
withheld (Allbutt) ; controls dyspnea from any cause, more energetically than 
any other agent, giving the very power to breathe (Huchard). Grindelia, of 
great service in dyspnea with cough, occurring in emphysema (W). Cimicifuga, 
has often relieved most distressing cases from cardiac disease (P). Spigelia 
Anthelmia, produces and often relieves it when with palpitations (P). Valerian 
has proved useful when nervous (P). Prunus Virginiana, has proved very 
efficacious in cardiac dyspnea (P). Amyl Nitrite, serviceable in cardiac 
dyspnea and other forms (Wa). Asafoetida, in combination with other anti- 
spasmodics, often very beneficial in dyspnea of chronic bronchitis (Wa). 
Strychnine, is a stimulant of the respiratory centre, and in small doses is use- 
ful for the dyspnea of pulmonary affections and that with cardiac palpitation 
in hysterical subjects. Arsenic, is efficient in the dyspnea of weak heart and 
in that of chronic bronchitis. Ether, in 3-doses internally, for uremic dyspnea 
(Whitla) ; seems to be of service only where there is much pulmonary en- 
gorgement [see under Uremia]. Chloroform, a few whiffs give great relief in 
the cough and dyspnea of phthisis and bronchitis (Wa). Ethyl Iodide, by 
inhalation, is very serviceable in many forms (See). Terpin Hydrate, of espe- 
cial value in asthmatic dyspnea, gr. ij every % hour until gr. x are taken 
(Boyland). Terebene, for the dyspnea of chronic emphysema of the lungs ; 
efficient in combating this symptom of various pulmonary affections. Bleed- 
ing, in a plethoric subject of pneumonia, with firm and incompressible pulse, 
suffering from dyspnea, or much pulmonary embarrassment and lividity, may 
be relied on to turn the scale in the patient's favor (Whitla). Oxygen inhala- 
tions, relieve the dyspnea of advanced phthisis and also the cardiac dyspnea 
connected with mitral disease (P). Dyspnea is a symptom, and may be due 
to cardiac, pulmonary, pharyngeal, laryngeal or tracheal disease (T). [Com- 
pare Angina Pectoris, Asthma, Bronchitis, Croup, Emphysema, Phthisis, 
etc.] 



U. Potassii Iodidi, .... gj. 
Tinct. Lobelise, . . . . ^ iv. 
Syr.'Sanguinarise, . . . Jj. 
M. Sig. — A teasp. every hour. 



R- . Liq. Morph. (Magendie), 3 j. 
Spt. Athens Compos., . J^ij. 
Syr. et Aquae, aa q. s. ad % iv. 
M. Sig. — 3J-ij thrice daily. 



Dysuria. 

Cantharis, gtt. j (sometimes v) of tincture ter die, for frequent micturition with 
pain (R) ; for irritable bladder, vesical tenesmus (B). Cannabis Indica, relieves 
dysuria (R) ; when bloody urine (P) ; an excellent anodyne in painful affections 
of the bladder, having specific action on that organ. Belladonna and Hyos- 
cyamus, have similar sedative effects in vesical and urethral irritation (P). 
Linseed, as infusion, is often a valuable adjunct (P). Opium, in suppository, 
gr. ij combined with Hyoscyamus, gr. x, an excellent palliative (P) ; an enema 
of Laudanum or Morphine hypodermically to relieve the strangury caused 
by blisters (B). Camphor, is said to relieve strangury (R). Chimaphila, has 
undoubted power (P). Squill, often produces the best effects, especially a com- 
bination of the Acetum with Spt. Athens Nitrosi equal parts, of which 5ss in 
^ij of Anise-water, every hour or oftener (Wa). Gelsemium, a useful remedy 



684 EAR AFFECTIONS ECTROPION. 

(B). Ergot, in paralytic dysuria, with sensation of bladder being imperfectly 
emptied (P). Alkalies, the Citrates, when dysuria from uric acid crystals in 
young male children (R). Nitrous Ether, Spt. Athens Nitrosi, 3j-jss in any 
convenient vehicle, a popular and efficacious remedy (Wa). Diluent Drinks, 
freely, especially a decoction of Uva Ursi or of Cotton-root (P). [Compare 
Vesical Sedatives, Bladder Irritable, and Cystitis.] 



Ear Affections. 

Boric Acid, dry by insufflation, to destroy aspergillus in the external meatus ; 
used after weak astringent injections, leeches, fomentations, etc., in general 
inflammatory conditions of the external ear (Whitla). Sodium Bromide, in 
large doses, gr. xxx ter die, gives some slight benefit in tinnitus aurium (Id). 
Cocaine, by instillation, sometimes gives considerable relief in tinnitus aurium, 
from its influence on arterial pressure (Id). Water, warm, by syringe, to re- 
move wax and foreign bodies. Olive Oil, poured into the canal, to drive out 
insects or their larvae. Iodol, renders good service in eczema of the ear ; in 
moist, confluent eczema of the pinna, extending within the auditory canal, the 
surfaces should be thoroughly cleansed and the powder insufflated into the 
canal ; in dry, external eczema it is best applied in the form of a Lanolin oint- 
ment. The inflammation disappears completely under this treatment in about 
2 weeks, but irrigation should be kept up for a short time afterwards to com- 
plete the cure (Chatellier). [Compare Boils, Deafness, Otalgia, Otitis, 
Otorrhea, Vertigo.] 

Ecchymosis. 

Arnica, rapidly disperses, if administered shortly after injury, rr^v-x in water 
every two or three hours (P). Alcohol, diluted more or less, according to the 
amount of irritation present, is a good lotion (P). Hamamelis, the tincture 
diluted with 5 to 8 parts of water, as lotion, when much discoloration. Ammo- 
nium Chloride, in solution, as lotion on lint, or with bread or Linseed to form a 
poultice, in ecchymosis of the eyelids (Wa). Capsicum, the tincture or a strong 
infusion mixed with an equal bulk of mucilage or gum arabic and a few drops 
of glycerin added, painted on over the bruised surface, a second or third coat- 
ing being applied as soon as the first is dry ; there is nothing to compare with 
this treatment for a black eye. [Compare Bruises, Purpura.] 



Ecthyma. 

Quinine, cures, though in many subjects will cause it (B) ; when due to mal- 
nutrition (R). Lead, the Liquor Plumbi Subacet., 3j ad Oj aquas, a soothing 
application (Wa). Zinc Oxide, the Glycerite with a little Camphor, an excellent 
application (Wa). Cod-liver Oil, internally and locally (B). Grape-cure, often 
happily modifies (P). Borax, a solution in rose or elder flower water (Wa). 
Chlorinated Lime, a solution as a lotion (Wilson). Chrysarobin, internally, 
half-grain doses, in wafer or pill, given with good results (Stocquart). 



Ectropion and Entropion. 

Silver Nitrate, freely to the exposed surface, in ectropion of lower lid due to 
hypertrophy of conjunctiva after inflammation (C). Collodion, successfully 
used in entropion to restore position of the lid by its contraction ; should be 
concentrated (Wa). Faradization, in paralytic ectropion (C). Operative 
Measures, of great variety, are in use, Arlt's being the best for bad cases of 
the upper lid (Roosa). Epilation of lashes gives temporary relief in entropion. 



ECZEMA. 685 



Eczema. 

Aristol, is an excellent application. Mercury, as black and yellow washes in 
early vesicular and pustular conditions ; mercurial ointments are the most 
efficient of the local applications, especially those of White Precipitate, Nitrate, 
mild Chloride, and Black Oxide ; ointments of the Biniodide or Bichloride as 
irritating application in chronic indolent form (Pf ) ; Brown Citrine Ointment 
nightly in eczema of the margin of the eyelids after detaching scales (B) ; very 
useful when eczema on hairy parts of face ; often is best mixed with a tar oint- 
ment (R). Arsenic, rr^v of Fowler's solution thrice daily on a full stomach, 
gradually diminishing the dose, in the chronic type (B) ; especially in eczema of 
vulva, anus and scrotum (R) ; small doses for acute, full doses for chronic form ; 
the urine to be closely watched and the drug discontinued on the least sign of 
renal irritation (Pf). Sodium Arsenate, hypodermically into an eczematous 
patch, to change the indolent form into an active one (Pf ). Rhus Tox., exter- 
nally and internally, when burning and itching, quickly subdues in some cases 
(P) ; in chronic form with rheumatism, worse at night-time ; also in acute cases 
if given at the very beginning, ttIt&o of a good tincture is dose enough to begin 
with (Pf ). Phosphorus, of undoubted service in eczema of long standing, prob- 
ably acts as a hepatic stimulant, gr. y^ to -^ in oil or reliable pill (Pf ). Viola 
Tricolor, an infusion the best form, with purgative doses of Senna for a few days 
then alone, in eczema of the head and face ; gives prompt results (good or bad) ; 
often aggravates, which though good in chronic forms must be avoided in 
acute types (Pf ). Calcium Sulphide, gr. j^ to -£% in acute and chronic cases 
of pustular character, the impetigo of old writers; small doses in acute form, 
larger ones in chronic cases (Pf). Sulphur, internally and Sulphides as baths, 
but not in the acute stage (R) ; solution of Potassium Sulphide in water locally 
(B). Liquor Potassse, or a stronger solution of Potash, to infiltrated patch of 
chronic eczema, before attempting to heal it (Pf ). Croton Tiglium, the seeds 
bruised in alcohol, as liniment (Wa) ; the Oil as basis of stimulating applica- 
tions in the chronic form (Pf ). Glycerite of Tannin, locally (R). Potassium 
Iodide, is often efficient where a syphilitic history or inheritance can be traced. 
Salicylic Acid, locally, in eczema of hands and feet has been very successful 
(B) ; in plaster is of very great value, and becoming more recognized (Unna, 
Pick) ; the best form is a salicylated soap-plaster (formula on next page). Salol, 
as an antiseptic powder, has done good service. Belladonna, gr. % of extract 
with gr. iij of Quinine Sulphate thrice daily in eczema of the hand , with Bismuth 
Subcarbonate as a dusting powder (B). Zinc Salts, the Oxide and Carbonate 
as dusting powder, or the Sulphate, etc., in astringent ointments (Bulkier). 
Buckwheat Flour, one of the best dressings ; a limb may be enveloped in a bag 
filled with the flour (Bulkley). Tar, internally, the Pix Liquida in doses of gr. 
ij-v thrice daily, when Arsenic fails to relieve or is contraindicated ; locally in 
third stage when redness, drying and scaling; Oleum Cadini when genuine 
is the best form of tar, mixed with simple ointment, 3ss-j to the 3j : 01. 
Rusci or Pix Liquida may be used (Pf ) : Tar should never be used in the moist 
stage, but only after the acute inflammatory symptoms have subsided, and then 
cautiously; a useful combination, and one less likely than tar ointments to 
cause irritation, is 01. Cadini, 3j-iij, 01. Amygd. Dulc, q. s. ad gj, brushed 
lightly over the diseased surface. 

Conium, the tincture may be added to one of the ointments for the pruritus, 
which is usually very obstinate ; so also Stramonium or crude Petroleum (Pf ). 
Hamamelis, locally as antipruritic, and in chronic eczema marked by decided 
venous retardation (Pf). Benzoin, to allay itching, the compound tincture 
painted on the skin (R). Lead, soluble salts as lotions when much inflamma- 
tion and discharge (R) ; also in early vesicular and pustular conditions ; 
Diachylon ointment comes next in efficiency to mercurial ointments (Pf). 
Zinc, the Oxide and Carbonate as dusting powders (R) ; the Sulphate with 
Alum, Glycerin and Rose-water, an excellent lotion (B) ; the Oxide is not 



686 



ECZEMA. 



curative, but as a protective is the best ointment, when freshly and well made, 
for use over a large surface (Pf ). Lime-water, as sedative application and to 
check discharge ; after inflammation is subdued, Lime-water and Glycerin (R) ; 
mixed with Carron Oil a very good application in acute eczema. Carbolic Acid, 
externally and internally in chronic forms (B) ; is analogous to Tar, and suit- 
able to the same types of the affection as the latter is (Pf). Phytolacca has cured 
obstinate cases (B). Graphite, in ointment, i to 10, or with some inert powder, 
as Lycopodium or precipitated Calcium Phosphate, in fissured eczema, espe- 
cially that of the hands and behind the ears (Pf). Bismuth, the Subnitrate or 
Subcarbonate locally (R) ; the Subgallate (Dermatol) has proven very useful 
in the treatment of moist eczema. Ichthyol, a promptly efficient remedy. 
Thiol, may well replace Ichthyol ; the dry form as a dusting powder has been 
used with remarkable benefit. Anacardium Orientale (Oil of Cashew), as oint- 
ment in patches of indolent chronic eczema (Pf). Iris Versicolor, in chronic 
eczema of gouty patients invaluable as a hepatic stimulant, rr^v-x of tincture 
from the fresh root twice daily (P). Glycerin, locally at night when caustic 
lotions have been used (R). Electricity has cured obstinate cases (B). Milk- 
cure, when acid indigestion present (B). Thyroid Extract, has been used with 
benefit (see page 158). Water, locally is injurious, unless its sp. gr. approaches 
that of the blood serum ; Rose-water with a little Glycerin and Sodium Chlor- 
ide when ablution necessary in second stage, that of exudation and crusting 
(Pf). Soaps, Petroleum, Cade or Carbolic (R) ; Sapo Viridis, to soften up in- 
filtrated patches of chronic form, instead of the potash solutions mentioned 
above (Pf). Chaulmoogra Oil, in old cases is often of great benefit, as an 
ointment (Wa). Oil of Cajuput, put up by mistake of druggist for Oil of Cade, 
made a remarkable cure in a case which had resisted treatment for some time 
(Claiborne). Diet should be largely vegetable, especially vegetables which are 
eaten raw ; Cod-liver oil as a supplemental article of diet. 



R. Violae Tricolor, %). 

Sennae, Jss. 

M. Fiant chartulse no. iv. 
Sig. — Make an infusion with hot water 
from each paper, and take every night. 

{Piffard.) 



R. Vini Ferri Amari, .... ^ jss. 

Syrupi Tolutani, giij. 

Liq. Potass. Arsenit., . . £j. 

Aquae Anethi, . . . . . . §ij. 

M. Sig. — A teasp. to a dessertsp. thrice 
daily. ( Wilson.) 



R. Potassii Citratis, gij. 

Liq. Potassii Arsenit. , . . gj-ij. 

Tinct. Nucis Vom., . . . 3ij. 

Tinct. Cinchon. Comp.,a^/ Jiv. 
M. Sig. — A teasp. in water, after meals, 
as a tonic and alterative. {Bidkley.) 



R. 



Emplas. Diachyli Simplicis, 
Emplas. Saponat., . . . aap. xl. 

Petrolati, p. xv. 

Acidi Salicylici, p. v. 

Sig. — Emplas. Salicyl. Compos. [Pick. 



R. Acidi Salicylici, gj. 

Zinci Oxidi, ;5"j- 

Pulveris Amyli, Z 1Y - 

Adipis Lanae Hydrosi, . . Jj. 
M. Fiat unguentum. Sig. — Apply daily 
as a paste for eczema. {Practitioner.') 



R 



. Hydrarg. Ammoniat., . . gr. xv. 

Glyceriti Amyli, !|j. 

M. Fiat unguentum. [Midler.) 



R . Olei Cadini, 

Zinci Oxidi, . . . 

Ung. Aquae Rosae, 
M. Sig. — Ointment, 
mildly astringent. 



. . aa ^ ss-j. 

■ • • Eh 

Antipruritic and 
{Bulkley.) 



R . Aluminis, gr. xx. 

Zinci Sulphat., gr. x. 

Glycerini, . gj- 

Aquae Rosae, % iv. 

M. Sig.— Lotion. (B.) 

R. Liq. Plumbi Subacet., . . :§j. 
Glycerini, % ss. 

Aq. Laurocerasi, .... ^ijss. 
M. Sig. — Lotion, where there is much 
weeping. (B.) 



EMACIATION EMPHYSEMA. 



687 



& . Picis Liquidce, 




Pulv. Sem. Anisi, . . 


. aa^ijss. 


Magnesiae Calcin., . . 


. . q. s. 


M. Ft. pil. no. c. Sig. 


— Two to ten 


pills daily. 


(Miguel.) 



R-. 01. Cadini, ^ss. 

Glycerini, ^j. 

Ung. Diachyli, ^ ijss. 

M. Ft. unguentum. In squamous ec- 
zema with thickened skin. (Fox.) 



Emaciation. 

Calcium Phosphate, is especially useful in chronic wasting disease (R). 
Arsenic, is used by cattle-breeders to fatten oxen, etc., quickly (Tr). Iodine, 
improves the appetite and digestion, and gives strength and plumpness to the 
body (Wa). Cinchona, in small doses' improves the appetite and the general 
tone (Wa). Iron Salts, cause marked gain in flesh and color (Wa) ; remark- 
ably promote the appetite and digestion (B). Cod-liver Oil, internally and 
externally with friction, often very effective in the malnutrition and marasmus 
of children (P). Olive Oil, by friction daily ; inunctions are of value in many 
wasting diseases (P). Pepsin, to promote digestion of food (P). [Compare 
Appetite, Atrophy, Phthisis, Tabes Mesenterica.] 

Emissions and Erections. 

Hyoscine, the Hydrobromate in pill, gr. y^ to -^ at bed-time, will always 
check seminal emissions (W). Belladonna, when emissions, genitalia relaxed, 
atonic state (B) ; in gradually increasing doses produces good results, even in 
extreme cases of emissions (Wa). Camphor, fails as often as it succeeds (P). 
Potassium Bromide, exercises special influence as a sedative in irritable states 
of the genito-urinary organs (Wa). Cimicifuga, as tonic to the nervous system, 
removes irritation and melancholy, procures sound and refreshing sleep (Wa). 
Lupulin, useful to check emissions (P) ; gr. v-x or xv to keep penis at rest 
(Wa). Ruta, in small doses to limit discharge (P). Chloral, at bed-time, re- 
peated every night until the habit is broken off (Wa). Iron, the tincture of 
the Chloride in g doses at bed-time, sometimes conquers nocturnal emissions 
(Wa). Cocaine, a few drops of a 4 per cent, solution upon the glans penis, 
promptly controls an erection. [Compare Chordee, Spermatorrhea, and 
the List of Anaphrodisiacs on page 31.] 



Emphysema of the Lungs. 

Morphine, gr. l /e, and Atropine, gr. T ^, hypodermically for the asthmatic at- 
tacks : no remedy so efficient; the disease being incurable treatment must be 
chiefly palliative (B). Potassium Iodide, in full doses alone or combined with 
the Bromide, affords most relief next to Morphine (B). Strychnine, is a valu- 
able respiratory stimulant ; useful where there is constant dyspnea with pro- 
longed expiration (Wa). Stramonium, the leaves smoked for the asthma and 
dyspnea before retiring, will often give a good night's rest (Wa). Ammonium 
Iodide, with Arsenic for the bronchitis, with Copaiba, Turpentine or Eucalyp- 
tol, continued for some time (B). Digitalis, or hydragogue cathartics as Pulvis 
Jalapas Comp., for the dropsy (Da C). Arsenic, when emphysema is con- 
nected with recession of a rash, is useful (R) ; long continued it ameliorates 
(B). Terebene, gives good results on the dyspnea. Lobelia, allays the dysp- 
nea which accompanies capillary bronchitis in emphysema (R). Senega, 
often acts beneficially (P). Cod-liver Oil, continued for a long time (R). 
Hypophosphites, are useful (B). Chalybeates, the Phosphate of Iron, Quinine 
and Strychnine (B). Grindelia, for asthmatic breathing and bronchitis (B) ; 
of great service (Wa). Chloral, for the short breath of such patients brought 
on by catching cold ; if obstructed circulation caution required (R). Bleeding 
and Purging, have been used with great success in many emphysematous con- 
ditions (R). Breathing into Rarefied Air, the only scientific remedy yet brought 



688 EMPYEMA ENDOMETRITIS. 

forward for this affection, affording much relief which is sometimes permanent. 
The Waldenberg-Schlitzner apparatus is the best for this purpose. When there 
is co-existing bronchial catarrh it is necessary to precede the expiration into 
rarefied air by inspiration of compressed air, else irritative cough is excited 
(Y). [Compare Asthma, Bronchitis, Dyspnea.] 

R. Potassii Iodidi, giij. R. Potassii Chlorat 



Strychninae Sulph., . . . gr. j. 
Liq. Potassii Arsenit., . . ^ijss. 
Aquoe Laurocerasi, q. s. ad £ iv. 
M. Sig. — Teasp. 4 times daily. For 



Tinct. Belladon., . . . aa^jss. 
Ext. Pruni Virgin. Fluidi, 
Tinct. Cinchonae Comp., aa^ij. 
M. Sig. — A dessertsp. 4 times a day, 



relief of dyspnea, toning the cardiac ac- when chronic bronchitis and anorexia, 
tion, removing the bronchial catarrh, and Dry cups also to chest night and morning, 
preventing the progress. [Hughes.) ' [Da Costa.) 



Empyema. 

Carbolic Acid, a weak solution to be injected after evacuating the pus (R) ; 
Carbolate of Iodine has been injected with benefit (B). Iodine, in solution to 
be injected after tapping (R) ; the undiluted tincture may be thrown in without 
risk and with great benefit ; or the compound solution ^j to ifxv aquse, as wash 
for the cavity to prevent re-formation of pus (B). Chlorine Water, or a solution 
of Quinine, to wash out the cavity (R). Salicylic Acid, in solution, answers 
well for the same purpose (P). Ammonium Acetate, the official Liquor Ferri 
et Ammonii Acetatis, with Quinine and stimulants, if the affection shows a ten- 
dency to linger (Da C). 

Endocarditis. 

Aconite, should be given early in all inflammations of serous membranes 
(Wa) ; gtt. l / 2 or less, frequently (R) ; it is rare to meet with permanent organic 
heart disease as a result of rheumatic fever when the disorder is treated with 
Aconite from its commencement (P). Spigelia Anthelmia, is very useful in 
rheumatic endocarditis (P). Opium, in inflammation of serous membranes 
(B). Digitalis, to control the circulation, especially where irregular heart 
action (Da C). Veratrum Viride, has been used with remarkable effect on the 
pulse (Wa). Alkalies, as Potassium or Ammonium Carbonate, freely until 
urine is alkaline, to prevent permanent changes about the valves or orifices 
(Da C). Potassium Iodide, to promote absorption of the exuded lymph. 
Quinine, at the onset, may check the inflammation (B). Salicylic Acid, is use- 
ful in the rheumatic form (P). Iron, the tincture of the Chloride with alkalies, 
if pyemic symptoms are manifested (Da C). Rest for some days after active 
signs have abated, with agents to lower the blood-pressure within the heart and 
vessels (Fothergill)'. Leeching, in the stage of acute inflammation is to be 
recommended if done early, later is useless ; use cups if no leeches are at hand 
(Da C). Poultices, give great relief and are of decided benefit (Id). Stimulants, 
as Ammonium Carbonate, etc., freely, if signs of oppressed circulation appear 
(Id). [Compare Pericarditis.] 



Endometritis. 

Carbolic Acid, undiluted, on cotton-wrapped probe ; no better method of 
treating uterine catarrh (B). Iodine, the most valuable of all local remedies 
(E) ; Churchill's tincture (Iod. gr. 75, Pot. Iod. gr. 90, Alcohol ^j), one of the 
most useful applications to the endometrium (Munde). Iodized Phenol (Iodine j, 
Ac. Carbol. iv), on cotton-wound probes, applied to the uterine cavitv, has 
given the best results of any agent used for years past (Battey.) Chromic 



ENEMATA ENTERITIS. 



68 9 



Acid, as caustic, when slough is required ; should only be used after dilatation 
of cervical canal, and at the patient's home (Munde) ; a solution of gr. xv to 
Z) of hot water applied with success to the uterine cavity for catarrh (Wooster). 
Nitric Acid, fuming, to uterine cavity through intra-uterine speculum (Atthill) ; 
is considered by many the one agent for all forms of intra-uterine medication ; 
is efficient and comparatively safe but produces too much cicatricial tissue 
(Munde). Iodoform, as suppository in rectum (B) ; in pencils to uterine canal. 
Iodo-tannin, locally in chronic cases (B). Ergot, or better Ergotin gr. j, sub- 
cutaneously, for the train of uterine disorders depending on passive congestion 
of the organ (P). [See Hysteria for formula.] Glycerin, as a local application, 
introduced by Sims, is of great value ; especially as vehicle for impure Carbolic 
Acid or Iodine, on cotton or oakum (E). Hot Water injections in large 
quantity about the os uteri, are of great value (E) ; as usually made are of no 
value; must be applied by special syringe, in the dorsal recumbent posture 
with elevated hips, at a temperature of ioo° to I20°F. twice daily for at least 20 
minutes each time, and persevered in for months and years (Munde). [Com- 
pare Uterine Congestion and Hypertrophy.] 



R . Potassii Iodidi, 

Potassii Bromidi, . . . aagr. xx. 

Tinct. Iodi, £ss. 

Aquae, Spj. 

M. For hypodermic injection into cer- 
vix, in chronic cervical metritis. [Bennett.) 



Be . Ergotini, gr. xx. 

Tinct. Iodi, sjj. 

Glycerini, . . . . q. s. ad%). 

M. Sig. — Apply twice daily with cam- 
el's-hair brush, in cervical metritis. 

[Dabney. ) 



Enemata. 

Enemata, for an infant, ^ss-j ; child of 2 to 5 years, ^ij-vj ; 5 to 15 years, 
^vj-Oj ; adult, Oj-quart j. A simple domestic enema consists of soapsuds with 
a little common salt, or a pint of cold water (B). Simple warm water or gruel 
sometimes ; or to one or the other of these add Soap, Turpentine or Castor 
Oil, with soap or gruel to suspend the two latter. Very cold water may be 
used without inconvenience. Starch, boiled or raw, of cream consistence, tem- 
perature ioo°, with a few drops of Tinct. Opii, in extreme cases of choleraic 
diarrhea, or that of phthisis or typhoid fever (R). Nutrient Enemata, should 
contain materials for artificial digestion, as the rectum is not an organ of diges- 
tion, and to secure rapid osmosis should have an acid reaction. A suitable 
formula is appended below. Inject slowly and not frequently; five times in 
twenty-four hours should be the maximum. Defibrinated blood has also been 
used as a rectal injection with good results, being completely absorbed (B). 
Enemata should not exceed three or four ounces of bland material, injected 
slowly, after ascertaining that the rectum is not filled with feces (R). [Compare 
the subtitle Injectiones, ante, page 577.] 



Nutrient Enema. 
& . Infusi Carnis (Beef-tea), . ^ iv. 
Acidi Hydrochlorici, . . TT^x. 
Glyceriti Pepsini (SchefTer), 3 ij. 
If rectum irritable add 10 to 20 drops of 
Laudanum. 



Enema Ricini et Terebinthince. 

Be. Ol. Ricini, -fjss. 

01. Terebinth., i|ss. 

Ovum, j. 

Decocti Hordei, vet 

Aq. Fervid., E xlv ' 



Enteritis. 

Opium, to the point of tolerance, is the remedy, the deodorized tincture in 

10-drop doses every second or third hour, according to age (Da C) ; of great 

value to control inflammation and quiet the intestines (B) ; proves of signal 

use (Wa). Aconite, of great utility in acute inflammation with high tempera- 

44 



690 



ENURESIS EPIDIDYMITIS. 



ture, sthenic condition, resisting pulse (R). Arsenic, surprisingly curative; 
small doses with Opium (B). Podophyllum, with occasional doses of Aconite, 
will often allay the vomiting and diarrhea (P). Ricinus Communis, is employed 
with great advantage (P). Lime-water, in mucous enteritis. Turpentine 
stupes, hot, over seat of disease, are of advantage (Wa). Skim-milk, is of the 
highest value as sole diet in acute inflammation of digestive organs (B). 
Poultices, Linseed, large and hot (Wa) ; may be used or not, as the patient 
feels benefit from them or otherwise (Da C). Water, hot fomentations, followed 
by a wet compress ; cold and hot, principally cold, or ice, of unquestionable 
advantage (B). Ice or cold water freely swallowed. Perfect quiet in bed. 
Diet, no food until inflammation subsides, then beef-tea, milk, gum-water, etc., 
the very mildest and most bland diet for four or five days (Da C). [Compare 
Cholera, Diarrhea, Dysentery, Peritonitis, Typhlitis.] 



Enuresis. 

Belladonna, no single remedy so uniformly successful ; children require large 
doses ; small doses are useless (P) ; a solution of Atropine best, gr. y^ to ^ 
(B) ; the best remedy for children, gtt. x-xx of the tinct. three times a day ; if 
unsuccessful and no worms or other irritation exist, try Strychnine, Cantharides, 
Turpentine, Santonin or Galvanism (R). Santonin, in over-doses produces 
incontinence of urine in children, but curiously will sometimes stay the habit, 
even when not dependent on worms and in cases where Belladonna fails (R) ; 
in the enuresis from worms (P). Cantharides, one or two drops of the tinct. 
three or four times a day in middle-aged women or the aged, even when due 
to paralysis ; sometimes also in children, but for them Belladonna is generally 
better (R). Chloral Hydrate, enuresis in children (R) ; three-grain doses thrice 
daily for infantile incontinence (Da C). Strychnine, may succeed when the 
above remedies fail (B) ; sometimes useful for old people with paralysis of 
bladder, also for children (R). Quinine, in full doses, does good service in 
cases where chorea exists (Potts). Buchu, often successful in chronic enuresis 
(P). Turpentine, small doses sometimes remove the trouble (B). Lupulin, 
said to be useful ; Herzfelder used it with advantage. Rhus Aromatica, has 
proven curative in 75 per cent, of cases treated with it and of great benefit in 
the other 25 per cent. ; the fluid extract, rr^x-xv four times daily in glycerin and 
water (Stein). Scutellaria, remarkably efficient in many instances, 3) of the 
fluid extract thrice daily for a child 12 years old. Potassium Nitrate, has been 
recommended for children (R). Potassium Bromide, succeeds in some cases 
(Wa). Collodion, painted to form a cap over end of prepuce (R). Ergot, 
when from paralytic state of sphincter (B) ; said to be useful (R). Iron Iodide, 
the syrup n\,xv-xx, well diluted with water, ter die, in pale, delicate, strumous 
children (B) ; sometimes useful even when no worms (R). Habits, children 
to be taught to retain water as long as possible during the day, little salt to be 
eaten, abstinence from fluids not necessary, bland fluids diminish acridity of 
the urine. Removing meat from the diet has cured several cases permanently, 
after all remedies had been tried without success. 



R. Strychninae Sulph., . . gr. j. 
. Pulv. Cantharidis, . . . gr. ij. 
Morphinae Sulph., . . . gr. jss. 
Ferri Reducti, . . . . gr. xx. 
Ft. pil. no. xl. Sig. — One thrice daily 
for a child of 10 years. (Gross.) 



R . Tinct. Ferri Chloridi, . gij. 

Ext. Ergotae Fluidi, . . 3 v. 

Spt. Chloroformi, . . • jj ij. 

Tinct. Quassias, q. s. ad %iv. 
M. Sig. — A teasp. in a winegl. of water 
thrice daily for children. 



Epididymitis. 

Aconite, alternately with Pulsatilla, the latter in very small doses, a few 
drops of tinct. in a glass of water, a teasp. every 2 or 3 hours, produces the 
happiest effects (Pf, St). Belladonna, the extract, gj-ij ad gj of glycerin and 



EPILEPSY. 69I 

water, on lint, applied to the inflamed testicle (Bumstead). Tobacco, with Lin- 
seed meal, as poultice, cautiously ! (P). Mercury and Morphine, locally, a 20 
per cent, oleate by inunction, in cases of syphilitic origin (R). Silver Nitrate, 
gr. lxxx ad ^iv aquae destil. freely applied to the scrotum will sometimes abort 
an epididymitis (Wa). Strapping and suspensory bandage to support the testicle, 
also rest in the recumbent posture from the beginning, with a saline cathartic 
to clear the bowels, are all measures of great importance (Bumstead). [Com- 
pare Orchitis.] 

Epilepsy. 

Bromides, should be first employed in all cases, there being no remedy equal 
to large doses of Bromine salts, which should be persistently continued for 
many months, and with short periods of rest may be kept up for years ; the 
combination mixture of Bromides has been taken by patients for 8 to 10 years 
without harm (Brown-Sequard) ; Bromides taken for long periods without a 
physician's supervision have caused profound muscular depression, mental 
alienation and death (Hammond). Potassium Bromide, gr. xl ter die before 
meals, double dose at bedtime, for two or more years after all epileptic indications 
have ceased ; is generally useful, especially in daytime seizures and grand mal 
of sexual origin ; also for infantile convulsions (B) ; especially in convulsive 
form, but often powerless (R). Sodium Bromide, gr. xx ter die, will arrest epi- 
lepsy without producing the cerebral symptoms of bromism (Clymer). Lithium 
Bromide, 3ss daily, acts in some cases after Pot. Brom. has failed, and is gen- 
erally efficient in about one-half the dose of the latter salt (Weir Mitchell). 
Nickel Bromide, gr. v thrice daily, is remarkably efficient in the epilepsy oc- 
curring at the menstrual epoch, and cases which have withstood the action of 
the other bromides (Da C). Ferrum Bromide, will often cure cases in weak and 
anemic subjects; also with Potassium Bromide to combat the anemia and 
depression produced by the latter (B). Ammonium Bromide, preferred in 
petit mal by many authorities ; combined with other bromides, as in Brown- 
Sequard's mixture (see formula on p. 693), before meals, with Strychnine 
or Arsenic and a vegetable bitter after meals ; in combination with Antipyrin 
(see next page) is efficient (W). Zinc Bromide, gr. v in water and glycerin 
four times daily ; may be combined with the other bromides. Strontium 
Bromide, in doses of gr. xx thrice daily, gradually increased ; has been bene- 
ficially used as an alternate, being much less liable than the others to produce 
bromism (See) ; should be given in 30-grain doses, and combined with a 
fair dose of Physostigmine, when its effect on epilepsy is very marked (Stanley); 
both the Strontium and Calcium Bromides may be used with benefit (Fere). 
Aurum Bromide, is highly efficient in doses of gr. % to % (see page 209) ; 
Aurum and Arsenic Bromide, the solution in 5-minim doses thrice daily, in- 
creased to 10 minims, gave very satisfactory results in a severe case in a boy 
aged j}i years (Barclay). 

Opium, a valuable adjunct to the Bromide treatment, a prolonged treatment 
by opium rendering the organism extremely susceptible to the action of bro- 
mides ; for 6 weeks ascending doses beginning with 1 grain, up to a daily 
dosage of 15 grains or more ; then suddenly stopped and replaced by 30-grain 
doses of Potassium Bromide four times daily, produced instantaneous effect on 
cases in which all other medication for several years had failed (Flechsig). 
Digitalis, Belladonna or Physostigma, in combination with bromides give better 
results than the latter alone (Poulet) ; Digitalis, is valuable in petit w«/and in 
nocturnal epilepsy (Da C), a good addition to the bromides when there is 
cardiac weakness (Huchard) ; 10-minim doses of the tincture with 20 grains of 
Potassium Bromide thrice daily, in cases complicated with cardiac dilatation 
(Gowers). Belladonna, for petit mal and nocturnal epilepsy, in pale and anemic 
subjects, should be given for a year or more ; extract and leaves, gr. i of each 
in pill, every day at same hour, one additional pill every month (Tr) ; useful, - 
especially when from fright (P). Atropine better, drop-doses of a 1 per cent. 



692 EPILEPSY. 

solution of the neutral sulphate in white brandy (Tr). Arsenic, in epileptiform 
vertigo from stomach disorder (B) ; sometimes useful (R) ; the Bromide of 
Gold and Arsenic (see ante). Sodium Borate, in doses of gr. xx 3 or 4 times 
a day, has produced very good results in nocturnal epilepsy ; is of real value 
and better than Bromides in symptomatic epilepsy, may also be found useful 
in nervous forms after the bromides have failed (Mairet) ; if begun with 
small doses may be gradually increased to 90 grains a day ; when dose exceeds 
60 grains daily it is advisable to add glycerin to the water and syrup used as 
excipients (Dijoud) ; excellent results obtained from a combination of Borax 
with Bromides, especially Sodium Bromide (Alexander) ; in most cases the 
disadvantages of this drug more than counterbalance the slight benefits result- 
ing therefrom (Fere) : for cases in which Borax acts best, and for the results 
of Borism see page 82. Physostigma used in 12 cases, of which 6 were im- 
proved, and in the others a notable increase took place in the number of the 
paroxysms (Williams). Chloral, a valuable auxiliary in troublesome cases with 
tendency to insomnia, violent convulsions or maniacal excitement; should be 
given in the evening, combined with bromides and used with caution when 
cardiac debility (Y) ; in full doses at night the most suitable remedy for the 
nocturnal variety (B). Antipyrin in combination with Ammonium Bromide 
(gr. vj with gr. xx) has proved very efficient, alleviating some quite hopeless 
cases (W) ; is a real gain in the management of epilepsy (Y) ; Potts has pub- 
lished a report of 43 cases treated with this combination. Acetanilid, of great 
value where bromides fail, in four such cases it produced definite cures in doses 
of 7^ grains in cachets thrice daily (Dujardin-Beaumetz) ; of very uncertain 
action (Y) ; is most useful in the diurnal form and in cases of full habit, active 
circulation, red face, and injected eyes (B). 

Amyl Nitrite, inhaled at the beginning of the aura will prevent an attack 
(B) ; or TT^ij-v in mucilage, when fits are very frequent (R). Nitro-glycerin, 
rriToo> slower in action than Amyl Nitrite, but more enduring (Pf). Chloro- 
form, by inhalation during paroxysm and also in intervals (Wa) ; is of high 
value especially in cases of an hysterical character (Brown-Sequard) ; Anes- 
thetics are rarely called for (W). Amylene Hydrate, in 10 per cent, solution, 
of which a tablesp. or two (gr. 30 to 90) a day, of value in petit mal and noc- 
turnal epilepsy, also when bromides have failed, and where the attacks are not 
only very frequent but severe (Nache). Hydrastinine, has been used with 
benefit, in doses of gr. % to gr. y z of the Hydrochlorate, up to gr. ij daily. 
Picrotoxin, anemic subjects, attacks occurring at night, g 1 ^ to fa of a grain 
hypodermically or fa to fa by stomach (B) ; benefits cases resulting from 
onanism (P). Cannabis Indica, has given good results; is suitable for petit 
mal, the nocturnal variety, and with Strychnine, Belladonna, or Picrotoxin 
for cases characterized by anemia and depression (B). Quinine, when of 
malarial origin (P) ; often useful in intermittent epilepsy (Ros). Ignatia, in 
convulsions unattended with cerebral congestion (P) ; is par excellence the 
controller of functional phenomena of the cerebro-spinal axis (Pf). Strychnine, 
is useful in idiopathic epilepsy, but injurious in symptomatic form ; benefits when 
Potassium Bromide fails ; when cerebral anemia, nocturnal attacks (S, Pf ) ; if 
bromides fail and case is anemic, give Strychnine, gr. g 1 ^ ter die, and push it 
(B). Silver Nitrate, is not without efficacy, and was formerly much used, but 
the danger of staining the skin has caused its disuse, especially as better agents 
have been found (Wa). Copper Salts, maybe useful in cases originating from 
the stomach ; were formerly much used (B) ; the Nitrate or Oxide often given 
with benefit (R) ; the Ammonio-sulphate, gr. % in pill, thrice daily to begin 
with; should not be continued beyond 3 or 4 months at a time (Brown- 
Sequard). Zinc Salts, have been much used in place of silver and copper 
salts, not having the serious drawbacks attending the latter agents ; the Oxide 
is probably useful only in cases originating from the stomach ; much said for 
and against it (R) ; the Citrate and the Lactate are preferred by many, as less 
likely to cause stomach derangement (Y). Orchitic Extract, also Spermine, have 
been used with benefit (see pages 163, 164). Turpentine, has long been used, 



EPISTAXIS. 



693 



when due to reflex impression of intestinal parasites (B). Conium, not equal to 
the bromides (B) ; not of much value (P). Valerian, has been used with some 
advantage (R). Bryonia, has an ancient reputation (P). Rue, may benefit 
when seminal emissions (P). Solanum Carolinense (the Horse-nettle), in tinc- 
ture of the berries, made by bruising them and steeping in whiskey, has quite 
a reputation among the negroes for epilepsy and other convulsive affections, 
and has rendered good service in my hands (Napier). Fats" and Oils, espe- 
cially cod-liver oil when faulty assimilation exists (B). Galvanism, only in 
idiopathic epilepsy (B). Meat Diet, in many cases must be prohibited entirely. 
Trephining the skull, has given good results in several cases where a distinct 
impression from injury existed ; in others where apparently indicated it has 
been of no service. [Compare Convulsions.] 



R. 



Potassii Bromidi, . 
Ferri Bromidi, . . 

Aquae, 

Syrupi Simplicis, . 
M. Sig. — A tablesp. 



. . . gr. v 
■ ■ ■ §9; 

twice daily. 



U. Strychnine Sulphatis, . . gr. j. 

Acidi Sulphurici Dil., . . tr\x. 

Aquae DestiL, ^ iv. 

M. Sig. — A teasp. gradually increased 
to a dessertsp. after each meal. 



R . Potassii Bromidi, . . . 

Sodii Bromidi, . . . . aa ^ ss. 

Liq. Potas. Arsenitis, . . ^ss. 

Ext. Conii Fl., .... fr\L 

Aquae Cinnamomi, . . . :§ij. 

Infus. Gentian. Co., q.s. ad 3 viij . 
M. Sig. — A tablesp. two hours after 
each meal. 



Pe. Potassii Bromidi, 

Sodii Bromidi, 

Ammonii Bromidi, . . aa ^iij. 

Potassii Iodidi, 

Ammonii Iodidi, . . . aa £jss. 

Ammonii Carbonat. , . . . zj. 

Tinct. Calumbae, .... ^jss. 

Aquae, . . . . q. s. ad ^ viij . 
M. Sig. — A teasp. and a half before 
each meal, and three teasp. at bed-time. 

(Brown- Seauard.) 



R- . Potassii Bromidi, 

Ammonii Brom., . . , aa^ij. 

Ext. Ergotse FL, . . . . 'Jj. 

Aq. Cinnamomi, . q. s. <7c/Jviij. 
M. Sig. — A dessertsp. in water thrice 
daily. When maniacal excitement and 
danger of cerebral hemorrhage. (Smith.) 



Epistaxis. 

Aconite, has been used with the best results (P) ; small frequent doses 
quickly check epistaxis in children and plethoric people (R). Antipyrin, has 
been highly efficient; in 5 to 15 per cent, solution as a local hemostatic, it 
will arrest almost any nasal hemorrhage (Huchard). Arnica, is of great ser- 
vice when from mechanical violence (P). Belladonna, when of congestive 
origin (P). Ipecacuanha, has been highly praised (R) ; acts upon the vessels 
(B); gr. j-ij every quarter hour until nausea is felt, but vomiting need not be 
excited (Wa). Hamamelis, venous hemorrhage (Pf ). Ergot, 3ss-3j of fresh 
powdered Ergot, or ,5j-3ij of flu. ext. every half hour or hour, necessary in 
urgent cases (B). Alum, injected or snuffed up in powder (R). Iron Spray, 
in obstinate cases Liq. Ferri Subsulph., 3j to 3 v i i j aquae by spray or injection ; 
the tinct. of the Chloride also useful (B) ; diluted 3 ] j in 3 v j injected into the 
nostrils is often effectual (Wa). Tannin, finely powdered, blown into the 
nostrils through a quill (Wa); a strong solution, gij ad ^iv, by nasal syringe 
(B). Turpentine, may be given internally with advantage (Wa) ; especially in 
debilitated conditions (B). Lead Acetate, gr. ij-iv with Opium gr. ss-j, proves 
signally useful (Wa). Vinegar, on lint introduced into the nostrils, sometimes 
highly efficient (Wa). Digitalis, is of undoubted benefit (B) ; the infusion best 
(R). Transfusion, when death from exhaustion is apparently imminent (B). 
Facial Artery, compression of (R). Keep head elevated and cool, warm the 
feet and hands by plunging into hot water, apply ice over the nose, resort at 
once to the tampon if bleeding becomes alarming. Cauterize with electric 
cautery any ulcers in anterior nares. [Compare Hemorrhage for formulas.] 



694 ERUPTIONS — ERYSIPELAS. 



Eruptions Produced by Drugs, etc. 

Aconite, vesicular exanthemata. Antimony (locally), papules, vesicles, pus- 
tules, similar to the eruption of small-pox. Antipyrin, erythema and urticaria, 
chiefly on thighs and abdomen, with much itching and dyspnea. Antitoxin 
(Diphtheritic), erythema, with pain in the joints. Arsenic, erythema, eczema, 
papules, vesicles, pustules. Atropine, erythema, like the rash of scarlet fever. 
Belladonna, as Atropine. Borax, papules, scarlatiniform. Bromides, acne, 
chiefly on the face and back ; pustules, deep tubercles with ecchymoses, ulcers, 
pemphigus. Castor Oil, urticaria. Cinchona, as Quinine. Carbolic Acid, 
erythema. Chloral Hydrate, erythema on face and neck, itching, desquama- 
tion, eczema, petechias, purpura. Codeine, as Opium. Copaiba, also Cubeb, 
urticaria, erythema, eczema, pemphigus; the Copaiba rash has a preference for 
the ankles and wrists. Cod-liver Oil, acne. Croton Oil (locally), papules, pus- 
tules. Digitalis, erythema, after long usage. Enemata, of the simplest form, 
as soap and water, may cause a bright scarlet rash and other symptoms of a 
mild septic toxemia (Burford). Iodides, acne, papules, vesicles, pustules, 
eczema, ecthyma, ecchymoses and purpura ; the Iodide rash prefers the face 
and back of neck and shoulders. Mercury, erythema, eczema. Opium and 
Morphine, erythema, papular eruption with marked desquamation and itching. 
Phosphorus, purpura. Quinine, erythema, scarlatina, papular erythema, 
hemorrhagic purpura, pemphigus and prurigo ; the prevailing type of the 
Quinine eruption is erythema, or exceptionally eczema or purpura, and is 
essentially ephemeral ; it is of a bright vivid hue, disappearing on pressure, 
and resembles the scarlatinal rash, first appearing on face and neck, and thence 
spreads over the body : in some instances it comes in distinct spots and 
resembles measles ; in others it is an urticaria, with some edema, and distress- 
ing burning, tingling and itching ; five cases of purpura are authentically 
reported. Rhus Toxicodendron (and other varieties of Sumac), vesicles perhaps 
pustules, with redness, swelling and intolerable itching. Salicylic Acid, urti- 
caria, purpura, pemphigus, vesicular angina. Santonin, pemphigus, vesicles. 
Stramonium, as Atropine. Strychnine, as Quinine. Sulphur (locally), ery- 
thema, eczema. Tar, acne. Tartar Emetic (locally), as Antimony ; in some 
cases of poisoning by tartar emetic a rash of the above description appeared 
all over the body. Turpentine, as Copaiba. 

Articles of Food producing eruptions are : Acid Fruits, may cause acute 
eczema. Strawberries, urticaria. Apples, acneform efflorescence about the 
mouth. Walnuts, inflammation of buccal mucous membrane. Shell-fish, 
urticaria. Roast Turkey, in one case caused great urticaria. Lager Beer, 
acne in some. Alcohol, aggravates cutaneous inflammations. Butter, Oat- 
meal, Buckwheat, Fish, are popularly credited with causing eruptions, but 
there is no evidence therefor. Mangos, pemphigus and other eruptions, in 
persons who are no.t accustomed to this fruit. 



Erysipelas. 

Antitoxin (Streptococcus), see page 182. Pilocarpine, to abort the disease, 
very efficient if used early, gr. l /e hypodermically, or fluid extract of Jaborandi 
internally ; when free diaphoresis occurs, the temperature and pulse fall to 
normal and the disease is checked ; not suitable to debilitated cases or those 
with a weak heart (Da C). Aconite, a favorite remedy with Liston, if used at 
beginning when fever high (Wa) ; no more useful agent in idiopathic erysipe- 
las especially facial, and cases of sthenic type (B) ; at onset often cuts the 
attack short; is very useful in the erysipelas following vaccination (R) ; very 
valuable in sthenic cases (P) ; especially so in traumatic erysipelas (Tr). 
Belladonna, rr\,v of tincture in water every hour for five or six doses, also 
locally ; has astonishing power in superficial and non-vesicular forms, also 



ERYSIPELAS. 695 

when erysipelas attacks the brain and in the phlegmonous type (P) ; for simi- 
lar indications as noted under Aconite, also when adynamia ; if much fever 
combine it with Digitalis or Aconite, when much depression give it with 
Quinine ; gr. % of the extract with gr. ij of Quininse Sulph. every 3 or 4 hours 
(B) ; the extract with Glycerin, equal parts, spread thickly over the surface 
(Quain) ; should be used both internally and externally and may be combined 
with Aconite (R). Iron, Tincture of the Chloride, the nearest to a specific yet 
discovered ; the remedy of most service, any man being decidedly to blame 
who neglects its use ; requires decided doses, gtt. xl every 4 hours (Da C) ; 
treatment by it very general but questionable (B) ; should be given with 
shorter intervals than 4 hours (R) ; is very successful in this disease (P) ; ten- 
drop doses every hour, or r^xl every 4 hours (Quain) ; is also used locally with 
much success, being painted over the surface in full strength. Quinine, may 
be given with the Iron, also alone if thoracic complications, wherein Iron 
might be contra-indicated (Da C) ; if pulse soft and tremulous, or very rapid 
with low muttering delirium (D) ; a combination of Quinine and Tincture of 
the Chloride of Iron offers special advantages (Wa) ; in the more severe cases 
to sustain the vital powers and prevent cerebral embolism ; but large doses, 
gr. xv-xx every 4 hours, are alone of any use (B). Ammonium Carbonate, 
when feeble circulation, cyanosis and delirium, also when any signs of embol- 
ism appear (B) ; highly useful in debilitated subjects (Wa) ; after free purgation 
the continued use of this salt is all that is needed in most cases (Watson). 
Potassium Iodide, with agents to secure free action of the bowels, skin and 
kidneys, the most efficient treatment in erysipelas ambulans, in which Iron 
and Quinine are useless (Da C). Antipyrin, is particularly efficient when 
hyperpyrexia (Ernst). Rhus Tox., a very useful remedy in the vesicular form 
(P). Tartar Emetic, in doses of gr. ^ frequently repeated, renders incontest- 
able service (B). Calomel and Jalap, as purgative at onset, followed in 4 or 5 
hours by Magnesium Sulphate ^ss (Da C). Chloral, is an admirable adjunct 
to give sleep at night (Id). Turpentine, as a stimulant in traumatic erysipelas, 
more generally serviceable than alcohol (B). 

Local Applications. Silver Nitrate, by Higginbotham's method in traumatic 
form ; gr. lxxx of the brittle stick dissolved in giv of water and painted 2 or 3 
times over inflamed surface and beyond, after careful washing and drying 
(R) ; no agent more useful in subduing external inflammation. Iodine, 
painted over affected and neighboring surfaces, to prevent spreading (R). 
Ichthyol, is very efficient as a 10 to 25 per cent, collodion : Ichthyol and Ether, 
of each 5, Collodion 10 parts, with or without the addition of Castor Oil; has 
almost specific properties in this disease (Radcliffe). Thiol, dry, as a dusting 
powder, has given excellent results. Iodized Collodion, is very successful as a 
local application. [See formula on next page.] Collodion, a thick coat relieves 
(B). Digitalis, an infusion is of much service, applied as a lotion (R). Sulph- 
urous Acid and Glycerin, equal parts, or a solution of Sodium Bisulphite 
(Dewar). Zinc, Benzoated, as ointment, or the Unguentum Zinci Oxidi, any- 
thing to exclude the air, and whichever one is most agreeable to the patient 
(Da C). Bismuth, the Ointment of the Oleate, a very certain application to 
allay itching and burning, lessen pain, etc. (Shoemaker). Oil, by inunction, is 
very grateful in simple erysipelas (B). Oil of Turpentine, painted over surface 
is said to be remarkably efficient. Vaselin, Lard or Mercurial Ointment 
diluted, Z] to %j of Vaselin ; the simplest applications are the best (B). Car- 
bolic Acid, one part, with 8 to 14 parts of Oleic Acid, locally by inunction for 3 
or 4 minutes every % hour, all around the edge of the diseased part until it 
ceases to spread (Jacobi). Cotton Wool, sprinkled with flour or a mixture of 
Starch and Zinc Oxide, is a good application (B). Earth, clean yellow clay, 
free from grit or sand and powdered, applied directly to the skin in the form 
of a smooth paste, made by mixing it with water, the best of all applications, 
having properties of antiseptic, antiphlogistic, antipyretic, and antimorbific 
nature (Hewson). 

Tracheotomy, promptly if edema of glottis occurs, the operation giving time 



6 9 6 



ERYTHEMA ESOPHAGEAL AFFECTIONS. 



for inflammation to subside (Da C). Incisions, may be necessary in traumatic 
erysipelas when limb is greatly swollen and inflamed ; also in the phlegmonous 
variety (Id). Diet, a milk-diet is generally suitable ; should be light but nutri- 
tious (R) ; feed the patient well (Da C). [Compare Phlegmon.] 



R. Quininae Sulphatis, . . . 5jj. 

Ac. Sulphurici Dil., . . . q. s. 

Aquae, ^ij. 

Tincturae Ferri Chlor., . . ^ ss. 

Spt. Chloroformi, . . . . £vj. 

Glycerini, . . . . q. s. ad ^ iv. 
M. Sig. — A teasp. in water every two 
hours. (Loomis.) 



R . Tinct. Ferri Chloridi, 

Syrupi Tolutani, . . . aa^j. 

Liq. Potassii Citratis, . . 3 iv. 

M. Sig. — Teasp. to tablesp. according 

to age, every 3 hours. gj has TT^x, £ij 

has H\xx, ^ ss has TT\xl. {Anderson.) 



R . Pyroxylini, 3 j. 

yEtheris, 

Alcoholis, aa^v. 

Solve, et adde — 

Ammonii Iod. , gr. xl. 

Cadmii Iod., 

Cadmii Brom., . . . . aagr. xx. 

M. Sig. — For local use with a camel's 

hair pencil. If the cadmium salts are not 

to be had use gj Ammon. Iod., and gr. xx 

of Pot. or Amm. Bromide. [Humphreys.') 



R . Plumbi Acetatis, 

Ammonii Carb., . . . . aagj. 

Aquae Rosas, ^ viij. 

Ft. lotio. Sig. — Apply on lint, to allay 
irritation. [Peart.) 



Erythema. 

Antipyrin, internally for the itching, is efficient. Belladonna, useful in 
cases resisting ordinary treatment (B). Quinine, the most valued remedy 
in erythema nodosum (B). Rhus Toxicodendron, a valuable remedy (P). 
Zinc Sulphate, as lotion, with Alum and Glycerin [see Eczema, for formula] ; 
or the Acetate, in ointment (see below). Bismuth Subcarbonate, dusted over 
erythema about genitals of infants soothes pain and promotes healing (B). 
Mineral Acids, Nitric and Nitro-hydrochloric, have been advantageously used 
in erythema from imperfect digestion (B). Dusting Powders, of Starch, Lyco- 
podium or Buckwheat flour are very useful. Thiol, the dry form, as a dusting 
powder. 



R . Plumbi Carbonatis, 

Bismuthi Subnit, , . , aa^j. 
Sodii Bicarbonat., . . . . ,^ss. 
Ung. Zinci Oxidi Benz. , . 25 ij. 
Ft. unguentum. Sig. — Local use. 



R. Zinci Acetatis, gr. ij. 

Aquae Rosae, ^j. 

Ung. Aquae Rosae, . . . ^j. 
M. Sig.— Ointment. 



Esophageal Affections. 

Belladonna, the liniment with frictions to the sternum, often very useful as a 
palliative in stricture of the esophagus (Wa). Conium, in spasmodic contrac- 
tions, with crampy pains of stomach, flatulence, and globus hystericus, has 
proved very serviceable (Wa). Hyoscyamus, or Conium, in stricture of esoph- 
agus, if much irritability; with occasional leeching to relieve exacerbations 
of pain or spasm (D). Silver Nitrate, in stricture of the esophagus, a weak 
solution on sponge probang (D). Anesthetics, should be used only to meet 
temporary indications (W). Nutrient Enemata, in stricture of the esophagus, 
when swallowing impossible (R) ; may, in some cases, even preserve life (Wa). 
[See Enemata.] Dilatation, by bougies, in non-spasmodic (structural) strict- 
ure, the only appropriate treatment (H). [Compare Choking, Dysphagia.] 



EXHAUSTION EXOPHTHALMOS EXOSTOSIS. 697 



Exhaustion. 

Acetanilid, for the " tired feeling," a pinch put into the mouth, mixed with 
saliva and swallowed, rests one up in a few minutes and makes one as fresh as 
before (Brodnax). Arnica, a few drops internally for aching of the muscles 
(R) ; in nerve prostration with general aching from over-fatigue (P). Phos- 
phorus, for physical or mental exhaustion ; also in depression from overwork 
(R). Calcium Phosphate, combined with Calcium Carbonate and Ferric Phos- 
phate, gr. j of each for a dose (R). Potassium Bromide, when insomnia, bad 
dreams and irritability (R). Opium, gtt. j of Laudanum with 2 or 3 of the 
Tinctura Nucis Vomicae, 3 or 4 times a day, for symptoms of exhaustion with 
headaches, flushing and dyspepsia (R). Ammonia, internally ; its influence is 
but brief (R). Coffee or Tea, in hot or cold climates (R). Castor, is service- 
able but seldom used (P). Musk, benefits all forms of nerve-exhaustion (P). 
Cimicifuga, for headache from overstudy or excessive fatigue (R). Alcohol, 
of value in all conditions of fatigue (P). Coca, lessens the sense of fatigue 
under exertion, relieves thirst, and obviates the effects of a too rarefied atmo- 
sphere ; is suitable for weakly subjects easily fatigued and convalescents (P). 
Cocaine, has been used successfully in exhaustion from sunstroke, loss of blood 
and diarrhea (P). Wet Sheet, dripping, cold, as a restorative and to prevent 
aching of muscles (R). Sea Bathing, is also valuable (R). Habits, change of 
occupation better than absolute rest. [Compare Adynamia, Convalescence, 
Insomnia, Myalgia, Neurasthenia.] 

Exophthalmos. 

Exalgin, has been used with some success in the treatment of exophthalmic 
goitre (Churton). Belladonna, rtVv of tincture hourly, of great service (R) ; 
results recorded from its use are very remarkable, but Digitalis will usually 
answer better (P). Duboisine, gr. y^-g of the sulphate 2 or 3 times daily, has 
produced remarkable results in one case (Hunt). Opium, may be of use in 
some cases (P). Iron, with Digitalis, seems to do more good than any other 
medicine (Da C). Chalybeate Waters, are beneficial (B). Aurum Bromide, 
in daily doses of gr. y% to ye, continued until its characteristic headache is 
produced (Goubert). Bromides, with Iron, of very great value in the milder 
forms associated with anemia in young women (Y). Digitalis, to raise arterial 
tension and slow the heart, is decidedly ameliorative in young subjects (B) ; 
in some cases beneficial, but in others it increases the cardiac excitement and 
makes matters worse, while its tendency to cause gastric irritation is more 
manifest in this disease than in any other (Y). Strophanthus, quiets the cardiac 
action and is of real service in this malady ; 5 minims may be given thrice 
daily (Y). Convallaria, ameliorates the painful palpitation (Wa). Arsenic, 
gr. -gVj- twice daily, increased with intermissions up to gr. -^ daily, is my favorite 
remedy (Jaccoud). Zinc Valerianate, gr.j thrice daily, is valuable to allay the 
nervous symptoms and the insomnia (Y). Thyroid Extract, has proved bene- 
ficial [see page 159]. Splenic Extract, has given excellent results (W) ; [see 
page 166]. Pancreatin, in full doses successfully used (Liegeois). Galvanism, 
of the cervical sympathetic and pneumogastric, also of the eyes and thyroid 
gland, is decidedly curative in uncomplicated cases (B). 

Exostosis. 

Potassium Iodide, may promote absorption when recent ; also use friction 
with an ointment of Mercury or Iodine (D). Aconite, was used by Storck (P). 
Mercury, a moderate course of mercurials may be effectual, when exostoses are 
due to a blow or from syphilis (D). Excision, if required (MacCormac). Ex- 
ostoses of the clavicles in children almost always disappear of themselves (D). 



698 EYE DISEASES — EYELIDS. 



Eye Diseases. 

Belladonna, locally and internally in iritis, conjunctivitis and other inflam- 
mations. Atropine, in iritis, locally ; hypodermically in glaucoma (R) ; the 
best application generally in inflammatory conditions of the eye; the indis- 
criminate instillation of Atropine in persons over 35 or 40 years of age by 
general practitioners is to be condemned, being liable to light up an incipient 
or latent glaucoma. Pilocarpus, is used with great benefit in many eye- 
affections, particularly amblyopia from alcohol and tobacco, detachment of the 
retina, chronic iritis, keratitis, hemorrhage into the vitreous, glaucoma, muscse, 
atrophic choroiditis, hemorrhages of the retina, white atrophy of the optic 
nerve, and inflammatory affections with effusion and exudation, to promote 
resolution and absorption (Wecker). Strychnine, hypodermically in muscular 
asthenopia, amblyopia, amaurosis, and in progressive nerve-atrophy not de- 
pendent on intercranial disease (R) ; increases the sensibility of the eye, the 
field of vision becoming extended, and the vision more acute (Br). Ergot, is 
useful in many eye affections, especially disturbances of accommodation, acute 
and chronic inflammations, and the blepharitis and pustular conjunctivitis of 
children (Wa) : is a myotic. Acetanilid, is exceedingly effective in optic neuritis 
with pain, not only to remove the latter but also to arrest the inflammatory 
process (Dujardin-Beaumetz). Cocaine, as a local anesthetic in ophthalmic 
surgery, a 4 per cent, solution, by instillation, sometimes injection required, as 
into the muscles for squint operation ; is mydriatic, and in some cases panoph- 
thalmitis has resulted after operations under it (R). Chloroform, vapor, close 
to a photophobic eye, relieves (R). Oleate of Mercury and Morphine, outside 
the eye in palpebral conjunctivitis and stye ; also in syphilitic iritis (R). Silver 
Nitrate, Copper and Zinc Salts, are much used in weak solutions for conjunc- 
tivitis, etc. Euphrasia, had an extended reputation in Germany, is a mild 
astringent, and of service in catarrhal conjunctivitis (P). Pulsatilla, as lotion 
in inflammations and ophthalmic cases (P). Santonin, gives good results in 
inflammatory and atrophic conditions of the retina and optic nerve, and in the 
stage of effusion of many other inflammations (Wa). Ruta, minim doses, night 
and morning, in dimness of vision depending on functional amaurotic condi- 
tion, produces good results (P). Physostigmine, topically, to contract pupils ; 
to reduce excessive atropinization ; stimulates the third nerve (P). [Compare 
Amaurosis and Amblyopia, Asthenopia, Cataract, Conjunctivitis, Cor- 
neal Opacities, Glaucoma, Iritis, Keratitis, Myopia, Ophthalmia, 
Photophobia, Retina, Strabismus, etc., also the lists of Mydriatics, Myotics 
and other Agents acting in the Eye, on pages 57 and 58.] 



Eyelids. 

Calomel, locally, or Brown Citrine Ointment, as an application in many dis- 
eases of the lids (B). Mercury and Morphine, the 20 per cent, ointment with 
Lard, applied outside the lid, for stye (R). Pulsatilla, internally, and exter- 
nally as wash, in ophthalmic cases and inflammations; the so-called stye may 
often be aborted by this treatment (P). Cadmium, much esteemed as colly- 
rium, gr. ij of sulphate to ^j aquae rosae (R). Zinc and Copper Sulphates, are 
esteemed applications (B). [See Conjunctivitis for formulas.] Ergot, an 
aqueous infusion as a collyrium, in ptosis and paralysis of the eyelids (Wa). 
Tannin, a strong solution (1 to 3 aquas) locally ; or a weaker solution (1 to 20, 
30 or 50 aquae), is much employed ; also used in pomade, or as fine powder 
(Wa). Veratrine, in solution, brushed over lids once daily in painful spasmodic 
contraction of the orbicularis (Wa). Ammonium Chloride, in solution as lotion, 
for ecchymosis of eyelids, vulgarly known as black eye. Capsicum, the tincture 
or infusion for a black eye (see under Ecchymosis). [Compare Blepharitis, 
Conjunctivitis, Ecchymosis, Ectropion, Ptosis, etc.] 



FACE FALSE PAINS FEET FEVER. 



6 99 



Face. 

Amyl Nitrite, tt\, T \j to l /e, in 30 times its volume of spirits, for flushing of face, 
or sensation of flushing, with cold feet and hands and great prostration, occur- 
ring in women at change of life (R). Curare, effective in facial spasm, when 
other remedies failed (P). Blisters, behind the ear, in facial palsy, followed by 
warm covering to the part (H). Strychnine, has improved some cases of facial 
palsy (P). [Compare Acne, Freckles, Neuralgia, Odontalgia, Parotitis, 

TlC-DOULOUREUX.] 

False Pains. 

Tartar Emetic, with small doses of Opium and external fomentations, where 
evidence of congestion (L). Opiates, to allay uterine irritation, after rectifying 
any derangement of bowels (L). Opium, is valuable, having specific action 
on uterine muscular fibres, relaxing some, stimulating others (Wa). Acetanilid 
may be given with benefit. 

Feet. 

Arsenic, swelled feet of old or weak persons (R) ; edema of feet and ankles 
in the old, from feebleness of the heart (B). Lead, as ointment, equal parts 
of Emplastrum Plumbi and Linseed Oil spread on linen and wrapped round 
sweating feet, to be renewed every third day for nine days (R). Potassium 
Permanganate, solution gr. j to the ^ as a wash, will remove fetor of feet (B) ; 
temporarily discolors the skin. Boracic Acid, in strong solution, is used with 
good results. Chloral, 1 in 50 of water as bath, efficient against fetor. Sodium 
Bicarbonate, a solution freely applied will remove fetor (B). Belladonna, will 
check fetid secretions (R). Salicylic Acid, in solution with Borax, the most 
agreeable and efficient deodorant for fetid perspirations (B) ; 3jss-iij with giij 
of dried Alum in powder, applied freely to feet after washing and drying ; Acid 
Salicylic 3, Magnesium Silicate 87, is the composition of the powder used in 
the German army for sweating of the feet. Iron, the Chloride, mixed with y^ 
its weight of glycerin, as paint to the soles and interdigital spaces, in severe 
cases of sweating feet ; should be exposed to the air while drying ; repeat after 
48 hours at first, subsequently at longer intervals, during which the feet should 
be washed in vinegar and water night and morning and powdered with sali- 
cylated talc or starch and tannin (Vignol). Alum, powdered, locally, the most 
satisfactory application for bromidrosis (Baylor). Sodium Chloride, 3 table- 
spoonfuls to % a pint of water, as antiseptic lotion for tender feet, answers per- 
fectly in most cases. Ice, to the spine, or heat and cold alternately, to equalize 
the circulation, has been strongly advocated (Wa). Stockings, should be 
changed every day, and dipped in a strong solution of Boric Acid and dried, to 
effectually check fetid perspirations. Cold Footbath, and drying with friction, 
for cold feet (R). [Compare Chilblains.] 



R . Ac. Salicylici, . . . . gr. xv. 

Amyli, gr. cl. 

Talci, jfiij. 

M. ettrit. Sig. — Locally. (Kohnhorn.) 



R. Ac. Borici (pulv.), . . gjss. 

Vaselini, ^j. 

M. Sig. — Ointment for bromidrosis. 

( Championniere. ) 



Fever. 

\_See also the titles of the Fevers, in their alphabetical order. ~] 

Guaiacol, applied to the surface, as antipyretic (see page 294). Aconite, has 
the highest value in the eruptive fevers, also in all hyperpyrexias (B) ; always 
indicated in early stage of simple inflammatory fevers, pneumonia, and in 
most acute congestions (P) ; has marvellous power over sthenic fevers ; the 



700 FEVER. 

thermometer should go hand in hand with Aconite (R). Veratrum Viride, has 
considerable power as an antipyretic ; useful in rheumatism and pneumonia 
(P) ; in delirium ferox of fevers it is of value (B) ; strongly recommended in 
both sthenic and asthenic fevers (R). Belladonna, in the eruptive fevers, espe- 
cially scarlatina (B) ; in typhus, with delirium, insomnia, painful sensitiveness 
to light and sound, and in all hyperemic states of brain and spinal cord (P) ; is 
prophylactic often against scarlet fever (Pf ) ; in delirium of fevers, also excellent 
in typhus (R). Gelsemium, in remittent and typho-malarial, of real benefit ; is 
antipyretic (B); in bilious remittent, of value (Pf). Arsenic, in prostrating 
acute fevers to strengthen pulse and invigorate patient; except quinine no drug 
subdues intermittents so well (R); in malarial, especially typho-malarial, it is of 
great value (B). Quinine, in the eruptive fevers and all malarial, remittent and 
intermittent; as apyretic less effective and more dangerous than cold baths; 
useless in typhus and typhoid, except for hyperpyrexia (B); it is antimiasmatic, 
antiseptic, and antiphlogistic, and of great value in intermittent, septicemic, 
and hectic fevers (P) : large doses at night to reduce temperature in typhoid 
and other fevers, are strongly urged in Germany. Cinchonine is better than 
quinine as prophylactic against ague (R). Antipyrin, the type, also the best, 
of the new series of synthetical antipyretics, which includes Acetanilid, 
Kairin, Phenacetin, Chinolin, Thallin, etc. ; is antipyretic and diaphoretic, 
moderates the intensity of the febrile movement, and is especially indicated 
in self-limited diseases with persistent hyperpyrexia, especially pneumonia, 
typhoid, etc. Phenacetin, the favorite antipyretic among the new synthetical 
compounds; is efficient and safe. Kairin, is an efficient antipyretic, but 
profusely diaphoretic, also a cardiac and nerve depressant of great power, 
and highly dangerous in pneumonia and other fevers where the heart is 
weak ; it often produces nausea and vomiting with headache and tinnitus 
aurium (P). Resorcin, has been given in acute rheumatism, typhoid, typhus, 
pneumonia, erysipelas, etc., as an antipyretic; like Kairin, however, its action 
in lowering temperature is transient as compared with Quinine or Salicylic 
Acid (P); may be used hypodermically as it is not irritant (B). Salicylic 
Acid, or Sodium Salicylate, nearly equal to Quinine as an antipyretic ; very 
useful in all forms with high temperature and in intermittents, especially in sep- 
ticemia, pyemia, erysipelas and surgical fevers (R). Digitalis, the German 
antipyretic; very useful in scarlet fever, rheumatic and pneumonia (B); espe- 
cially in typhoid (R). Cimicifuga, as substitute for Digitalis, but less effective; 
good in hectic fever (B). Hydrastine, intermittents, typhoid with copious sweats 
(P). Arnica, is antipyretic, full doses in sthenic cases, small (n\,v of tincture) 
in asthenic ; large and small doses produce different results (B) ; in rheumatic 
fever and typhoid it is highly extolled (P). Camphor, subdues reflex excita- 
bility; is praised as stimulant in adynamic fevers (P); in adynamic fevers and 
where there is delirium (R). Mercury, large doses of Calomel, the German 
specific treatment of typhoid (B); small doses in typhoid at commencement; 
has marked effect on tonsils in scarlatina (R). Rhus Tox., in rheumatic fever 
after Aconite, and in scarlatina with typhoid symptoms, is invaluable (P) 
Opium, much less used than formerly; useful in delirium and with Quinine in 
remittents and intermittents (B) ; fevers characterized by prostration, insomnia 
and delirium, noisy or muttering, with picking of bed-clothes and twitching of 
the muscles, — in such cases Opium, judiciously given, may save an almost hope- 
less case (R) : Morphine, hypodermically, the best form in febrile diseases, 
being less disturbing to the stomach and digestive power (P). Turpentine, in 
typhoid, puerperal, and yellow (rr^x-xxx) as a stimulant to vaso-motor nervous 
system (B); as enema (3ss-j in starch mucilage with Tt^x of Tinct. Opii if 
pain) invaluable when in typhoid hemorrhage occurs with tympanites (R). 
Tartar Emetic, minute doses (gr. ^) frequently repeated and with Opium, are 
of great value in many acute febrile diseases (B); as a diaphoretic; in ague; 
in large doses to abort specific fevers (R). Muriatic Acid, very useful in all 
forms, especially in typhoid and the exanthemata; relieving dryness of the 
mouth and fauces, increases digestion and restrains the diarrhea (B). Acid 



FEVER, SIMPLE, TROPICAL. 



70I 



Drinks, such as raspberry vinegar, citric acid, etc., very grateful and useful 
(R, B); two sliced limes or lemons, with §ij of sugar in Oj of boiling water, 
cooled and strained, makes an agreeable refrigerant beverage (Wa). Baptisia, 
useful in common continued fever, or in the first stage of typhoid ; drop-doses of 
a fresh tincture every hour. Eucalyptus, has given varied results in malarial 
fevers, some observers praising it very highly (P). Valerian, has done much 
good in fevers of a nervous character (P). Sumbul, is used in Russia for low 
fevers of typhoid type (P). Cocculus, for tympanites of typhoid (P). Ammo- 
nium Acetate, as a diaphoretic and in simple forms, as catarrhal ; the Carbonate 
in scarlet fever and measles (R). Purgation, by Castor Oil, Magnesium Sul- 
phate, etc., before exhaustion (R). Mustard Bath, on recession of rash in 
eruptive fevers (R). Aliment, milk and beef-tea alternately, every 3 hours ; 
milk in fevers and in inflammations of the digestive tract (B). Alcohol, in 
low conditions is useful when it causes improvement in symptoms, which may 
become worse (R) ; Coffee better than alcohol (P). Water, especially car- 
bonated water as a drink, is a valuable adjunct to remedies in the treatment of 
fevers ; warm baths, the wet pack, hot and cold compresses, fomentations, 
moist inhalations, etc., have great value (see the various fever titles) : a most 
important agent : cold baths or cold wet pack to reduce temperature (B) ; cold 
affusion, baths, packing, ice and ice-bag, hot affusion and sponging, all of 
great value in every form (R). [Compare Fevers, Tropical.] 

R- . Tinct. Aconiti, .... £ss-j. R. Phenacetini, 5 ss -j- 

Spt. /Etheris Nitrosi, . ^ij. Aquae Cinnamomi, . . ^iv. 

Glycerini, . . . q. s. ad J ij . M. Sig. — A teasp. every 2 hours for 

Sig. — A teasp. hourly to an adult. children, to control pyrexia. 



Fever, Simple. 

Aconite, in small repeated doses, the best remedy for febricula (B) ; in ordi- 
nary febrile conditions, if given early, will abate fever and induce free per- 
spiration ; may be administered in conjunction with any other remedy indi- 
cated (R). Veratrum Viride, in small doses, as antipyretic (P). Hyoscyamus 
or Belladonna, very useful in febricula, especially for head symptoms and con- 
stipation (P). Gelsemium, when remittent or bilious symptoms (P). Arsenic, 
if typho-malarial symptoms (B). Phenacetin, in hourly doses of gr. ij or less, 
in the simple continued fever of children, as antipyretic. Hydrochloric Acid, 
in the continued fever of childhood, has a beneficial influence (West). Valer- 
ian, when nervous excitability (P). Lemon-juice, as lemonade or with Potas- 
sium Bicarbonate, as a mild diaphoretic and diuretic (P). Pomegranate-juice 
is very grateful if mixed with sugar or honey (P). Bromides, gr. ss-j every 
quarter-hour are excellent for the febrile disturbances of children (Smith). 
Baths, warm, in simple fevers of children (R). Aliment, milk and beef-tea 
alternately every 3 hours, the most useful (B). 



R. Ac. Hydrochlor. Dil., . s^ss. 
Spt. ^Etheris Co., . . . ^jss. 

Syr. Rosae, ^ss. 

Aquae Camph., q. s. ad ^iv. 
M. Sig. — Teasp. to tablesp. , according 
to age, every 6 hours. 

{Modified from West.) 



R. Potassii Acetatis, . . . gij. 

Spt. ^Etheris Nitrosi, . ^iv. 

Syr. Simplicis, .... 5j. 

Liq. Ammonii Acetatis, 3 ij. 

Aquae Camphorae, q. s. ad£ viij. 
M. Sig. — Teasp. to tablesp. doses, ac- 
cording to age. 



Fevers, Tropical. 

Unclassed fevers of the tropics include a simple continued fever, a low 
fever and a non-malarial remittent (Crombie); also a double continued fever 
(Mn). Calomel and Quinine Bisulphate, aa. gr. iv, with Rhubarb and Jalap, 
aa gr. vj, as in Dr. Livingstone s " liver rousers," has given excellent satisfac- 



702 



FISTULA — FLATULENCE. 



tion at the commencement of such cases, especially when symptoms of hepatic 
congestion exist (Potter) ; purgation should not be actively continued, but each 
case should be treated on its own merits and on general principles (Mn). 
Quinine must not be continued if it has been tried without benefit (Id). Anti- 
pyrin, or some similar drug, for the headache, if no contra-indication exists 
(Id). Medication should be confined to some simple fever mixture, there being 
no specific treatment for any of these affections (Id). Diet, bland, unstimu- 
lating and fluid. Sea-voyage, is especially serviceable in low fever, which is 
unrelieved by quinine or arsenic (Mn). 



Fistula. 

Piper Nigrum, the confection, as a gentle stimulant in anal fistula (P). 
Iodine, by injection, sometimes curative, but generally fails (Wa). Sangui- 
naria, as injection, has cured (P). Capsicum, the weak infusion, a useful 
stimulant in fistulous ulcerations (P). Glycozone, Z) in £j of lukewarm water, 
as enema once or twice daily, soon produces good effects in cases of fistula in 
ano (Edson). Bismuth Subiodide, after operation, dusted over the surface of 
the wound after washing, to stimulate granulations when the healing process is 
indolent, is remarkably efficient. Surgical, division of sphincter in anal 
fistula by knife or ligature, the best treatment (D) ; in fistula lachrymalis dila- 
tation of passage by probing the canaliculus or slitting the canaliculus up (D) ; 
in vesico-vaginal or recto-vaginal, surgical methods best. Diet, should be 
nourishing and digestible ; fresh air and good general hygienic conditions are 
necessary (R). 



Flatulence. 

Nux Vomica, will remove flatulence and intestinal indigestion (B) ; when 
constipation, heartburn, weight on head (R). Charcoal, gr. v or x, soon 
after or just before meals (R) ; mixed with Bismuth (R). Chloroform, pure, 
in drop doses, benefits (R) ; by far the best agent in flatulent dyspepsia to 
prevent flatulence, always given well diluted (Huchard). Carbolic Acid, 
when no acidity present (R). Turpentine, gtt. iij-v on sugar, will quickly 
relieve (B). Strontium Bromide, is excellent in flatulence from decomposition. 
Asafoetida or Valerian, quickly relieves the flatulence of hypochondriasis (P). 
Asaf. 5j of tinct. to Q)/ 2 water, dose Z) \ useful for children (R). Sodium 
Sulpho-carbolate, gr. xxx after eating, will be found very serviceable (R). 
Phosphoric Acid, dilute, is often promptly alleviative. Anise, the Oil, also 
Ether, or any other member of the carminative group (see page 41), will 
promote the expulsion of gas from the stomach and intestines. Mercury, in 
flatulence with. clayey stools (R). Calumba, an effective remedy for flatulent 
disposition is an infusion of ^ss of Calumba and Ginger, Z] of Senna, hot 
water Oj, a wineglassful ter die (P). Potassium Permanganate, in flatulence 
attendant on obesity (B). Physostigma, flatulence of women at climacteric 
(B). Sulphurous Acid, in 5 to 10 minim doses, when flatulence due to fer- 
mentation (R). Diet, abstain from sugar, starchy food and tea — especially 
sugar ; eat little, slowly and regularly ; as a general rule abstain from alcoholic 
drinks and from vegetables, especially cabbage. Pepsin or Ingluvin after 
meals, to promote digestion (R). [Compare Colic, Dyspepsia.] 



R . Tinct. Illicii Anisati, 

Tinct. Gentianse, 

Tinct. Nucis Vomicae, aa gj. 

Chloroformi, TTLxv-xxx. 

M. Sig. — 8 to 10 drops in a winegl. of 
water, before meals. 



R . Bismuthi Salicylatis, 

Magnes. Calcinat., . aa ^iv. 
Pulv. Carb. Ligni, . . gvj. 

Olei Anisi, gij. 

Ft. pulv. Sig. — A teaspoonful before 

each meal. (Uicchard.) 



FLUSHING-HEATS FRECKLES. 703 



Flushing-heats. 

Nux Vomica, tt\jj of the tinct. with tt\J of Laudanum in hysterical flushings 
of the middle-aged, with flatulence, weight on head and perspirations (R). 
Amyl Nitrite, Tr]^ to l /e in thirty times its volume of rectified spirits, is effec- 
tive for flushing of face, or sensation of flushing, followed by coldness, with 
cold feet and hands and great prostration occurring at climacteric chiefly (R). 
Potassium Bromide, at climacteric, with mental depression (R). Zinc Vale- 
rianate, or Valerian, flushings at the climacteric (R). Eucalyptol, for the 
flushings, palpitations and flatulence incident to the change of life (R). 
[Compare Climacteric Disorders.] 

Foreign Bodies. 

In the Eye, remove by bathing, or wiping towards the lower inner corner 
with a soft, moistened handkerchief or a bent bristle, the two ends being held 
in the fingers ; use tepid solution of Vinegar (£>ss to the %) for removing lime, 
tepid water for powder ; then apply a weak Zinc or Alum collyrium, or instil a 
solution of Atropine (gr. ij to the ^), or of Cocaine 4 per cent. In the Ear, 
examine carefully with speculum before removal ; first syringe with warm 
water, or instil a drop of sweet oil to drive out insects, before using the forceps ; 
apply equal parts of Laudanum and Olive Oil, a few drops on cotton, if much 
pain. In the Nose, a current of tepid salt water, forced up one nostril, may 
force down the body through the other, if the mouth be held open. In the 
Larynx or Pharynx, if water can be swallowed the obstruction is in the 
trachea. Never push a body down ; remove by curved forceps or blunt hook. 
If passed into the stomach use solid diet to inbed the article. If all fail and the 
case be urgent, resort to catheterism or tracheotomy. In the Flesh, remove at 
once by forceps, or sponge and water. [Compare Asphyxia.] 



Fractures and Dislocations. 

Arnica, internally is excellent to neutralize the ill effects of mechanical inju- 
ries, riLv-x in a wineglassful of water every 2 or 4 hours ; when used after 
amputations it certainly has the power of promoting the rapid union of the 
surfaces; the infusion is better than an alcoholic preparation for external use 
(P). Aconite, quickly and repeatedly, if feverish symptoms ensue (P). Iodine, 
internally and by friction, occasionally useful in ununited fractures (Wa). 
Calcium Phosphate, promotes formation of callus (Wa). Opium, useless in 
surgical fever and may do harm (CI) ; for nervousness or muscular spasms 
after dressing, gr. % of Morphine hypodermically as anodyne (Ag). Benzoin, 
the tincture on lint as a dressing for compound fractures and other severe 
injuries, leads to rapid and satisfactory healing (Bryant). Carbolic Acid, 1 to 
20 or 1 to 40 solutions, for irrigation and dressings in compound fractures, 
obviates pyemia and most of the other preventable causes of death (P). Lead- 
water and Laudanum, on lint, or a Calendula lotion to the part, after reduction 
of the injury, with morphine hypodermically and perfect quiescence. Diet, 
should be very simple for a week or ten days. [Compare Wounds.] 



Freckles. 

Resorcin, as paste with Zinc Oxide, applied to the face, to promote peeling 
of the skin and removal of freckles and other superficial spots (Unna). [See 
under Acne]. Iodine, the tincture or glycerite, locally (B). Liquor Potassse, 
3j in §ij aquae rosse, as a lotion (Todd). Benzoin, the compound tincture with 
water, as cosmetic to remove freckles (P). Sodium Borate, a saturated solution 



704 



GANGRENE GASTRALGIA, GASTRODYNIA. 



of Borax is a safe and often efficient lotion to remove freckles (B). Lime- 
water, and Olive Oil, equal parts, with a little Liq. Ammonise, as liniment 
(Wa). Potassium Carbonate, makes a good lotion for freckles, sunburn and 
tan (B). Mercury, the Bichloride, with Alcohol and Glycerin, as a lotion, has 
been found effective : Donovan's solution, tt^Ixxx to ^viij of water, of which 
^j every three hours, has been highly successful (Wa). 



R. Potassii Carbonatis, . . . ^iij. 

Sodii Chloridi, gij. 

Aquae Aurantii Flor., . . j§ij. 

Aquae Rosae, S V "J- 

M. Sig. — Face-wash. (B.) 



& . Hydrarg. Chlor. Corr., . gr. vj. 
Ac. Hydrochlor. Dil., . . gj. 
Alcoholis, Aq. Rosae, aa ^ij. 
Glycerini, ^j, Aquae, ad ^viij. 
Apply at night, wash off in morning. 



Gangrene. 

Salicylic Acid, pure, in powder locally, to destroy fetor and change the 
character of the morbid action (B). Carbolic Acid, acts in the same way 
(B) ; a i per cent, solution as lotion in gangrenous ulcers (Wa). Sodium 
Sulphate, in solution, i to 5 or 10 of water, as lotion or applied on compresses, 
to destroy odor, soothe pain and restore healthy action (Wa). Ammonium 
Chloride, in solution as baths and fomentations, very successful in one case ol 
senile gangrene (Wa). Cinchona, or better, Quinine, has often proved of value 
(P) ; generally decoction of Cinchona is best (Wa). Turpentine, locally, after 
removal of gangrenous part, a most efficient application (B) ; by stomach and 
inhalation from hot water in gangrene of lungs ; the oil locally in dry and 
chronic gangrene (P). Sanguinaria, has been recommended (P). Oxygen, as 
gaseous bath in senile gangrene (R). Charcoal, as poultice, value doubtful (R). 
Citric Acid, Lemon-juice dropped into wound, which is then covered with lint 
steeped in a solution of Chlorine ; very effective for hospital gangrene in 
Parisian hospitals {Lancet). Ferric Chloride, locally, is considered superior to 
the mineral acids (Wa). Nitric Acid, strong, applied carefully until the ulcer 
is converted into a firm, dry mass (Wa) ; is probably the best escharotic, next 
to Bromine, for destruction of gangrenous tissue (B). Bromine, is the best 
escharotic for hospital gangrene (B). Chromic Acid, is a very efficient caustic, 
penetrating deeply with but little pain (B). Opium, to soothe the pain, and 
diminish restlessness and irritability (Wa). Myrtol, 1 or 2 drops, in capsules, 
internally, for gangrene of the lungs. 



Gastralgia, Gastrodynia. 

Resorcin, internally, acts exceedingly well. Opium, in some form necessary 
to relieve the pain in severe cases (Da C). Morphine, is of great value (P) ; 
subcutaneously in epigastrium very efficient, or in small doses with Bismuth and 
milk before meals (R). Belladonna, is useful in painful affections of the stomach 
(R). Atropine, often relieves promptly, and is excellent in neuralgic pain of 
the abdominal viscera (P). Nux Vomica, an excellent stomachic, gtt. v-x of 
tincture before meals (B) ; gtt. j-ij every 2 hours in many forms of gastric de- 
rangement (R). Strychnine, hypodermically for gastralgia and gastrodynia 
(R) ; in very small doses, gr. t^o"^ two or three times daily, a very successful 
remedy (P). Arsenic, sometimes dissipates the pain surprisingly (B) ; a drop 
of Liquor Arsenicalis before food in irritative dyspepsia and gastralgia with 
heartburn (R). Bismuth Subnitrate, when gastralgia due to irritation of mucous 
membrane, acts well alone, but is most efficient when given with aromatic pow- 
der and a little Morphine (R) ; or a combination of Bismuth and Arsenic in 
more chronic cases (B) ; the Subcarbonate is especially adapted to gastralgia 
with laborious digestion and putrid or acid eructations (Wa). Manganese, the 
Black Oxide in gastrodynia and pyrosis (R). Zinc Oxide, an excellent remedy 



GASTRIC DILATATION. 



705 



when gastralgia occurs after food, gr. v-x with aromatic powder and Morphine 
before meals (B). Silver Nitrate, in solution to check the pain of many stom- 
achal disorders (R) ; a pill of gr. ss, with Extr. Hyoscyami gr. ij-iv (Wa). Hydro- 
cyanic Acid, often cures rapidly when gastralgia from nervous derangement (B); 
may check vomiting as well as relieve pain (R) ; Cherry-laurel water a useful 
form (P). Nitro-hydrochloric Acid, gtt. ij-iij of the dilute acid, is serviceable 
(Da C). Ether, a few drops or the compound spirit rr^x-xx, often relieves 
quickly (B). Chloroform, TT^ij-v on sugar, often relieves (B). Chloral, some- 
times relieves pain in gastralgia (R). Pulsatilla, is efficient in many cases of 
painful dyspepsia, with coated tongue, headache and nervous depression (P). 
Pepsin, when gastrodynia from indigestion (P). Creosote, checks pain after 
food (R). Cocaine, in doses of n\v of a 4 per cent, solution every hour, given 
by the mouth for its local action, is an efficient gastric sedative and anodyne. 
Alum, often affords relief (B). Ergot, of value in visceral neuralgias (P). 
Alkalies, for pain in stomach, Liquor Potassse generally employed (R). 
Quinine, in cases showing periodicity and those of neuralgic type(P). Sodium 
Salicylate, for gastralgia with fermentation (R). Nitroglycerin allays the pain 
speedily (B). Carbonic Acid Water, in painful and irritable conditions ; may 
be mixed with milk (R). Milk-cure, very efficacious in obstinate cases (B). 
Galvanism of the pneumogastric, and locally to the organ itself (B). Aqua- 
puncture has given extraordinary relief (B). Diet is of the greatest importance ; 
food should be digestible, varied and plainly cooked ; persons of sedentary life 
should refrain from much animal food ; meals regular and frequent, eating 
little at a time and that very slowly. Alcoholic beverages do harm as a rule, 
but may benefit particular cases. Eating should be done in as agreeable a 
frame of mind as possible and the patient should rest for a time after a meal. 
[Compare Acidity, Dyspepsia, Neuralgia.] 



R. 



g r - J- 

Zss. 



R 



Morphinae Sulph., . . 
Ac. Carbolici, . . . 
Aq. Menth. Pip., . q. s. ad £iv. 
M. Sig. — Teasp. thrice daily. 

{Da Costa.) 

. Bismuthi Subnit., . . . . gij. 

Ac. Hydrocy. DiL, . . . ^ss. 

Mucil. Acaciae, 

Aq. Menth. Pip., . . . aagij. 
M. Sig. — Tablesp. thrice daily. 



R. Atropine Sulph., . . . . gr. j. 

Zinci Sulph., % ss. 

Aquae Destill., ^j. 

M. Sig. — 3 to 5 drops two or three 
times daily. (B.) 



R. Bismuthi Subnit., 

Magnesii Carb., .... aagr. xvj. 

Ac. Hydrocy. Dil., . . . TTlx. 

Aquae, J iv. 

M. Sig. — Dessertsp. for a child of 3 
years in flatulent gastrodynia and gastralgia. 



R. Ac. Hydrocy. Dil., . . . !?ij. 
Aq. Laurocerasi, . q. s. ad ^iv. 
M. Sig. — Teasp. every 4 hours. 



R. 



M, 



Pepsini, . . gj. 

Ac. Hydrochlor. Dil., . . ^ss. 

Glycerini, .^j ss - 

Aq. Cinnamomi, . . . . % ijss. 
et filtra. Sig. — Tablespoonful doses 



for slow and feeble digestion. 



Gastric Dilatation. 

Carbolic Acid, internally to allay fermentation, with an occasional washing 
by the stomach-pump (Da C). Strychnine, hypodermically or by the mouth, 
or Nux Vomica, the best remedy, conjointly with washing of the stomach and 
strict diet (Da C). Bismuth Subnitrate, with Magnesia or Soda, or Lime-water 
frequently, for the acidity, which is one of the most distressing symptoms (Fen- 
wick). Bismuth Salicylate, as an internal antiseptic, is highly praised. Salo- 
phen, relieves the fermentative disturbances. Diet, should be free from all 
starch and sugar and from vegetables of any kind (Fenwick) ; milk not advis- 
able as much fluid will further dilate the organ ; solids better, as small quanti- 
ties of dry, stale bread or gluten bread and underdone meat (Da C). 
45 



706 



GASTRIC ULCER GASTRITIS. 



Gastric Ulcer. 

Arsenic, Fowler's solution in drop doses lessens the pain and relieves the 
vomiting remarkably (B) ; has given relief when commonly-used remedies 
failed (R) ; gives good results when used in very small doses (Da C). Bismuth 
Subnitrate, relieves pain and vomiting and contributes to the cure (B) : see 
under Gastralgia for formulas. Chloroform I, with Bismuth Subnitrate 3 and 
Water 150, of which 3 j-ij hourly, or without the bismuth, which is not necessary, 
gives marked improvement in recent ulcer as well as in long-standing cases 
(Stepp). Silver Nitrate, in solution, to check pain and relieve the vomiting 
(R) ; is next in value to Bismuth, promoting cicatrization and easing the pain 
(B). Silver Oxide is equally efficient, and is not liable to produce staining 
(Da C). Atropine, often happily relieves the pain and vomiting even when 
given in very small quantity (B). Morphine, for the pain and vomiting (R) ; 
in full doses if perforation occurs, to localize peritonitis until adhesions take 
place (Da C). Ergotin, 1 part to 10 of water, of which gtt. xv hypodermically 
several times a day for the hemorrhage. Gallic Acid, in 5-grain pill every hour 
for hemorrhage. Lead Acetate, is sedative and hemostatic ; gr. ss-ij in pill 
with Opium, very useful to check hemorrhage and allay pain (R). Turpentine, 
5 to 10 drops frequently repeated in hemorrhage (R). Resorcin, acts very well ; 
its analgesic property herein is so marked that the stomach is enabled to tolerate 
food (Pope). Glycozone, is the best of all known 'agents for the treatment of 
gastric ulcer (Edson) ; should be given on an empty stomach, one or two teasp. 
in a wineglassful of water. Charcoal is said to ease the pain by preventing 
formation of acid products (R). Mercury, Corrosive Sublimate an effective 
remedy, gr. gL~ J- thrice daily before meals (B). Pepsin, by facilitating diges- 
tion is useful (B). Iron, for the anemia ; the Lactate or Ammonio-citrate if 
stomach irritable (Da C). Ice-bag, to the epigastrium, for pain and vomiting 
(R). Nutrient Enemata, to rest the stomach ; (see under Enemata for formu- 
la) ; Brandy may be added, also Laudanum gtt. x-xx, if the rectum is 
irritable (B). Milk-cure, has succeeded admirably (B) ; a strictly skimmed 
milk diet with Lime-water, 2 parts of milk to 1 of Aqua Calcis (Da C). Diet, 
should be of non-irritating character, with cold or hot compresses to the epi- 
gastrium, leaves little room for medicine : in bad cases nourish per rectum so 
as to give the stomach complete rest ; in any case use such food as is chiefly 
digested in the small intestine, farinaceous vegetables, rice, arrowroot, etc. 
A nice change from milk diet is a warmed pancreas, chopped up with rare meat, 
being nutritious and well relished (Da C). Rest, in bed for several months is 
imperative (Da C). Defibrinated Blood, by injection into rectum, in doses of 
]§iij-vj (A. H. Smith). [Compare Hematemesis.] 



R . Argenti Oxidi, 

Ext. Hyoscyami, . . aa gr. x. 
Ft. pil. no. xx.. Sig. — One pill thrice 
daily before meals. 



R. Bismuthi Subcarb. , . . ^iij. 

Morphinse Sulph., . . . gr. j-ij. 

Pulv. Aromat., . . . . ^j. 
Ft. pulv. no. xij. Sig. — One powder in 
milk before each meal. 



Jjt . Argenti Nitratis, 
Ext. Opii, . . . 
Ft. pil. no. xx. Sig. 
daily, after meals. 



. . gr. v. 
. . gr. iij. 
-One pill thrice 



R. Argenti Oxidi, . . . . gr. v. 

vel Zinci Oxidi, . . . . 3 ss. 

Morphinse Sulph., . . . gr. j-ij. 
Ft. pil. no. x. Sig. — One pill thrice 
daily, before meals. 



Gastritis, Acute. 

Mercury, Calomel in broken doses with ice, frequently swallowed, for the 
idiopathic form, which is occasionally seen and cannot be distinguished from 
that due to irritant poisons (Da C). Bismuth, the Subnitrate or Subcarbonate 
in full doses after the acute symptoms have abated (Da C). Morphine, hypo- 
dermically for pain (B). Ice, internally and externally gives great relief (R). 



GASTRITIS. 707 

Aliment should be given per rectum ; no food, except milk and Lime-water, 
being admitted to the stomach for some time (Da C). Antidotes, in cases of 
irritant poisoning, as Alkalies to neutralize acids, Dialyzed Iron or the Hy- 
drated Sesquioxide for arsenic, Turpentine for phosphorus, etc. (see Poison- 
ing) : then Oil, Albumin or milk, to protect the mucous membrane ; stimulants, 
Opium, Ammonia, etc., to antagonize depression of the vital powers. 

Gastritis, Chronic. 

Arsenic, sometimes surprisingly curative ; for the vomiting gtt. j-ij of Fow- 
ler's solution before meals (B). Pulsatilla, in subacute gastritis of phlegmatic 
temperaments, white tongue, heartburn, nausea, flatulence, little or no taste 
(P). Hydrastis, gtt. v-xv of tincture or fluid extract, daily before meals, espe- 
cially for gastric catarrh of acute alcoholism (B). Nux Vomica, gtt. j of tinc- 
ture every 5 to 10 minutes for 8 or 10 doses, in acute gastric catarrh, with head- 
ache or sick-headache ; also drop or 2-drop doses every 2 hours or oftener, 
when chronic gastric catarrh occurs in the course of chronic disease (R). Cin- 
chona, to promote healthy state of mucous membrane, the infusion with min- 
eral acids, or Quinine ; the Red Bark in gastric catarrh of drunkards (B). Alka- 
lies, either shortly before meals to stimulate production of gastric juice, or some 
hours after to neutralize the acids of decomposition (Da C). Pepsin, gr. v 
immediately after a meal, to assist digestion (Da C). Podophyllum, in small 
doses at night, to act on upper bowel ; purgation as a method of treatment 
stands at the head (Da C). Ipecac, in small doses may prove useful, ff\,v-x °f 
the wine (P) ; for the nausea and vomiting (R). Tannic Acid, in4-grain doses 
with a drop of glycerin to make a pill (B). Bismuth Subnitrate, is very useful 
in chronic gastritis, especially that of drunkards, and the chronic gastric catarrh 
of children with vomiting (R); invaluable for its sedative, alterative and as- 
tringent action ; 10-15 g ram doses several hours after meals (Da C) ; the Sub- 
gallate (Dermatol) is being advertised as a remedy for chronic gastritis. Bis- 
muth Salicylate, as an internal antiseptic, is praised in chronic gastric affec- 
tions. Strontium Bromide, gave successful results in 32 cases of gastric catarrh 
(See). Resorcin, acts exceedingly well. Glycozone, is one of the best reme- 
dies for the chronic gastric catarrh of alcoholism, and that from other causes 
(Edson). Hydrocyanic Acid, is much used (R) ; in subacute gastritis it often 
proves useful given in an ordinary effervescing draught (Wa). Silver Nitrate, 
in % or ^-grain doses with Opium if pain, or preferably Belladonna, is ex- 
tremely useful (Da C) ; to check pain and vomiting (R). Silver Oxide, is nearly 
as good as the nitrate, and not liable to produce staining (Da C). Opium, or 
Morphine, to quell pain in chronic gastritis from alcoholic excess (R). Eucal- 
yptus, a useful stomachic, not to be used in inflammatory states (B) ; is used 
with benefit (R). Mercury, the Yellow Oxide, in doses of gr. 6 u~F5> m chronic 
form (see under Dyspepsia). Calumba, and other bitters are useful (B). 
Ammonium Chloride, in high repute in Germany (B). Caffeine, especially 
when associated with migraine (B). Lead Acetate, in chronic gastritis with 
gastralgia and pyrosis, may be combined with Morphine beneficially (B). 
Alum, when vomiting of glairy mucus (B). Aliment, such as will be digested 
in the small intestine; requires careful attention ; the milk-cure has been very 
effective in bad cases ; malt liquors are harmful (B) : mineral waters of purga- 
tive type, to keep the portal system drained : exercise is not beneficial, better 
live quietly and occasionally spend a day or two in bed (Da C) : Kumyss 
agreeable and tolerant to stomach ; the milk-cure and buttermilk have been 
efficient ; the farinaceous vegetables, rice, tapioca, arrowroot, aerated bread. 
[Compare Dyspepsia, Gastralgia.] 

R. Sodii Bicarbonat., . . £jss. 
Tinct. Aurantii Cort., . }f ss. 
Infusi Calumbse, q. s. ad ^ viij 



M. Sig. — Two tablesp. before each 
meal. In chronic gastric catarrh. 



R- . Magnesii Sulphatis, . . 3 j-ij. 

Sodii et Potassii Tart., . gss-j. 

Ac. Tartarici, . . . . gr. xx. 
Sig^ — Dissolve in a glass of water and 
drink, an hour before breakfast. 



708 



GLANDERS AND FARCY GLANDULAR AFFECTIONS. 



R. Aluminis, gij. 

Ext. Gentianse, . . . . gss. 
M. Ft. pil. no. xxx. Sig. — Two pills 
twice daily. 



R . Argenti Oxidi, . . 

Ext. Belladonnse, . 

Olei Caryophylli, . 
M. Ft. pil. no. xxiv. 
twice daily. 



. gr. xjj. 
• gr- iij- 
. gtt. xx. 
Sig. — One pill 
[Da Co si a.) 



R . Sodii Bicarbonat., .. . . gr. lxxx. 

Spt. Chloroformi, . . . gjss. 

Tinct. Gentianae, . . . ,^ss. 

Infusi Rhei, ^ iv. 

Aq. Menth. Pip., q. s. ad ^viij. 
M. Sig. — A tablesp. or two before each 
meal. In chronic gastric catarrh with flat- 
ulence. 



Glanders and Farcy. 

Ammonium Carbonate, in water hourly; as concentrated as can be swallowed,, 
followed by an opiate and preceded by an emetic of Ipecac, and an incision 
into each of Wharton's ducts ; proved successful in a case of acute glanders 
(Wa). Carbolic Acid, and the Sulphites, as Sodium Sulphite, are most worthy 
of trial. Creosote, or Carbolic Acid, in Glycerin, locally (Wa) ; or dilute 
Chlorinated Soda and Lime-water. Escharotics, to destroy the affected spot,, 
if inoculation occurs. Iodine, internally, also Arsenic and Strychnine, have 
been recommended. Quinine, in large doses and Ferric Chloride, may be 
useful. Potassium Iodide, gr. 150 daily, with baths in Hot Springs of Arkan- 
sas, conquered the disease in me, probably the only man who ever survived 
it. (Dr. Paul Paquin, Univ. Mo.) No drug yet tried has any marked specific effect 
on the disease (Durham). Mallein, for diagnostic purposes (see page 518). 



Glandular Affections. 

Iodine and Iodides, no remedy more efficient, when simple hypertrophy ; 
useless (with all other medicines) when caseation or suppuration has set in ; 
Iodine injected into cystic and glandular growths of neck; Syrup of Ferrous 
Iodide occupies an important place (B) ; Potassium Iodide for mammae and 
testicles, but especially for thyroid (R). Iodoform is equal, if not superior to 
Iodine, in enlarged scrofulous glands and other glandular swellings (Wa). 
Lead Iodide, as an ointment. Ung. Hydrarg. Iodidi Rubri, produces very 
striking effects in goitre, enlarged spleen, etc. (B). Sulphides, especially the 
Blue Lick water, are said to abort or to mature suppuration in glands (R). 
Calcium Sulphide, for hard, swollen glands behind the angle of the jaw, with 
deep-seated suppuration (R). Calcium Chloride, highly useful in strumous 
inflammation and suppuration (B). Pilocarpus, is curative in acute affections 
of parotid and submaxillary glands (B). Mercury, useful in acute inflamma- 
tory states, tonsillitis, parotitis, etc.; Hydr. Chlor. Corr. gr. ■£$ or Hydr. cum 
Creta, gr. i, every two hours (B) ; the Oleate of Mercury and Morphine in 
obstinate and painful tonsillitis and inflammation of lymphatic glands (R). 
Aurum Salts, have cured enlarged and indurated cervical glands. Aurum and 
Arsenic Bromide, the solution is highly efficient in cervical adenitis (Barclay) ; 
rendered good service in a case of adenitis with enormous enlargement of the 
left side of the neck (E. A. Wood). Belladonna, especially in tonsillitis (P). 
Valerian, with Guaiacum,in strumous enlargement (P). Hydrastis, frequently 
controls (P). Carbolic Acid, a 2 per cent, solution injected into substance of 
gland (B). Electrolysis, used by me to remove a number of swollen and pain- 
ful lymphatic glands in the neck (Remak) ; by the use of strong and often 
interrupted faradic currents multiple indurated lymphatic tumors have been 
removed or diminished (Meyer) ; enlarged glands have been repeatedly cured 
by electrolysis (B). [Compare Bubo, Goitre, Parotitis, Tabes Mesenterica, 
Tonsillitis, Wen, etc.] 



GLAUCOMA — GLEET. 



709 



Glaucoma. 

Atropine, gr. g 1 ^ hypodermically is beneficial (Anstie) ; imprudently used has 
caused the disease (Graefe, Wells) ; should not be indiscriminately instilled 
into the eyes of persons over 35 or 40 years of age, in whom it may light up a 
latent or incipient glaucoma. Physostigmine, lowers intra-ocular tension, and 
with Quinine is indicated in all cases of threatened glaucoma, to preserve the 
eye from the risk of consecutive glaucoma, and after iridectomy or sclerotomy 
(de Wecker). Iridectomy, the only remedy for the disease, medicine being worse 
than useless ; the operation should be performed as soon as a state exists which 
can be called glaucomatous ; even when vision is lost the operation will best 
relieve the pain (C) : almost a certain cure in early stages, in later nearly 
always palliative and often curative. Drainage of Eye, by gold wire or catgut, 
has proved successful (de Wecker). 



Gleet. 

Cantharis, in drop doses, when frequent desire and pain in region of pros- 
tate (R) ; of benefit in subjects of relaxed fibre and feeble circulation (B). 
Blisters, to the perineum, of undoubted benefit (R). Piper Methysticum, has 
cured obstinate gleet (Switzer). Bismuth, 1, glycerin 1, water 6 parts, as an 
injection, often useful in gleet (R). Eucalyptol, is used with benefit in chronic 
catarrh of the genito-urinary tract (R). Iron, the tincture of the Chloride, £ss 
in Oss of water with 3j of Laudanum, makes a good injection for gleet (R) ; 
internally for anemic subjects (St). Mercury, yi grain of Corrosive Sublimate 
in 3VJ of water, is a good injection in gleet, used every 2, 3 or 4 hours (R); 
Donovan's Solution in doses of 10 minims thrice daily, so uniformly successful 
in controlling chronic urethral discharge as to be almost a specific for gleet. 
Zinc Salts, the Sulphate or Chloride, gr. ij of the latter to a pint of water, as 
injection every hour (R). Bougies, of gelatin, medicated with astringents, are 
extremely efficient. Turpentine, in moderate doses, when due to relaxed con- 
dition (R). Copper Sulphate, a solution as injection (R) ; astringent injections 
may be used with benefit (Wa). Copaiba, smeared on a bougie and introduced 
into the urethra, will sometimes cause gleet to yield (Wa). Sandalwood Oil, 
Tt\,xv ter die (R). Glycerite of Tannin, with equal quantity of Olive Oil or 
mucilage, as injection, Z\) enough ; persevere 8 or 10 days after discharge 
ceases and do not use at bedtime (R). Balsams of Peru and Tolu, Buchu, 
Canada Balsam, Copaiba, Mastic, and Tannin, are used with advantage (P, R). 
Gleet is often kept up by over-treatment, will some time or other come to an 
end (St). Diet and Habits important ; stimulants, both solid and liquid, 
should be rigidly avoided, also coffee ; frequent ablutions, fresh air, good nour- 
ishment. [Compare Gonorrhea.] 



R. Tinct. Ferri Chlor. , . . . gyj. 
Tinct. Cantharidis, . . . gij. 
M. Sig. — 15 drops in water three times 
daily. 



R . Zinci Sulphatis, . . 

Ac. Carbolici, . . 

Ext. Hydrastis, 

Ext. Belladonnse, . 

Gelatini, 

M. Ft. bougia no. vj. 
-•urethra at bedtime. 



. . gr. nj. 
. . nuj. 

. aa gr. vj. 
. . q. s. 
Sig. — One in 



R . Pulv. Cantharidis, . . . . gr. iij. 

01. Terebinth., 5J. 

M. Ft. pil. no. xij. Sig. — One thrice 
daily in obstinate gleet. If strangury 
occur, stop for a day or two. 



R. Ac. Tannici, gr. x. 

Bismuthi Subnit., . . . . gij. 

Aq. Rosse, ^vj. 

M. Sig. — Shake and use as an injection 
thrice daily. [Maury.) 



7io 



GLOSSITIS — GLOTTIS — GOITRE. 



Glossitis. 

Bismuth, gr. xx of Subnitrate with ^j of glycerin and ^vij of water, as lotion 
for erythematous inflammation of the tongue (A). Purgatives, with gargles,, 
leeches, antiphlogistic regimen generally (D). Quinine and Iron, should be 
given internally, with dilute acid washes, and free purgation (CI). Alum, dry, 
powdered, may be dusted on tongue (CI). Leeches, applied beneath the jaw, 
if symptoms are urgent (CI). Abscess, should be opened, if any form. In- 
cisions, along superior surface, followed by vapor of hot water, may instantly 
relieve congestion (A). Tracheotomy or Laryngotomy, if suffocation is appa- 
rently imminent (A). 



Glottis, Edema of. 

Emetics, when edema slight (A). Inhalations, of steam with Benzoin or 
Conium of great service (A); or of Tannin, grain viij or x to gj of water ; or 
Alum, gr. x to the 25, or a saturated solution of Potassium Chlorate, all as spray 
(Walker). Ethyl Iodide, by inhalation, proved curative in one case in which 
it was repeated twelve times (See). Scarification, by laryngeal lancet, of par- 
amount value (A). Tracheotomy, if the above fail (A). O'Dwyer's laryngeal; 
tubation promises well. [Compare Croup, Laryngitis.] 



Goitre. 

Iodine, is curative in simple hypertrophy (ordinary goitre) used both inter- 
nally and externally : deep injection Of the tincture is very successful in cystic 
degeneration of the gland (B) ; also in the fibrous and fibro-cystic varieties,, 
if injection be made into the tumor ; dangerous, if into a vein or into the 
surrounding areolar tissue (Wa). Mercuric Iodide, as oint. assisted by the 
sun's rays ; a piece the size of a large pea rubbed in daily, very successfully 
used in India for simple hypertrophy (R) ; the official Unguent. Hydrarg. 
Iodidi Rubri, 1 in 10, daily (B) ; is too strong (Gross) ; gr. xv to the g strong 
enough for the worst cases (Wa). Potassium Iodide, internally, also exter- 
nally as ointment, in simple hypertrophy of the gland (R). Strychnine, 
gr. ^g- thrice daily, has been successful in several cases (Holmes). Ferric 
Chloride, injections of the solution used in thirty-eight cases with curative 
results (Mackenzie). Ergotin, injected with benefit into the parenchyma of 
the goitre (P) ; also used hypodermically with good* results (Wa). Ammon- 
ium Chloride, as an internal remedy has proved curative (Stevens). Thyroid 
Gland, £>j to ij, once a week, cured 4 children completely, and cured or relieved 
9 out of 12 cases so treated (Bruns) ; Thyroid Extract is used with benefit (see 
page 159). Electrolysis, has sometimes cured in cases of simple hypertrophy 
and cystic gland (B) ; 6 out of 14 test cases of goitre were absolutely cured by 
electrolysis (Duncan). Spongia Usta, was formerly considered a sovereign 
remedy (Wa). Seton, has cured. Fluoric Acid, in doses of rr\,xv to Z) thrice 
daily, largely diluted, cured seventeen cases out of twenty (Woakes). Excision, 
is a very difficult operation, only to be considered in extreme cases ; it has been 
performed successfully by Desault, Harris, Lane, Hedenus, Billroth and Greene. 
[Compare Exophthalmos.] 



}£ . Ammonii Chloridi, . . . £vss. 
Syrupi Simplicis, . . . . jf ss. 
Aq. Cinnamomi, . . . . ^ iv. 
M. Sig. — Teasp. thrice daily. 



& . Unguenti Hydrargyri Iodidi 

Rubri, gj. 

Vaselini, £ vr j« 

M. Sig. — Use as directed. * {Gross. )> 



GONORRHEA. JW 



Gonorrhea. 



Aconite, a drop of tinct. each hour in the acute stage (R) ; when inflamma- 
tion (Pf, St). Gelsemium, serviceable, acute stage (Pf ). Cannabis Sativa, 
after acute symptoms subside, a few drops 3 or 4 times a day, is fully as effec- 
tual as Copaiba or Sandal and infinitely more pleasant to take (Pf ). Canna- 
bis Indica, relieves pain, diminishes discharge (P) ; occasionally useful (R). 
Colchicum, the wine of the seed has frequently cured gonorrhea, and was used 
in thirty-minim doses nightly for the relief of chordee by Brodie (B). Ferric 
Chloride, when acute stage has passed and the discharge is degenerating into 
gleet, few remedies are more useful than this tincture in doses of tt^xv-xx 
thrice daily (Wa). [See Erysipelas for formula.] Alkalies, Citrates or Bicar- 
bonates to render the urine alkaline (R) ; Lithium Carbonate in five-grain 
doses thrice daily, for the same purpose : Alkalies are the chief factor in Otis's 
treatment ; Potassium Bicarb., gr. x in a tumbler of water or in Flaxseed tea, 
or Infusion of Triticum with gr. xv of Potass. Bromide if great pain present ; 
Vichy Water (Celestin) freely (Otis). Turpentine, in chronic stage when 
parts are relaxed, moderate doses are of great benefit (B). Cantharis, drop- 
doses may be used (R) ; in the chronic stage (B). Pulsatilla, in subacute and 
gonorrheal ophthalmia (P). Copaiba, especially adapted to gonorrhea (B) ; 
pour it upon half a winegl. of water to which add some bitter tincture (Chap- 
man) ; if given too early in the disease it will aggravate the symptoms (P) ; 
should not be used until pain in urinating is nearly gone, chordee ceased and 
the discharge diminishing and of yellow color (Wa) ; does no good but is 
injurious, and prolongs the disease (Otis). Saw Palmetto, the fluid extract of 
the berries of this palm, has been used with good results in doses of 3j (Porter). 
Santal Oil, is valuable in subacute gonorrhea (P) ; a good quality difficult to 
obtain (Pf) ; the best internal remedy, Copaiba next (St). Cubeb, unlike Co- 
paiba, is given with good effect in acute stage ; best results from a mixture of 
both as in electuary (see formula p. 713) ; is not irritating to the stomach, and 
agrees with some patients better than Copaiba (Wa). Balsams of Peru and 
Tolu, also Buchu, Uva Ursi, Chimaphila, Pareira, etc., are among the numer- 
ous remedies used for gonorrhea (R). 

Injections, of Tannin, Copper Sulphate, Iron, Cadmium, Port-wine, Brandy- 
and-water and 1000 other agents (R) ; injections are very bad, especially in 
the acute stage ; should never be used until the 5th week and then only if the 
case is not progressing (Otis) : true gonorrhea is never cured in less than four 
weeks (Van Buren and Keyes) ; urethritis is a different disease entirely (Otis). 
Silver Nitrate, a weak solution, gr. j-v to the ^, as injection ; in vaginal gon- 
orrhea a strong solution, Z) to the %, through speculum to every part of the 
canal (B) ; as abortive injection is useless and dangerous (St). Argonin (Sil- 
ver Casein), is less irritant than silver nitrate and less efficient (Kopp) ; up to 
4 per cent, strength of solution it usually does not irritate, though sometimes 
even a 2 per cent, solution causes symptoms which necessitate its abandon- 
ment. Largin (Silver Protalbin), irritates about as much as the nitrate and 
possesses no marked superiority over the latter salt (Kopp). Argentamin 
(Ethylene-diamine Silver Phosphate) is markedly irritant even in 1 to 4000 
solution ; no cures resulted from its sole use (Id). Protargol (Silver Protein), a 
few drops of a 20 per cent, solution in glycerin instilled into the fossa navicu- 
lars after a suspected coitus, will secure almost perfect immunity from infection 
(Kopp) ; in gonorrhea a 1 per cent, solution injected every 30 minutes during 
the day (Neisser) ; causes but little irritation and a rather speedy checking of 
the gonorrheal discharge ; on the whole it presents no decided advantage over 
silver nitrate (Kopp). Itrol (Silver Citrate), is strongly advocated by Crede, 
and seems to possess real merit, its disadvantages are the difficulty of prepar- 
ing aqueous solutions and the rapidity with which they decompose (Id). Zinc 
Salts, a weak injection of the Chloride, gr. j to ^vj or viij of Rose-water ; or of 



712 



GONORRHEA. 



the Sulphate, gr. j to the ^, frequently repeated, is probably the best treatment 
(B) ; the best injections are those of the Sulphate or Acetate, gr. vj-xij to ^iv 
aquae, after the acute inflammation subsides (St). Bismuth, the oleate, smeared 
on a sound, and inserted for 5 minutes (Shoemaker) ; with mucilage as an in- 
jection, excellent in chronic gonorrhea (Hill). Lead Acetate, the dilute solution 
of the Subacetate, as injection, may be employed at any stage (B). Chloral, a 
weak solution, gr. j-iv to the %, a very good injection (Hill). Resorcin, a 1 
per cent, solution makes a useful injection (Wa). Antipyrin 100 parts, Corro- 
sive Sublimate 1, Distilled Water 10,000, used as injection four times daily 
and retained as long as possible (Vatier). Boric Acid 3iss, Tinct. Iodine 3ij, 
Glycerin ^ij, Distilled Water q. s. ad ^iv, as injection morning and night, has 
given excellent results in both acute and chronic cases when other treatment 
proved inefficient (James). Potassium Permanganate, a solution of 1 to 1000, 
one or two quarts at each sitting, washing out the bladder as well as the urethra 
several times daily, is highly efficient ; a solution of 1 or 2 per cent, as injection 
in chronic gonorrhea (Keyes) ; a hot solution of 1 in 2000, gradually increased 
to 1 in 1000, injected into the bladder, in chronic gonorrhea, especially poste- 
rior urethritis (Ultzmann) ; has proved disappointing, both as an abortive agent 
and for acute gonorrhea (Kopp). Alumnol, 1 to 3 per cent, solutions as injec- 
tions ; is reported to be efficient. Mercury, excellent results from Corrosive 
Sublimate (Pf) ; gr. X~K to ^ vn J aquae destill. in subacute and chronic stages, 
as injection thrice daily ; may have gr. ss-j of Zinc Chloride added with bene- 
fit ; is often effectual (Wa) ; the Oxycyanide, in solutions of 1 to 3000 or 1 to 
1000, is well tolerated by the urethral mucous membrane ; resembles Protargol 
in action and has no specific power in gonorrhea (Kopp). Gallobromol, a 1 or 
2 per cent, solution [see page 97]. Hydrastis, the infusion best for injection, 
3] of root to ^viij aquae (Pf ) ; the fluid extract is one of the best injections, 
properly diluted; or the Muriate of Berberine (Hydrastin) Z] to ^iv mucil. 
acacias (B). Soluble Bougies made of Iodoform, Eucalyptus and Cacao-butter, 
are highly recommended to cut the disease short (Wa) ; a series of similar 
preparations, having a basis of gelatin and glycerin, medicated with the usual 
astringent and sedative drugs, is manufactured by C. L. Mitchell, of Philadel- 
phia and may be obtained of the drug trade. Wrappings of several folds of 
cotton are heating and uncomfortable, also dirty and productive of balanitis, 
etc. ; pin a false front to the shirt for covering (St). Rest, in bed is an absolute 
desideratum, especially during the inflammatory stage. Hot water, ioo° F., to 
the penis during urination, extreme cleanliness, milk diet; water freely as a 
beverage, flavored with a few drops of Oil of Gaultheria ; or Flaxseed tea, or 
Infusion of Triticum with Potassium Bicarbonate. Sexual thoughts to be 
entirely avoided (Otis). Alcohol, or any other stimulant, must be avoided 
entirely (R). [Compare Chordee, Gleet, Orchitis, Rheumatism Gonor- 
rheal, Urethritis, Urethral Stricture, Vaginitis.] 



For Internal Use. 

R. Potassii Citratis, ^ ss_ j- 

Spt. Limonis, 7, ss. 

Syr. Simplicis, %\). 

Aquae, %'}. 

M. Sig. — Dessertsp. largely diluted, 3 
or 4 times daily. As alkali for the increas- 
ing stage. {Otis.) 

&. Oleoresinae Cubebae, . . . ^iv. 
Potassii Bromidi, . . . . %}. 

Olei Sassafras, rrix. 

Syr. Acaciae, ,^ij. 

Aquae, q. s. ad Jvj. 

M. Sig. — Dessertsp. 3 or 4 times daily. 
(/. Wm. White.) 



R 



M 



For Local Use. 

Resorcini, ^j. 

Ac. Borici, gr. xx. 

Zinci Acetatis, gr. %- 

Aquae Destil. , ^ iv. 

Sig. — Dessertsp. as injection. 



R . Zinci Sulphatis, . . . . gr. viij. 
" Liq. T Plumbi Subacet. Dil. , ^ iv. 
M. Sig. — Use as an injection. 



R 



. Zinci Chloridi, gr. j. 

Aquae Rosae, § v j- vn j' 

M. Sig. — Use as an injection. 



GOUT. 



713 



For Internal Use. 
The Black Paste. 

R. Pulv. Cubebae, ^iij. 

Copaibae, oJ ss< 

Aluminis, ^ij. 

Sacchari Albi, ^j. 

Magnesiae, 5J SS - 

Olei Cubebae, gj. 

Olei Gaultheriae, . . . . sjj. 
M. fiat electuarium. Sig. — A piece the 

size of a walnut after each meal. [Otis.) 



[For Alkaline Emulsion of Copaiba see 
ante, page 572.] 



For Local Use. 

R . Zinci Sulphatis, .... 

Plumbi Acetatis, . . . 

Ammonii Chloridi, . . 

Aluminis, 

Aquae Rosae, ..... 
M. Sig. — Injection to be 
acute symptoms subside. 



gr- vj. 
gr. viij. 
gr. iv. 
gr. v. 



• 3J- 

used 



after 



R . Pulv. Iodoformi, . . . . ^ss. 

Ac. Carbolici, £ij. 

Glycerini, gij. 

Aquae Destil., . q. s. ad ^ viij . 
M. Sig. — Teasp. as injection. 



[For Injection Brou and others, see ante, 
page 578-] 



Gout. 

Piperazin, the best solvent for uric acid; promptly reduces the redness and 
swelling of the joints in acute gout, remarkably relieves the paroxysm and 
promotes elimination of uric acid and urates ; should be given in doses of 15 
grains daily, dissolved in a pint or more of carbonated water. Lysidin, is still 
more powerfully solvent on uric acid [see page 430] ; tried in cases of chronic 
gout with exacerbations with excellent results (Grawitz). Phenocoll, when much 
pain and fever ; combined with Piperazin, gr. xv of each daily in a pint or more 
of carbonated water, is very efficient treatment. Morphine, hypodermically, as 
close to the affected joint as possible outside of the red areola, is miraculous in 
giving immediate relief. Antipyrin, remarkably efficient for relieving the pain 
as well as prophylactic against future attacks (Marshall). Aconite, may cer- 
tainly relieve pain (P). Belladonna, the best remedy effectually and speedily to 
soothe the pain, also in gout of the stomach ; 5-TTL doses efficacious (P). Potas- 
sium Iodide, especially when pain is worse at night (R). Colchicum is merely 
palliative ; 3>j of the wine often removes the severest pain in an hour or two, and 
soon after the swelling and heat subside (R) ; it is especially useful in acute 
and rheumatic gout (B) ; is not specific, nor a lasting or final remedy for gout, 
but acts very directly on the pain and inflammation of acute attacks (P) ; is 
useful in the bronchitis, asthma, dyspepsia, urticaria, etc., of gouty subjects 
(R). Colchicine Salicylate, is highly efficient in chronic gout [see page 285]. 
Strontium Salicylate, in chronic gouty conditions, appears to be the most valu- 
able drug that we have(VV). Sodium Salicylate, 10 grains every 2 hours inter- 
nally, also <j>ij in ^vij of warm water as lotion on lint covered with oiled silk, in 
acute gout is very efficient treatment. Salicylates do not cure gout, they simply 
aid in keeping down the diathesis (W). Ammonium Salicylate is much better 
than the sodium salt, which is the worst of all ; it acts immediately and severely, 
the Strontium salt acts slowly and does not derange the digestion like the others 
(W). Cascara Sagrada, is said to promote the elimination of uric acid to a 
remarkable extent. Coffee, a tincture of green coffee promotes elimination of 
the poison of gout from the system. Veratrine, as ointment to painful joints 
(R). Sulphides, as baths in chronic gout, or fumigation with Sulphurous Acid, 
and bed-clothes exposed to its strong fumes (R) ; Sulphur waters certainly 
benefit (B). Iodine, painted around joints in chronic gout (R). Strychnine, 
hypodermically for later stage of gout paralysis (R). Lithium, the Bromide 
internally and a strong solution of Lithia to the joints (B); the Bromide is the 
most efficient agent in combating the disease (Aulde) ; the Carbonate, in solu- 
tion, gr. v to the ^, on lint around gouty enlargements, joints, etc. (R). Chi- 
rata, for the dyspepsia of gouty subjects. Guaiacum, has long had high repute, 



7H 



GUMS. 



and may be given for a long time without injury (Wa). Rhubarb with an 
alkali, regularly during intervals, very serviceable (Halford). Manganese, 
Syrup. Ferri et Mang. Iodidi, ttlx-^ss, for the cachectic state (B). Alkalies, to 
relieve indigestion, especially Lithium Salts ; alkaline mineral waters have long 
had a deserved reputation (B) ; Magnesia and its Carbonates often of great 
service ; the latter dissolved in excess of C0 2 an elegant form of administra- 
tion (Wa). Alkaline Poultice, Linseed meal 9 parts to one of Sodium Bicarb. 
is a useful application (R). Turkish Baths, are useful in chronic gout (R). 
Carbonated Water freely, has an exceedingly beneficial influence. Oxygen, is 
used with benefit in cases of deficient oxidation (Br). Aliment, farinaceous 
vegetables and acid fruits ; avoid animal or saccharine food ; Milk-cure has 
improved cases and apparently removed the diathesis (B) ; God-liver oil in 
chronic gout (R) ; entire abstinence from alcoholic beverages; the most inju- 
rious wines are port, sherry and madeira. Local Measures, the affected limb 
should be raised, and surrounded by hot, moist flannels ; wrap the hands in 
flannel dripping with water and cover with water-proof bag, to dissolve gouty 
deposits. Baths, are useful, especially hot, steam and Turkish baths, but they 
do not cure the disease (W). Exercise, if there be any cure for gout it is exer- 
cise (W). [Compare Arthritis, Lithemia.] 



Scudamore' 's Mixture (Modified). 

R . Vini Colchici Radicis, 

Magnesii Sulphatis, . aa^j. 
Magnesiae Optimse, . . gij. 
Aquae Menth. Pip., . . Jx. 
M. Sig. — Tablesp. every hour until it 

operates on the bowels. 



R. Colchicinae, gr. j. 

Ext. Colocynthidis Co., gss. 

Quininas Sulphat., . . . giij. 
Ft. pil. no. lx. Sig. — One pill every four 
hours. (B.) 



R. 


Vini Colchici Seminis, 


. gss. 






Tinct. 


Digitalis, . . 


• 3'J- 






Liq. Potassii Citratis, 


• ,liJ ss - 




M 


■ Sig. 


— A teasp. in water every 


SIX 


hours. 









Lallemand's Specific. 
R . Ext. Colchici Acet. (B. P.), 

Ext. Opii Aquosi, . . aa gr. xv, 
Potass. Iodidi, . . . . £iv. 
Potass. Acetatis, . . . gij. 
Aquse Destill., .... .^iijss. 

Vini Albi, Sj ss. 

M. Sig. — 20 drops thrice daily. 



Gums. 

Myrrh, the tincture for spongy and ulcerated gums (P) ; £ij-iv in ^iv of 
water or Infusion of Cinchona, is highly serviceable as a gargle or mouth-wash 
(Wa). Alum, for spongy and ill-conditioned gums, tending to recede from the 
teeth, whether of mercurial or scorbutic origin (Wa). Catechu, a piece dis- 
solved slowly in the mouth is often of service in similar conditions (Wa). 
Rhatany, the powder as a dentifrice, keeps gums in good order (B). Potassium 
Chlorate, gr. ij every four hours for a child of one year, for inflammation of 
gums in teething (Wa). Carbolic Acid, gr. iij ad gj aquas, as lotion in diseases 
of the gums (Hilditch). Pomegranate, the bark an excellent basis for gargles 
in relaxed gums (P). Potassium Iodide, gr. x thrice daily, for periostitis of 
alveolar processes, marked by looseness of teeth, pain and swelling of gums 
(Graves). Sodium Salicylate, in doses of gr. xv every 4 hours, is highly efficient 
for the same condition, especially in combination with tt\,xv of tincture of Bella- 
donna (Coley). Iodine, gr. j ad ^j aquas, applied by a brush after each meal 
to the margin of the gums, for retraction thereof with loosening of the teeth (S) ; 
the tincture is a good application in many morbid conditions of the gums. Zinc 
Chloride, a saturated solution applied by cotton to the margins, an excellent 
astringent tonic. Tannin, the glycerite, for spongy and bleeding gums (B). 
Carbolate of Iodine, when fetor (B). Benzoin, the tincture a good application 
(B). [Compare Odontalgia, Scurvy, Teeth.] 



HAIR HAY-FEVER. fl$ 

R. Aluminis, gss. ' R. Tinct. Orris, 

Tinct. Myrrhas, ^j. Spt. Rosas, 

Tinct. Cinchonas, . . . . giv. Alcoholis, aa ^iv. 

Mel. Rosas, ...... £j. 01. Amygd. Amar., . . . gtt. ij. 

Vini Albi, ^ v "j- M. Sig. — Violet Mouth-wash. 

M. Sig. — Mouth- wash. (Piesse.) 



Hair. 

Rosemary, encourages the growth of hair, mitigates baldness, and is supposed 
to prevent uncurling in a damp atmosphere (P). Hydrogen Dioxide and 
other preparations of oxygen, are used to "blonde" the hair, for purposes of 
fashion (Wilson), Hair-dyes, comprise Potassium Permanganate, Pyrogallic 
Acid, Black Oxide of Lead, which are temporary, and the Black Oxide of Silver, 
which is permanent in its action (Wilson). Depilatories usually consist of 
powders containing Quicklime 3 parts, Sodium Sulphide 1, and Starch 4: a 
powerful depilatory is Barium Sulphide made into a thin paste with Starch 
(Wilson) : another contains Yellow Sulphide of Arsenic, gr. xx, Quicklime, ^ss, 
Starch, 5ij : a very effective one is Barium Sulphide and Zinc Oxide (B). 
Sarsaparilla is stated by Teste to possess the curious property of changing red 
hair to a light flaxen color, when taken internally for three months. [Compare 
Alopecia, Syphilis, Tinea Tonsurans, etc.] 

R . Sodii Boratis, % iv. 

Aq. Ammonias, jfj. £. 01. Ricini, gjss. 

Spt. Myrcias, |ij. 01. Bergamottas, .... ^jss. 

Aq. Rosas, gxiij. Ql. Cinnamomi, 

M. Sig.— Shampoo Hair Wash. 01. Caryophylli, . . aa n\,vij. 

■ 01. Lavandulas, l^xl- 

R. Ac. Salicylici, gr. xl. Tinct. Cantharidis, . . . ^j. 

Tinct. Benzoini, . . . . £ss. Aq. Ammonias, Sjij. 

Alcoholis, Glycerini, . aa 3 viij. Alcoholis, . . . q. s. ad Oj. 

M. Sig. — Hair Wash. M. Sig. — Hair Tonic. 



Hay-Fever. 

Arsenic, especially valuable when disease is more of catarrhal than of asth- 
matic type, 3-minim doses of Liquor Arsenicalis (Mackenzie) ; as cigarettes, 2 
or 3 daily. [See Asthma for formula.] Belladonna, when nasal secretion is 
very profuse (B). Euphrasia, of decided benefit for the catarrhal symptoms 
(Pf ). Quinine, very useful after the more acute symptoms have subsided (R) ; 
injected into the nares checks catarrhal discharge and spasmodic symptoms 
(P) ; a solution of the Hydrochlorate, gr. iv-viij ad ^j aquse, applied locally to- 
nasal mucous membrane by a spray-producer or a brush, will arrest the disease 
if confined to the nares and fauces (B). Ipecacuanha, in hay-asthma (R) ; 
is of great value, though the smallest doses cause similar effects (P). Aconite 
is better than Arsenic in true hay-fever (R) ; has been used with the best results 
(P). Grindelia benefits cases of asthmatic type (B). Iodides are very ser- 
viceable, locally and internally ; large doses until some iodism observed ; may 
be combined with Arsenic (B). Opium, especially as Morphine, of great value 
in any stage, but great danger of the opium-habit (B) ; the tincture in doses of 
nxij-iij every 2 hours for three doses, then Try* every 2 hours until the discharge 
abates, has given excellent results (Wa). Black Coffee is highly recommended 
(P). Cocaine, a 5 to 20 per cent, solution of the Hydrochlorate, brushed over 
the nasal mucous membrane after drying it as far as possible, is the most effi : 
cient palliative yet obtained (R) ; a 4 per cent, solution dropped from a medi- 
cine-dropper well into the anterior nares the head being thrown well backward, 
or sprayed up the nostrils from a small atomizer ; gives immediate relief, and 



yi6 



HEADACHE. 



though not curative it prevents so much suffering and distress that in no case 
should it be left untried (Da C). Ignatia, the tincture has seemed to benefit 
some cases, and to influence favorably the course of the disorder (Da C). 
Lobelia, has been found an efficient remedy (Wa). Tobacco, smoking helps 
some and aggravates the symptoms in other instances ; internally ad nauseam 
it helps, but there are better and safer remedies (Wa). Removal to the sea- 
coast or a barren, mountainous district, gives the only relief to some sub- 
jects; though many of the worst cases, hitherto unaffected by medicine, are 
now relieved by the local application of Cocaine. [Compare Asthma, 
Catarrh, Conjunctivitis, Influenza.] 



For Internal Use. 

R. Potassii Iodidi, gj. 

Liq. Potass. Arsenit., . . gj. 
Aquae Cinnam., . , . . ^iv. 
M. Sig. — Teasp. every 4 hours. 



R. Ext. Hyoscyami, . . . . gr. xij. 

Potassii Iodidi, gj. 

Potassii Bicarb., . . . . gij. 

Ext. Glycyrrhizse Pur., . £iv. 

Aquas Anisi, ...... ^ ivss. 

M. Sig. — Dessertsp. every 4 hours until 

relieved. ( Weber.) 



R. Liq. Potassii Arsenit., . . 25 j. 
Tinct. Belladonnas, . . . ^ij. 
M. Sig. — 5 to 10 drops after meals, as 
a prophylactic. 



R. Tinct. Euphrasiae, .... gjss. 
Aq. Camphorae, . q. s. ad ^ij. 
M. Sig. — Teasp. four times daily, for 
the catarrh. 



For Local Use. 
R. Tinct. Iodi, ...... ^j. 

Ac. Carbol., gtt. x. 

Aq. Destill., |iv. 

M. Sig. — For local use with atomizer 
or post-nasal syringe. 



R. 



M 



Mentholi, 5fj. • 

Ac. Carbol. , 3 ss. 

Zinci Oxidi, gj. 

01. Amygd. Dulcis, . . . ,^jss. 
Cerati Simplicis, . . . . ^ij. 
Sig. — Apply thoroughly to the nos- 



trils every few hours. 



R. Quininae Bisulph., . . . ^iij. 

Aquae, ^iv. 

M. Sig. — Irrigate the nares, after 
cleansing with a weak alkaline solution. 



R. Cocainae Hydrochlor., . . gr. vj. 

Aquae Destill., gij. 

M. Sig. — 5 per cent, solution. A few 
drops to be instilled into nares while head 
is lowered. {Da Costa.) 



Headache, Bilious-sick. 

Antipyrin, the most valuable single remedy for headaches ; an 8-grain dose 
for dyspeptic headache, in a little water, at commencement of attack, the patient 
lying down in a dark room ; a second dose one hour after is generally enough, 
but a third or fourth may be required : sleep generally follows, and there are 
no unpleasant after-effects. Acetanilid, in 4-grain dose, equally effective. Nux 
Vomica, gtt. j of tinct. frequently, when acute gastric catarrh, with headache 
and nausea (R) ; gtt. j every 10 minutes, soon after meals, often gives marked 
relief in sick-headache not of neurotic origin (Smith) ; drop doses every 10 min- 
utes for an hour cure sick-headache, especially when accompanied by bilious- 
ness (M). Strychnine, with Aloin and Belladonna, in minute granules, for 
bilious headache from obstinate constipation, effective if given several times a 
day for a week or ten days (Roy). Belladonna, the extract in doses of gr. -^~yu, 
in similar form. Iris, blinding headache in right supraorbital region, with 
nausea and vomiting, usually the result of hepatic derangement; tt\j every half- 
hour for three doses, usually relieves promptly (Pf ). Bryonia, ordinary bilious 
sick-headache with vomiting (P). Picrotoxin, gr. -^ by stomach, in periodical 
form (B). Chamomile, a popular remedy (R). Salol, is one of the most effi- 
cient remedies. Podophyllum, in sick headache, with dark bilious diarrhea, 
or when constipation with dark evacuations (R). Sanguinaria, when due to 



HEADACHE. 



717 



stomach derangement, a few doses relieve (P). Hydrastis, from constipated 
bowels (P). Mercury, as Blue Pill, to prevent or mitigate ; or small doses, gr. 
y^q, of the Bichloride when headache with light-colored diarrhea (R). Ammo- 
nium Chloride is an efficient remedy in most forms (Wa). Sodium Phosphate, 
a useful laxative in so-called bilious sick-headache (B). Potassium Bromide, a 
large dose in ordinary or sick headaches (R). Ginger, in paste, as counter- 
irritant (P). Water, as cold or hot affusion, or ice-bag to head ; hot sometimes 
best ; the purgative waters (as Friedrichshall) before breakfast in a cup of hot 
water (R) ; a brisk saline purgative, or small doses of Epsom salts thrice 
daily, very effectual for frontal headache with constipation (Br). Nitro-muri- 
atic Acid, 10 drops of the dilute acid in a winegl. of water before each meal, 
often an effectual remedy (Br). Charcoal, two teaspoonsful stirred in half-glass 
of water, as a draught, is an efficient remedy for sick-headache with sour stom- 
ach and flatulence, etc. [Compare Hemicrania.] 



R 



3 ij J- 



M 



Ammonii Chloridi, 
Morphinae Acetatis, . 
Caffeinae Citratis, . . 
Spt. Ammonii Aromat. 
Elix. Guaranae, 

Aquae Rosae, aa ^ iv. 

Sig. — Dessertsp. every quarter-hour 



g r -J- 
gss. 

3J- 



until relieved. 



{Carpenter 



U . Podophylli Resinae, . . . gr. ij. 
Tinct. Zingiberis, . . . . gij. 
Alcoholis, ... q. s, ad £]. 
M. Sig. — Teasp. in a winegl. of water 
every night at bedtime, or every second, 
third or fourth night as required. 

(Dobell.) 



Headache, Congestive. 

Antipyrin or Acetanilid (see preceding article). Aconite, to reduce the cir- 
culation (R). Veratrum Viride, at menstrual periods (R). Belladonna, relieves 
cerebral congestion, and distress from light and sound (P) ; pain over brows 
and in eyeballs, often due to stomach or uterine derangements, especially in 
young women ; rtljij of tinct. every three hours (R). Potassium Bromide, gr. 
xv-xx, in ordinary or sick headaches (R) ; Bromides are useful when nervous 
system has been irritated, but when exhausted they do harm (Hammond). 
Calomel, gr. -^, every hour for ten or twelve doses, will relieve the headache 
of syphilis occurring at night (Tr). Cannabis Indica is given with uniformly 
good results in the headache of the climacteric. Potassium Iodide, throbbing, 
intolerance of light, pain passing from back of neck over vertex to brow, noc- 
turnal, tender scalp, almost unbearable ; ten-grain doses ter die will cure (R). 
Hydrastis, when constipated bowels (P). Amyl Nitrite, for headaches with 
severe flushing heats at menstruation or climacteric, "1^ a sufficient dose (R). 
Mustard, in hot foot-bath, or as poultice to nape of neck in various forms ot 
headache (R). Water, cold water poured gently over forehead, sometimes 
warm water better (R) ; a very hot foot-bath often effectually relieves (Wa). 
Purgatives are often beneficial, especially when congestive headache arises 
from suppression of hemorrhoidal discharge, or in persons of phlegmatic habit ; 
Aloes best(Wa) ; or Colocynth, as derivative, when cerebral hyperemia (Da C). 



& . Ext. Colocynthidis Co., . gr. xij. 

Pulv. Capsici, gr. iv. 

Ext. Gentianae, gr. xxiv. 

Ft. pil. no. xij. Sig. — One pill thrice 
daily ; also a 25-grain dose of Sodium Bro- 
mide nightly, at bedtime. [Da Costa.) 



R. Spt. Ammoniae, .... %]. 

Spt. Camphorae, J ss. 

M. Sig. — For a quart of water, in which 
a handful of common salt has been dis- 
solved. Cork tightly and use locally on 
lint as an evaporating lotion. 



Headache, Nervous. 

Antipyrin, is efficient [see under Headache, Bilious-Sick]. Acetanilid, 
is very efficient in headache from fatigue (Brodnax) ; as routine remedies for 
the relief of headache these agents are much more valuable than bromides 



;i8 



HEADACHE. 



and caffeine (Whitla). Phenacetin, is used with much success (M). Cannabis 
Indica, ten-minim doses of the tincture thrice daily in the intervals, often 
curative in bad cases of neuralgic headache; or % to )4-gra.m doses of the 
extract (P). [See under Hemicrania.] Belladonna, rr\jij of tinct. every 3 
hours, when pain over brows and in eyeballs, especially when at menstrual 
periods ; also when from over-study or fatigue (R). Nux Vomica, if with 
gastric symptoms (R) ; is better than Strychnine, and should be given in 
quarter-grain doses of the extract after meals, combined with Iron and Quinine 
if patient is chlorotic (Hammond). Bromides, are useful when the nervous 
system has been irritated, but harmful when it is exhausted (Hammond). 
Silver Nitrate, half-grain doses with minute doses of Pil. Coloc. Comp., in- 
valuable in headaches of hysterical women and especially stomach headaches 
of delicate and literary men (Wa). Ignatia, removes clavus hystericus (Pf ). 
Ammonia, the Aromatic Spirit (5ss-3\j) or the Carbonate (gr. v-x) in nervous 
headache (B) ; the Hydrochlorate (gr. x-xx) in bilious and hysterical head- 
aches, especially in hard-worked and delicate young women (Wa). Amyl 
Nitrite, inhaled, when extreme pallor of face (B). Arsenic, throbbing supra- 
orbital headache (R) ; as a nerve tonic stands next in value to Zinc (Hammond). 
Cimicifuga, in nervous or hysterical women, especially at menstrual periods 
(R) ; in rheumatic and menstrual headaches (P). Coffee and Tea, when from 
nervousness or exhaustion (R) ; Coffee especially useful (P). Caffeine Citrate, 
one to two-grain doses in capsule every half-hour, a very effectual remedy for 
nervous and sick-headache, but causes insomnia if used in the evening. 
Guarana, a very effective palliative, gr. xx every half-hour for three doses (P) ; 
rr\,xv of the fluid extract every quarter-hour increased to rrvxl will often relieve 
periodical headaches not of malarial origin (Smith). Sodium Salicylate, in 
small doses, gr. ij-iij every quarter-hour, is very efficient in neuralgic headache 
(Br). Phosphorus, as dilute Phosphoric Acid, in doses of rt\,xxx well diluted, 
thrice daily ; or Zinc Phosphide, gr. T ^ in pill, ter die, very useful in most 
forms of nervous headache (Hammond). Cajuput Oil, well rubbed in twice 
daily (P). Menthol, locally to forehead in frontal headache (Wa). Potassium 
Cyanide, locally in reflex headaches, as gastric, cardiac, pulmonary, menstrual 
(B). Valerian is of great value in excitable persons (P). Camphor, a satu- 
rated solution in Eau-de-Cologne rubbed on head, when headache of uterine 
origin (R) ; in hysterical females, internally, with Magnesium Carbonate (P). 
Podophyllum, purgative doses often give relief when near menstrual periods, 
with constipation and dark stools (R). Zinc Oxide, two- to five-gr. doses useful 
(R); a remedy of great value (Hammond). Bismuth, the Subcarbonate, in 
two-grain doses after each meal, often better than Zinc, especially where 
gastric disturbance (Hammond). Ether Spray, for frontal headache, after 
acute illness or fatigue (R). Chloroform, rt\,xv-xxx of the spirit internally, often 
effective (Wa). Galvanism, sometimes valuable ; the constant current always, 
avoiding too great intensity lest amaurosis ensue (Hammond). [Compare 
Hemicrania, Neuralgia.] 



& . Potassii Cyanidi, . . . gr. x-xx. 
Aquae Laurocerasi, . . ^ iv. 
M. Sig. — Apply locally on a compress 



for */ to l A an hour. 



(B- 



R. 



Zinci Phosphidi, . . . gr. iij. 

Ext. Nucis Vom., . . . gr. x. 

Confect. Rosae, . . . . q. s. 
M. et div. in pil. no. xxx. 
Sig. — One pill after each meal. 

{Fordyce Barker.} 



R- . Extracti Nucis Vom., . gr. iij. 

Ferri Reducti, . . . . gr. xij. 

Quininse Sulphatis, . . gr. vj. 
Ft. pil. no. xij. Sig. — One after each 
meal. [Hammond.) 



M 



Ext. Cannabis Ind. Fl., giv. 
Pulv. Acaciae, . . . . 3 v. 
Syr. Aurantii Cort., . . ^ij. 
Aquae, . . . . q. s. ad t ^vj. 
Sig. — Teasp. every 3 hours. 



HEART AFFECTIONS. 719 



Heart Affections. 

Potassium Iodide, the true remedy for the heart ; especially applicable in 
non-compensatory mitral or myocardial diseases, and where there is cardiac 
debility ; restoring energy and vascular tension at first ; then by dilating, later 
on, all the arterioles, it frees the heart from resistance, and enables it to re- 
cover its contractile power ; also dilating the coronary arteries it furnishes 
nutrition to the heart itself (See). Strychnine, in medicinal doses, is said to 
strengthen the heart-beats (R). Nux Vomica, gave speedy relief in several 
cases of heart-failure in which death was imminent ; small doses every y z hour 
for four successive doses, then every hour (Bowie) ; in a case of cardiac hyper- 
trophy and mitral insufficiency, in which death was imminent from heart- 
failure, one drop of the tincture in a teasp. of water every 5 minutes for 10 
doses, then every 10 minutes for 3 doses, continuing at longer intervals, com- 
pletely restored the cardiac force, and dispelled the accompanying cardiac 
asthma (Macfarlan). Digitalis, acts as a stimulant tonic (P) ; small doses for 
sedative action ; tonic or physiological doses to create hypertrophy in dilata- 
tion (Tr) ; irregularity of pulse is best indication (R) ; irritable heart (Da C) ; 
the tincture, given without water, is the best preparation; especially indicated 
in weak heart acting rapidly because of its weakness, and in valvular disease 
(Wa). Helleborei'n, as a substitute for Digitalis (see page 338). Chloral, is 
generally contraindicated in heart affections, but may be used with benefit in 
neurotic palpitation and in pseudo-angina pectoris. Convallaria Majalis, will 
usually succeed in all cases in which Digitalis is useful, acting similarly to that 
drug, but with less reliability ; is useful in aortic disease and in others where 
Digitalis cannot be used (Wa) ; valuable in all forms of heart disease where 
there is edema of tissues (See). Morphine, next to Digitalis, is in general the 
most indispensable remedy in the treatment of severe heart disease, being by 
far the most efficient agent for the dyspnea (Strumpell) ; hypodermically is 
employed in many cardiac disorders with marked advantage, especially in 
dyspnea and angina with diseased coronary arteries, mitral regurgitation with 
its dyspnea and insomnia, aortic disease, etc. Cimicifuga, safer than Digitalis 
in fatty heart (B) ; its action is strongly stimulating and tonic ; it relieves exces- 
sive dyspnea when weak heart (P). Cactus, is highly esteemed in functional 
cardiac affections. Caffeine, an excellent cardiac stimulant, and diuretic, gr. 
ij-v of the Citrate every three hours (Da C). Arsenic, for dyspnea from weak 
heart (R) ; in all cardiac neuroses it is especially valuable when combined with 
Iron and Strychnine, and is regarded as indispensable in all forms of weak 
heart accompanied by pain (Wa). Aconite, in the highest degree serviceable 
to diminish excitement or irritability ; is more a remedy for functional de- 
rangement than for organic disease (Wa) ; in pericarditis (R) ; in nervous pal- 
pitations and hypertrophy (P) ; the heart seldom affected in rheumatic fever 
if Aconite be used from the start (P). Veratrum Viride, as cardiac depressant 
(B) ; in chronic cardiac diseases where excessive hypertrophy, i. e. when Digi- 
talis is contraindicated (W). Iron, useful in various forms, especially anemic 
disorders and palpitation ; also in dilatation and fatty heart, and mitral regur- 
gitation (B). Hyoscyamus, in functional derangement from emotion, is specially 
indicated ; requires large doses, tt\,xl-lx of tinct., or gr. fa of Hyoscyamine 
Sulphate hypodermically (Wa). Amyl Nitrite, relieves heart-pains resisting all 
other treatment (W). Blisters, flying blisters over the precordial region, to 
stimulate action in extreme weakness (R). Alcohol, as Brandy when heart 
suddenly enfeebled by fright, loss of blood, etc. (R). Ether, rr\,xx hypodermic- 
ally and repeated soon, is a very promptly-acting stimulant in sudden heart- 
failure ; the compound spirit in gj doses for less urgent cases. Schott Cure, as 
practised at Nauheim, is a combination of saline baths containing C0 2 in so- 
lution, and a series of graduated gentle exercises ; the best results therefrom 
are obtained in cases of cardiac dilatation due to overwork or worry, but it is 



720 



HEART AFFECTIONS. 



also useful in fatty infiltration of the heart (not fatty degeneration) accompany- 
ing general obesity (M). [Compare Angina Pectoris, Dropsy, Endocar- 
ditis, Pericarditis, Syncope, and the five following articles.] 



& . Ext. Ergotse Fl. , . . . !§ n J ss - 
Tinct. Digitalis, . . . j|ss. 
M. Sig. — Teasp. thrice daily in en- 
larged heart without valvular lesion. 



R-. Spt. ^Etheris Comp. , 

Liq. Morphine Sulphatis, 

(U. S. P., 1870), aa gj. 
Teasp. as required for dyspnea. 



Heart, Dilated. 

Digitalis, where much dilatation and hypertrophy of left ventricle without 
valvular disease ; is not contraindicated when aortic disease (R) ; use in physio- 
logical doses (Tr) ; in simple dilatation gives most favorable results (Wa) ; very 
useful in mitral disease, when dilatation of the left ventricle (P) ; gives miracu- 
lous relief, is not sufficiently appreciated, but requires skilful administration ; 
use the infusion in preference to other preparations, a tablespoonful thrice daily, 
watching its effects (Da C). Scoparius, the infusion (Broom-tea), to maintain 
the kidney action if Digitalis is not sufficient (Da C). Purgation, brisk, free, 
watery stools, next to Digitalis is the best treatment (Da C). Morphine, hypo- 
dermically, gr. Y~Y two or three times a week in dilated heart with dyspnea (B). 
Amyl Nitrite, dyspnea from dilatation (R) ; is useful when great dyspnea, the 
cardiac asthma (P). Ether, the Compound Spirit an excellent remedy for the 
dyspnea (Da C). Mercury, a classical pill and a very efficient one as a diuretic 
in dropsy from cardiac disease is the combination of gr. j each of Pulv. Digitalis,. 
Pulv. Scillae, and Hydrarg. cum Creta (Foster). Schott Cure, in dilatation due 
to overwork or worry (see preceding page). 



Heart, Fatty. 

Strychnine, often the first remedy to do good ; unduly pushed will produce 
nervous worry and be injurious (P) ; is the remedy with Iron, nourishing but 
not fat-making diet, and wine to keep up the tone of the blood (Da C). Ergot, 
in occasional doses has been given with apparent benefit (Wa). Iron, the 
tincture of the Chloride in small doses for a long time, has been of remarkable 
benefit (Wa). Cimicifuga, safer than Digitalis (B) ; the latter should not be 
used (Wa). Digitalis, of no value except for very temporary use and for some 
special indication (Da C). Chloral, must be entirely debarred (Id). Ether, the 
compound spirit for sudden attacks of pain or dyspnea (Id). Amyl Nitrite, 
for the same indications (Id). Stimulants, freely used, in an acute attack of 
any kind, afford the only chance (Id). Schott Cure, useful in fatty infiltration 
(not fatty degeneration) accompanying general obesity (M). 



Heart, Hypertrophied. 

Aconite, often better than Digitalis (R) ; dangerous in hypertrophy of left 
side with diseased valves, but useful in simple hypertrophy (P) ; for over- 
action with hypertrophy (B) ; the one remedy which can be depended on ; 
small doses for months, say gtt. j of a good tincture ter die, to lower the heart 
gradually and keep it low (Da C). Digitalis, very useful in pure hypertrophy due 
to valvular disease or excessive muscular exertion (R) ; the primary action 
(small doses) required, as it creates hypertrophy when given in physiological 
or tonic doses (Tr). Veratrum Viride, as a cardiac depressant, gtt. v ter die, 
will relieve in simple hypertrophy, and irritable heart from abuse of tobacco, 
inadmissible when valvular lesions exist (B) ; gives the best results next after 
Aconite (Da C). Lead Acetate, for violent palpitations, in some instances effi- 
cient (Wa). Amyl Nitrite, for dyspnea, syncope (R). Ergot, in enlarged heart 



HEART AFFECTIONS. 721 

without valvular lesion ; may be combined with digitalis (B). Potassium 
Iodide, small doses long continued benefit some cases (Wa). Camphor, in 
doses ofgr. iij-xij daily for tumultuous palpitations and dyspnea ot hyper- 
trophy with dilatation (Wa). Iron is necessary where anemia exists (Da C). 
Quiet Life of great importance, no stair-climbing, no long walks; rest in bed 
for days at a time often of service, moderate diet, avoiding fattening foods, 
meat and stimulants (Da C). 

Heart, Palpitation of. 

Aconite, for the fluttering heart of nervous persons and nervous palpitations 
(R) ; for over-action with hypertrophy (B) ; for palpitation with simple hyper- 
trophy^). Hydrocyanic Acid, when from dyspepsia (P). Iron, when palpitation 
due to anemia, a very frequent cause; other causes are tobacco, coffee, tea, etc. 
to excess, dyspepsia, venery, excessive exercise (Da C). Spigelia Anthelmia, 
when due to mitral and aortic disease, with much dyspnea (P). Digitalis, in 
small doses as sedative (Tr) ; combined with Iron in palpitation with valvular 
disease, or given alone in very severe cases (Wa) ; suits a large number of 
cases, especially for temporary purposes (Da C) ; the only remedy of positive 
service for the actual palpitation (Richardson). Camphor, recommended in 
nervous palpitations (R). Veratrine, as ointment to chest, when rapid, irregular 
pulse, hurried breathing, dropsy and lividity, palpitation, inability to lie down 
(R). Nux Vomica, of great value in nervous palpitation. Bromides, in flut- 
tering heart (B) ; are useful when tolerated by the stomach (Da C). Hyos- 
cyamus, in nervous, and violent palpitations from excited state of the brain (P) ; 
in large doses, for functional disturbance arising from emotion (Wa). Bella- 
donna, in small doses, when irregularity of rhythm ; may also be applied exter- 
nally (Da C). Valerian, nervous palpitation, with dyspnea (P). Eucalyptus, 
palpitation and weak heart (B). Galvanization, of cervical sympathetic and 
pneumogastric (B). Hot Foot-bath relieves palpitations (R). Milk-cure, has 
been beneficial in irregular action (B). Ice, to the cardiac region, has benefited 
many cases ; is of chief value when patient can be kept in bed, which some- 
times becomes necessary (Da C). 

I& . Pulv. Digitalis, gr. xx. J R. Tinct. Digitalis, . . . . gij. 

Pulv. Colchici Sem., . . gr. xl. Sp. ^Etheris Nitrosi, . . . f > ]. 

Sodii Bicarb., gr. lx. Liq. Ammonii Acet, q.s.ad^ iv. 

M. et div. in chart, no. xl. Sig. — One I M. Sig. — A dessertsp. every 4 hours, 
powder at first 3 or 4 times daily, gradually If prolonged insomnia with palpitation add 

reduced to one at bedtime. For irregular j of Morph. Sulph. gr. ^ to each dose, 

cardiac action. (Bowditch.) \ [Richardson.) 



Heart, Valvular Disease. 

Nux Vomica, the tincture in one-drop doses every 5 minutes, remarkably 
efficient in heart-failure, even with death impending (Bowie) ; also for the 
asthma (Macfarlan). [See under Heart Affections.] Digitalis, in aortic 
regurgitation (R) ; most effective in mitral insufficiency (P) ; in rapid action 
with low arterial tension, and in mitral disease ; infusion best, tablesp. doses 
twice daily (B) ; rr\j of tinct. every }i hour or hour, often gives more relief than 
larger doses (Smith) ; when heart is weak and struggling (Da C). Cactus, is 
especially recommended in complicated aortic regurgitation, as it does not 
prolong the diastole like Digitalis, but stimulates the cardiac action. Morphine, 
hypodermically for the dyspnea, is better in mitral than in aortic disease (R) ; 
the agent above all others in aortic insufficiency, combating the two great 
symptoms therein, the cerebral anemia and the dyspnea ; is to aortic regur- 
gitation what Digitalis is to mitral (Dujardin-Beaumetz). Aconite, useful for 
the palpitation, but dangerous in hypertrophy of left side with diseased valves 
46 



722 HEAT-STROKE. 

(P) ; for cases presenting excessive growth and strong action, diminishes the 
blood-pressure in the arterial system, and gives great relief (Da C). Veratrum 
Viride, has similar applicability, but is more apt to nauseate ; an admirable 
sedative, and one which does not sicken, is a mixture of Tinct. Aconiti, tt\j, 
Tinct. Veratri Vir., rr^iij, Tinct. Zingiberis, rr\,vij (Da C). Strophantus, is a 
cardiac tonic like Digitalis, but does not contract the vessels nearly so much 
(Br). Nitroglycerin, is the best of all remedies when actual cardiac pain ; it 
lessens blood-pressure and diminishes the resistance the heart has to overcome 
(Da C). Caffeine, as a tonic and diuretic, of especial value in cases where 
urine is scanty, with cardiac pains, headache and dyspnea, and weak heart ; 
gr. ij of the Citrate every three hours (Id). Adonidine, in doses of gr. ^ to ^ 
thrice daily, acts excellently as a cardiac regulator (Id). Barium Chloride, gr. 
^ in pill three or four times daily, is diuretic, lessens cardiac pain, increases 
tone in the vessels, and is a good general and cardiac tonic (Id). Purging, with 
Jalap, etc., in engorgement of right side of heart (R) ; occasionally useful (Da C). 
Treatment is directed chiefly to the dilatation or hypertrophy resulting from 
the valvular disease ; the simplest rule is to use one's best judgment as to 
when the heart needs strengthening by the use of Digitalis or reducing by the 
administration of Aconite or Veratrum Viride (Da C). [Compare Endocar- 
ditis.] 



Heat-stroke. 

Quinine, in all fulminating fevers, including siriasis, occurring in warm cli- 
mates, if malaria be suspected and especially if its plasmodium is discovered in 
the blood ; gr. vij of the Hydrochlorate hypodermically at once and repeated 
3 or 4 times at intervals of 4 hours (Mn). Morphine to control the convulsions 
(Bevan). Chloroform by inhalation cautiously, for the convulsions (Mn). 
Strychnine, must be avoided in heat-stroke, there being a tendency to convul- 
sions in this affection (Chandler). Digitalis, ir^xl of the tincture hypodermic- 
ally as soon as possible in siriasis, preceded by a small bleeding in plethoric 
cases showing high arterial tension (Chandler). Bromides, for restlessness 
and insomnia (Mn) ; courses of the Bromides and Iodides, with repeated blis- 
tering of the neck and scalp, also careful dieting and general hygiene, for per- 
sistent headache and other signs of chronic meningitis (Id). Antipyrin and 
other antipyretic drugs are to be avoided in all serious cases of siriasis, as they 
are dangerous by their depressant action on the heart (Id). Alcohol in every 
form, must be strictly forbidden in any case of heat-stroke in which the cerebral 
symptoms suggest meningeal congestion or inflammation (Id). Stimulation is 
indicated in the syncopal form, generally called " heat-exhaustion " ; Ammonia 
held to the nostrils and a stimulant given by the mouth or rectum or hypoder- 
mically (Id) ; external stimulation in asphyxial cases to the precordium by 
mustard, also to the feet by hot bottles, and hypodermics of nitro-glycerin, 
atropine, brandy, camphor or ether (Anders). Cold by ice-bag applied to the 
shaven scalp for a time in heat-stroke, the bowels kept free, the food light and 
non-stimulant (Mn) ; Ice packed around the head and body, iced water 
dripped on the body from an elevation of 5 to 10 feet for 30 or 40 minutes, a 
fine iced spray on the forehead for only 1 or 2 minutes ; a thermometer in the 
rectum and the cold application to be discontinued in hyperpyrexial cases 
when the rectal temperature reaches 104 F., and in cases of simple thermic 
fever when it has fallen to 102 F., as dangerous collapse may ensue from 
a longer application ; then wrap the patient in a blanket and apply hot 
bottles to the limbs and trunk (Chandler). Artificial Respiration, when the 
breathing threatens to become suspended, has given marvellous results in some 
cases (Id). Climate should be changed ; as soon as the subject of heat-stroke 
is able to be moved he should go to a cold climate and should not return to the 
tropics while the slightest evidence of cerebral trouble remains (Mn). [Com- 
pare Cerebral Congestion, Meningitis cerebral.] 



HECTIC FEVER HEMATEMESIS HEMATOCELE. 723 



Hectic Fever. 

Quinine, in large doses, gr. xv-xx daily, if stomach and intestines do not 
rebel (P) ; given before the paroxysm, to limit it (Roberts). Antipyrin, is better 
than Quinine, but must be used in much smaller dosage than ordinarily em- 
ployed, say gr. iv or v about % hour before fever rises, then doses of gr. ij 
hourly as long as temp, remains above 100. 5 ; this daily, will give excellent 
results in the hectic of phthisis (Pibram). Phenacetin, is safer and equally 
efficient. Phenocoll, as an antipyretic, is used with marked success. Aconite, 
in small doses, a remedy of much value in the irritative fever of phthisis (Da C). 
Morphine and other anodynes, are of especial value, given in full doses toward 
bed-time (Gross). Prunus Virginiana, the bark has been found useful, espe- 
cially when irritable cough (P). Calcium Phosphate, is especially useful (R). 
Calumba, excellent for tonic effects (P). Digitalis, the tincture, combined with 
Tinct. Ferri Chloridi, abates the temperature and diminishes the sweats (B). 
Iron, the Mistura Ferri Composita has obtained great celebrity, especially when 
much debility and anemia (Wa) ; the Sulphate and Tincture of the Chloride 
are of especial value in the treatment of hectic (Gross). Ipecacuanha, a few 
grains of Dover's powder at bed-time, will stop the profuse perspirations (Wa). 
Salicin, for profuse perspirations (Wa) ; as antipyretic. [Compare Perspira- 
tion, Phthisis.] 

R . Quininse Sulph., ... . £jss. 
Elix. Taraxaci, . . . . ^iv. 
M. Sig. — Teaspoonful every hour for 
six hours. 



R. Tinct. Digitalis, . . •. , ^iij. 
Tinct. Ferri Chloridi, . gv. 
M. Sig. — 15 drops 3 or 4 times a day. 

(B-) 



Hematemesis. 

Ipecacuanha, is decidedly effective in small doses, also when hematemesis 
is vicarious of menstruation (P, Wa). Hamamelis, TT\j-ij of tinct. every 2 or 3 
hours (R) ; effective from its Tannin (B). Alum, serviceable in passive hemor- 
rhage ; Iron better (B). Turpentine, especially in passive hemorrhage with 
debility (R); and in hemorrhagic transudations on the free mucous surfaces, 
hematemesis, etc. (B). Ergot, has often cured when other means failed (P) ; 
most valuable ; in urgent cases Ergotin in 2 to 5 gr. doses hypodermically 
(R). Iron, the Subsulphate (Monsel's solution) or Pernitrate, the best remedies ; 
gtt. j — ij frequently, diluted with ice-water (B) ; the Chloride, in a mixture with 
glycerin and pounded ice, a teasp. every hour, gave excellent results in two 
cases of very severe hematemesis (St. George Reid). Lead Acetate, especially 
when gastric ulcer, gr. ss-v (B). Tannic Acid, gr. x-xx, when hematemesis 
from gastric ulcer or obstructive disease of the liver (B). Gallic Acid, an ex- 
tremely useful agent ; is best used in combination with dilute Sulphuric Acid 
(Wa). Ice, in small pieces swallowed, a most useful agent, with perfect rest 
for stomach ; when hematemesis from that organ, nutrient enemata must be 
employed ; iced champagne to arrest faintness, if persistent ; when moderate 
the bleeding need not give cause for alarm. 



R. Olei Terebinth., giij. 

Ext. Digitalis Fluid. , . . gj. 
Mucil. Acaciae, ..... j^ss. 
Aq. Menth. Pip., . . . . ^j. 
M. Sig. — Teasp. every 3 hours. 



R . Ac. Gallici, gj. 

Ext. Ergotse Aquosi, 

Digitalis, aa gr. xx. 

M. et div. in pil. no. xx. Sig. — One 
every 4 hours. 



Hematocele, Pelvic. 

Opium, or Morphine, if needed for pain, with absolute rest in bed, and a 
moderately tight abdominal bandage (E). Hemostatics, as Gallic Acid, Lead, 
Turpentine, etc., to arrest the hemorrhage, if it be still going on, combined with 
opiates, and the use of ice-bags or cold lotions to the abdomen or per vaginam. 
Tonics, as Iron and Quinine, while resolution of the extravasation is going, on. 



724 



HEMATURIA HEMERALOPIA AND NYCTALOPIA. 



Bromides and Iodides, to quiet the action of the ovaries, if the hemorrhage 
recurs at different periods. Potassium Iodide, as an absorbent, may be given 
with Quinine (Braxton Hicks). Iodized Cotton, an excellent application to the 
cervix uteri in cases of hematocele (Wa). Leeches, should be applied early 
in cases of peri-uterine hematocele ; later, except to check inflammation, they 
are inadmissible (Wa). Mercury, gr. -^ of the Bichloride thrice daily, with 
Iron and Ergot, conjoined with vaginal injections of hot water morning and 
evening ; later in lieu of the mercurial the Syrup of Ferrous Iodide in 20-drop 
doses thrice daily, was thoroughly efficient treatment in one very bad case of 
retro-uterine hematocele (Hengst). Surgical interference has many advocates, 
but is criminal in a large majority of the cases (E). If the case does not end 
in resolution it will terminate in pelvic abscess. 

R. 



Iodi, .... 
Potassii Iodidi, 
Glycerini, . . 



Mix and saturate 8 oz. of cotton with 
the mixture ; then carefully dry, and label 
" Iodized Cotton." [See above.] 



Hematuria. 

Turpentine, when with constitutional debility (B) ; in very small doses (R) ; 
is often very efficacious (P). [See under Hematemesis, for formula.] Hama- 
melis, has arrested severe cases (R). Chimaphila, controls hematuria (P). 
Gallic Acid, the most uniformly successful remedy (B) ; gr. x-xx every hour or 
two (Da C). Sulphuric Acid, alone or with Gallic Acid, is an efficient remedy 
(Da C). Acetic Acid, in a case of alarming hemorrhage from the bladder, 
which occurred after an operation for vesico-vaginal fistula, and resisted all 
other means, an injection of apple-vinegar and ice-water, equal parts, suc- 
ceeded in arresting it (Ghent). Quinine, large doses necessary ; cures when 
intermittent or from malarial infection (B) ; useful in some cases of intermittent 
hematuria (R). Myrtol, has been used with success in hematuria not due to 
acute congestion (B). Iron, the tincture of the Chloride, Tr^x-xx several times 
daily ; in this affection the best form of Iron for internal use (Wa). Ipecacu- 
anha, exercises a powerful influence (Wa). [See under Hematemesis.] Ergot, 
by stomach or subcutaneously ; may be combined with Ipecac, Krameria, or 
other astringents (B). Ergotin, hypodermically, is far superior for efficacy and 
rapidity of operation (Wa). Matico, the infusion, in doses of ^ij every 2 or 3 
hours, is fully equal to Gallic Acid, Lead, etc. (Thompson). Ammonium Ben- 
zoate, in 5-gr. doses every 2 hours for the albuminuria and hematuria of scarla- 
tina (Hillier). Cannabis Indica, is especially indicated in dysuria and strangury 
when there is bloody urine (R). Camphor, in 2 to 5 grain doses is said to 
promptly remove the renal hyperemia with bloody, coagulable urine, caused 
by Cantharis, Turpentine, Oil of Mustard, Copaiba, etc. (R). Ice in rectum or 
to perineum, for vesical hemorrhage (Thompson). Endemic hematuria, due to 
the bilharzia parasite, can only be palliated ; as yet we know of no means by 
which the bilharzia can be destroyed (Mn). 



R. Acidi Gallici, gss. 

Acidi Sulphurici Dil., 
Tinct. Opii Deodor., . aa 55 j. 
Infusi Digitalis, . . . . Jiv. 
M. Sig. — Tablesp. every 4 hours or 
oftener. In hematuria, menorrhagia, pur- 
pura hemorrhagica, and the hemorrhagic 
diathesis. (D.) 



R . Ext. Ergotae Fluidi, 

Tinct. Kramerise, . . aa 3J. 
M. Sig. — A teasp. every hour or two. 



R. Ext. Ergotae (Squibb), . . zj. 

Aquas, §j. 

M. Sig. — For hypodermic use ; Ti^x 
contain gr. j. 



Hemeralopia and Nyctalopia. 

Strychnine, for night-blindness ; small doses gradually increased, of service 
(Wa). Mercury, Hydrarg. Chlor. Corr. gr. ij ad %} aquae, dropped into the eye 
twice daily, with blister on each temple, and mild aperients, has cured hemera- 






HEMICRANIA. 725 

lopia (Smith). Quinine, in as large doses as can be borne, after cathartic and 
emetic, for night- and day-blindness (Howard). Blisters, small, i}i inches in 
diameter, close to external canthus of the eye (Bampfield). Electricity, occa- 
sionally useful (Wa). Rest, protection of eyes from bright light, constitutional 
remedies as indicated by state of the general health, and change of climate, 
speedily cure hemeralopia. It is sometimes merely a symptom of pigmentary 
degeneration of the retina, or a feature of scurvy. 

Hemicrania. 

Antipyrin, the most valuable single remedy for headache, especially in 
migraine and those cases for which Ergot and Amyl Nitrite are indicated; 5 
grains at beginning of the attack often sufficient (Birdsall) ; of great value in 
true migraine, employed in twenty cases with unfailing benefit; less useful in 
the malarial or dyspeptic forms, and useless in uremic (Thompson); one dose 
of gr. xx, or 2 doses of gr. x each, }4 hour apart, given in the prodromal 
period, or at the very beginning of a paroxysm, will invariably cut it short 
within an hour (Sprimon, Ungar, etc.). Acetanilid and Antipyrin, the striking 
powers of these two agents are best demonstrated in severe migraine (Whitla). 
Phenacetin, has been given with great benefit, in doses of 2 grains with y 2 
grain of Caffeine Citrate, for migraine. Belladonna, when due to vaso-motor 
spasm, the face being pallid (B) ; the tincture in small and repeated doses if 
the disease be of reflex character (H). Iris, in blinding form, from hepatic 
trouble, right supra-orbital region ; rr\j every half-hour for 3 doses, usually 
relieves promptly (Pf ). Cannabis Indica, one of the most valuable remedies 
for megrim or sick headache, apparently acting on the nervous centre whence 
the disorder springs ; is most useful in the intervals to prevent the attacks, and 
especially when the paroxysms are becoming more frequent ; it may be com- 
bined in pill with either Iron or Aloes (K); of especial value in the con- 
gestive form, the tincture in repeated doses until some physiological action 
is induced (H); gr. y^ of the extract before each meal, increased gradu- 
ally to y z or ^3 grain, in the intervals, kept up for 3 months (Seguin) ; gr. yi 
of the solid extract night and morning, very efficient in migraine, if used con- 
tinuously for a long time (Hare). Camphor, gr. iij-v, with a 20- or 30-grain 
dose of Magnesium Carbonate, is very useful, especially in hysterical females 
(P). Croton-chloral, in milder forms without severe vomiting, headache 
being predominant; the Bromides are useful after it (R) ; rarely of any use, 
but if given it should be in 20-grain doses twice daily (H) ; Guarana, is useful 
(B), a very effective palliative; gr. xx every ]/ 2 hour for three hours (P) ; its 
efficacy diminishes by degrees, attacks usually becoming longer (Tr); Z'\] of 
fluid extract in course of an hour or two, to anticipate the attack when expected 
(Seguin). Caffeine, in typical migraine; gr. j hypodermically (P) ; is espe- 
cially adapted when chronic gastric catarrh, gr. j every half-hour (B) ; the 
Citrate in grain doses every hour for some time before a paroxysm (Wa) ; gr. j 
every half-hour often gives marked relief (Smith). Valerian, of especial value 
when hemicrania in excitable temperaments, and after profuse or painful 
menstruation (P). Ammonium Chloride, is exceptionally serviceable ; seldom 
failing to cut short an attack (Austin) ; 10- to 15-gr. doses (R) ; as a diffusible 
stimulant is very efficient, gr. xx up to 3j every hour during the attack (H). 
Sodium Chloride, in small doses, proved very efficient in six positive cases 
attended by gastric distress (Rabon). Podophyllin or Mercury, when of bilious 
origin (R). Bromides, for true migraine ; Raspail's Eau Sedative locally, gives 
great relief (B) ; when due to uterine disorder (R). Potassium Bromide, very 
serviceable in the paroxysm, also in the continuous form (R). Eucalyptus, 
in cerebral anemia (B). Digitalin, gr. -^ bis die in granules for congestive 
hemicrania (B). Ergot, if due to miliary aneurisms of intercranial arterioles ; 
also in congestive migraine and in nearly all kinds (B). Menthol, locally in 
frontal headache due to migraine, is said to be very efficient (Wa). [See for-^ 
mula on next page.] Piscidia, recommended (Wa) ; efficient in doses of £ij 



726 



HEMIOPIA HEMOGLOBINURIC FEVER. 



of the fluid extract (Ford). Arsenic, for cerebral congestion and hemicrania 
(B) ; for throbbing pain in one brow (R) ; often has the best effect : Watson 
believed that gtt. iv-vj of Liq. Arsenicalis, 3 or 4 times a day, with due attention 
to the bowels, would cure 9 out of every 10 cases (Wa). Aconitine or Vera- 
trine, ointment over brow (R) ; Aconitine internally is of great service (Seguin). 
Phosphorus, is strongly recommended (R). Amyl Nitrite, by inhalation, in 
migraine with pallor of face (R). Sanguinaria, a few doses very successful, 
when migraine is due to gastric derangement (P). Ignatia, removes clavus 
hystericus (Pf). Nux Vomica, when of gastric origin (R). Cimicifuga, is 
strongly recommended (P). Rubber Bandage, applied tightly from eyes up, 
protecting the temporal arteries by pads, or a dry muslin bandage wetted after 
being put on (Weir Mitchell). Acupuncture, the needle run down to the cra- 
nium will give relief in clavus hystericus, when nothing else will do so (Pan- 
coast). [Compare Headache, Bilious Sick and Nervous.] 



R 



E ss - 

gr. x. 



Quininae Sulphatis, . 

Pulv. Belladonnse, 

Ext. Digitalis, g-r. xv. 

Ext. Valerianae, 3 SS « 

Mellis, q. s. 

Ft. pil. no. xl. Sig. — 2 to 10 pills daily, 
gradually increased, during three or four 
days before the expected attack. 



R-. Mentholi, gj. 

Alcoholis, ^j. 

01. Caryophylli, 

01. Cinnamomi, . . aa TTlxx. 
M. Sig. — Apply with finger over seat 
of pain. 



R. Ammonii Chloridi, . . . ^vj. 

Ammonii Bromidi, . . . giv. 

Spt. ^Etheris Nitrosi, . . gj. 

Syr. Pruni Virgin., . . . ,:§iij. 

Aquae, .... q. s. ad ^yj. 
M. Sig. — Dessertsp. 3 or 4 times daily, 
conjoined with the use of RaspaiVs Eau 
Sedative (see page 145), locally. 



R 



g r - 



M 



Aconitinae (Duquesnel), 
Alcoholis, 
Glycerini, . . . aa gj. 

Aq. Menth. Pip., q. s. ad 3 i j . 
Sig. — Teaps. thrice daily. 

{Seguin.) 



Hemiopia. 

When established, hemiopia offers little hope of cure, though it has no ten- 
dency to progress. In hemiopia scintillans, Potassium Bromide, gr. xl-lx 
daily, or a band of such metal as idiosyncrasy of the patient may decide, with 
stimulants to ward off the aura ; Quinine, Iron, Hydropathy, when Potassium 
Bromide fails (De Wecker). 

Hemiplegia. 

Strychnine, is most useful when the muscles are relaxed ; hypodermically, 
when paralysis incomplete and the muscles flaccid but not wasted (B). [See 
Paralysis for formula.] Potassium Iodide, gr. x-xviij daily, occasionally 
proves effectual (Wa). Galvanism, constant current to the brain or cord, 
faradic to the muscles opposite those contracted (Hammond). Physostigma, 
prevents muscle wasting, and hence is given with benefit to hemiplegics ; gr. 
JL-^ of the extract repeated frequently (R). Massage, in hemiplegia and 
other forms of paralysis due to intercranial lesions, when cold and blue skin, 
wasting and contracted muscles, ulcerations, etc. (B). Cocculus, in hysterical, 
epileptic and choreic hemiplegia, acts well ; also in hemiplegia from cold (P). 
[Compare Paralysis Facial.] 



Hemoglobinuria Fever. 

Antipyrin, Phenacetin, and similar antipyretics, are dangerous (Mn). Qui- 
nine, is less efficient in this than in any other form of malaria (Mn) ; as it con- 
duces to hemoglobinuria its use is deprecated (Plehn) ; should be given in this 
affection if the malarial parasites are found in the blood, but not if they are 
absent (Bastianelli). Calomel, in large doses, 20 to 30 grains, is the favorite 



HEMOPTYSIS. 727 

remedy in Africa (Mn) ; Calomel and Jalap, separately or combined, to keep 
the bowels well open (Copeman). Chloroform, in small doses internally ; 
Chloroform Z], Pulv. Acacias q. s., Sweetened Water, ad ^viij, of which ^ss 
every ten minutes until a certain degree of chloroform intoxication is produced, 
the effect to be kept up by enemata of Chloral ; of 22 cases so treated none died 
(Quennec). Chloral, with perhaps small doses of Jaborandi, if uremic convul- 
sions or coma supervene (Copeman). Tannic Acid, gr. xv well diluted, every 
2 hours for 4 or 5 times, repeated on the third and sixth days to the extent of 
two doses each day (Mn). Transfusion of blood has been successfully prac- 
tised in high degrees of anemia in some of these cases (Id). Hot Water, in 
bottles in the bed, if the temperature should fall below normal (Copeman). 
Diuretics must not be given if urine suppressed, but hot fomentations to the 
loins, diaphoretics and plenty of bland diluents internally (Mn). Milk Diet 
exclusively until all albumin has disappeared from the urine (Id). Care neces- 
sary at all times to avoid getting wet or chilled or over-fatigued, for those who 
have suffered once from this affection (Id). [Compare Malaria, Intermit- 
tent Fever, Remittent Fever.] 

Hemoptysis. 

Atropine, gr. ^q hypodermically, is remarkably efficient in stopping the 
bleeding in phthisical hemoptysis (Squibb). Gallic Acid, exceedingly effective 
(P) ; may be combined with Ergotin and Digitalis. [See Hematemesis and 
Hematuria for formulas.] Lead Acetate, with Opium (B) ; proves signally 
useful (Wa). Ergot, the fluid extract in 30 to 40 minim doses, every 3 or 4 
hours, or hourly in severe cases ; or Ergotin hypodermically for urgent cases, 
in 2 to 3 grain doses (R). Opium, should be freely used for the attendant 
excitement (W). Chloral, is used with benefit, its vaso-dilator power probably 
acting as a derivative, and its sedative influence allaying excitement. Ipecac- 
uanha, has been highly praised (R) ; in emetic doses arrests hemoptysis (Tr), 
though in poisonous doses produces it (P) ; a well-founded case is recorded 
where Ergot and Gallic Acid utterly failed, and Ipecac was effectual ; but it 
must be pushed to the nauseating point, in order to effect the control (Squibb). 
Turpentine, in drachm doses every 3 hours, may cause unpleasant symptoms 
which soon disappear on its discontinuance (R) ; has proved very efficient (P) ; 
after other hemostatics fail it is worthy of trial (Wa). Alum is serviceable in 
purely atonic hemorrhages (Wa) ; in 10 grain doses every 2 hours (B). Oil of 
Erigeron, is very efficient when no fever or other signs of constitutional irrita- 
tion (Wa). Hamamelis, "H^j-ij of tincture every 2 or 3 hours (R) ; Truj-x of 
fresh tincture several times a day (Pf ). Ferric Acetate, a little added to water 
so as to taste, this constantly sipped (R) : Iron spray will often arrest (B). 
Digitalis, has undoubted power over hemoptysis (B) ; small doses daily (P) : 
infusion in large doses (R). 'Arnica, of great service, if from violence (P). 
Aconite, employed with best results (P). Sodium Chloride, half a teaspoonful 
of common salt, taken dry, repeated till nausea (R). Sulphuric Acid, the dilute 
acid a useful adjunct to other treatment (Wa). Spinal Hot-water Bag, to cer- 
vical or upper dorsal vertebrae (R). Auxiliaries, Cold externally, acidulated 
drinks, perfect rest, and antiphlogistic diet (Wa). 



R. Ext. ErgotseFl., .... ^jss. 
Ext. Ipecac. Fl. , 
Tinct. Opii Deod. , . . aagij. 
M. Sig. — Teasp. every l / 2 hour. 



R. Aluminis, gj. 

Sacch. Alb., gss. 

Pulv. Ipecac. Comp., . . gr. xx. 
M. ft. pulv. no. vj. Sig. — One powder 
every 2 hours. [Skoda.) 



R. Plumbi Acetat. , . . . . gr. xx. 

Pulv. Digitalis, gr. x. 

Pulv. Opii, gr. v. 

M. ft. pil. no. x. Sig. — One every 4 
hours. (B.) 



R. Liq. Ferri Subsulph., . . TT^xx. 

A q u9S > lij- 

M. Sig. — Use as spray by inhalation for 
5 minutes every hour. 



728 HEMORRHAGE. 

Hemorrhage, Hemorrhagic Diathesis. 

Iron, when hemorrhagic diathesis due to anemia ; the tincture of the Chloride 
preferred (B) ; this tincture as a styptic (Wa) ; 1 or 2 teaspoonfuls of the con- 
centrated solution in a glass of water an excellent hemostatic (Tr) ; the Acetate, 
just enough to make water taste, in hemorrhage of lungs and kidneys (R). 
Ergot, in uterine hemorrhage of any kind, and many forms of hemorrhage, 
Ergot or Ergotin of great value (P) ; not to be relied on alone (B). Antipyrin, 
is a most efficient hemostatic ; a 4 per cent, solution checks general oozing 
from a bleeding surface ; as a styptic it constricts the small vessels without 
causing an external clot to break down (Park). Alum, is sanctioned by high 
authority (B) ; dusted on in slight cases (R); in uterine and traumatic hemor- 
rhage, when small vessels open (Tr). Hamamelis, tt\j-ij of tincture every 2 or 
3 hours, effective in many forms (R). Ipecacuanha, produces hemorrhage in 
poisonous doses, yet has great energy in arresting it (P) ; exercises a powerful 
influence on internal hemorrhage generally, and in exhaustion therefrom; gr. 
j-ij every % hour (Wa) ; in emetic doses serviceable (Tr). Turpentine, few 
agents more useful in the passive forms (B) ; small doses in hematuria (R) ; for 
serious hemoptysis, and hemorrhage of typhoid (P). Belladonna, hemorrhage 
from rectal ulcers (P). Digitalis, in uterine, and many other forms, of great 
value (P) ; with restoratives has undoubted power in the hemorrhagic diathesis 
(B). [See Hemoptysis.] Bone-marrow, in hemophilia due to anemia (see 
page 160). Gallic and Tannic Acids, in all passive hemorrhages, especially in 
that of the bladder (P) ; Tannic Acid for local use, Gallic for systemic effects 
upon remote parts : when hemorrhage occurs in relaxed and debilitated con- 
stitutions, Gallic Acid may be combined with Ergot and Digitalis (B). Matico, 
proves useful in many cases, especially menorrhagia, hematuria and hemop- 
tysis (Wa). Nux Vomica, in hemorrhagic diathesis, especially when occurring 
in anemic subjects ; also the Syrup of Iron, Quinine and Strychnine Phosphates; 
no prescription more generally useful (B). Aconite, to reduce the circulation, 
in epistaxis, hemoptysis, etc. (P). Cinchona, internally very efficient in some 
forms of hemorrhage (Tr). Copper Sulphate, in stick, solution or ointment, to 
arrest hemorrhage from small vessels (R). Arnica, in ecchymoses from me- 
chanical violence (P). Rhatany, the extract, one of the most powerful hemo- 
statics (Tr). Hematoxylon, is devoid of irritant qualities and is therefore well 
adapted to check the diarrheas and hemorrhages of young children. Sulphuric 
Acid, the dilute acid an excellent internal hemostatic, sometimes very effective 
in uterine hemorrhage (B). Dilute Vinegar to leech-bites, piles, cuts, etc. (R). 
Apple-vinegar as injection for vesical hemorrhage. [See under Hematuria.] 
Grape-cure, as tonic for convalescents (P). Alcohol, in hemorrhagic diathesis, 
to elevate the arterial tension (B) ; Brandy, Wine, when heart suddenly enfee- 
bled by hemorrhage (R). Venesection, will promptly arrest pulmonary hem- 
orrhage (B). Styptics, are either needless or inefficient, hence practically use- 
less in general surgery ; hemorrhage should be controlled by either pressure or 
ligation (Roberts). Hot Water, sponged over a bleeding surface, is the best 
agent to stop hemorrhage (Gross). Transfusion, when death imminent (B). 
Ice, internally in wounds or hemorrhage of lungs, or from stomach ; small 
pieces frequently (R). Rest, perfect rest is often indispensable, especially in 
hematemesis, in which nutrient enemata may be required. [Compare Dysen- 
tery, Ecchymosis, Epistaxis, Hematemesis, Hemoptysis, Hemorrhoids, 
Hematuria, Hemorrhage Post-partum and Intestinal, Menorrhagia, 
Metrorrhagia, Purpura, Wounds, etc.] 

R. Infusi Digitalis, ^ij. I Pancoasf s Styptic. 

Ext. Ergotse Fluidi, | g # Potassii Carbonat., . . . gij. 

Tinct. Kramerise, . . . aagj. Saponis, gj-ij. 

M. Sig.— A tablesp. as required in J Alcoholis, §iij. 

hemorrhagic conditions generally. (B.) j Mix and use as a styptic especially for 

I operations about the face. [Jos. Pancoast.) 



HEMORRHAGE. 729 



Jjt . Tinct. Benzoini, .... Jfviij. 

Aluminis, It), j. 

Aquae, R). x. 

Boil 6 hours in a glazed earthenware ves- 
sel, adding hot water in lieu of that vapor- 
ized, and keeping well stirred ; filter, and 
put up in stoppered bottles. PagliarV s 
Styptic. 



R. Ext. Ipecac. Fl., . . 
Ext. Ergotse Fl. , ... 
Ext. Digitalis FL, . 


• ■ 3U- 


M. Sig. — Half teasp. to 
dose, repeated as required. 


a teasp. at a 
An excellent 



anti-hemorrhagic combination. (B.) 



Hemorrhage, Intestinal. 

Turpentine, should be used (B) ; especially in that of typhoid (P). [See Hema- 
temesis, for formula.] Belladonna, for irritable and bleeding rectal ulcers (P). 
Iodine, in passive form, gtt. j-ij of tinct. frequently repeated, of great service 
(B). Sulphuric Acid, is serviceable (B). Lead Acetate, often of great service, 
especially when used as an enema (Jenner). Tannin, one of the most service- 
able remedies for the intestinal hemorrhage of typhoid fever (B). Hamamelis, 
very effective in intestinal hemorrhage, owing to its large proportion of Tannin 
(B). Ergot is most valuable ; may be given hypodermically in urgent cases 
(R). Gallic Acid, gr. xv with gtt. iij-iv of Laudanum, in a winegl. of iced water 
every 2 or 3 hours in the hemorrhage of typhoid (Jenner). Opium, a valuable 
adjunct to astringents, allaying the nervous excitement (Wa); most useful (Da 
C). [Compare Dysentery, Hemorrhoids, Typhoid Fever.] 

Hemorrhage, Post-partum. 

Atropine, hypodermically, is remarkably efficient. [See under Abortion.] 
Hamamelis, for persistent oozing (R). Ipecacuanha, in flooding after delivery 
(R). Iron, Monsel's solution, j to iij of water, strong enough and safe as 
injection (B) ; the Perchloride diluted (R). Amyl Nitrite, rr^v by inhalation, 
has stopped a hemorrhage promptly and permanently (Kerr). Ergot, a full 
dose of the fluid extract as soon as birth is completed, as a prophylactic (Play- 
fair); hypodermically in urgent cases, gr. ij of Bonjean's Ergotin deeply into 
the tissues of the arm (Wa) ; £ss doses of the fluid extract every 2 to 4 hours 
in secondary hemorrhage. Cimicifuga, will check post-partum hemorrhage, 
especially when tediously prolonged (P). Digitalis, the infusion best ; a 
tablesp. bis die, or in urgent cases every half hour for 4 doses (B). Nux 
Vomica, the tinct. gtt. xx ; Ext. Ergotae Fl. gtt. xxx ; each hour for 2 or 3 doses 
(B). Opium, the tincture Z] with Brandy, in profuse flooding (R). Vinegar, a 
handkerchief soaked in vinegar and carried into the uterus, will often check 
a severe hemorrhage (Landis) ; is antiseptic, astringent and sufficiently irrita- 
ting to produce contraction, yet not so irritating as to cause subsequent mis- 
chief, and always acts promptly (Penrose). Tamponade by absorbent cotton, 
plugs of linen, etc., is indicated in hemorrhage from abortion or placenta 
praevia (Parvin) ; never tampon after delivery ! you might as well hang the 
woman by the neck (Wallace). Auxiliary Measures of importance are firm 
pressure on the uterus, compression of the abdominal aorta, the plug, and if 
necessary intra-uterine injections (Wa). Hot Water, uo° to 122 F., injected 
into uterus, extremely successful in checking post-partum hemorrhage (Att- 
hill); the most prompt and certain method, and the least unpleasant to the 
patient (Parrish). [See also Dr. Cameron in Canada Med. and Surg. Jour., 
March, 1878, with record of 16 cases so treated.]. Ice, to abdomen or within 
the womb (B) ; into womb or rectum (R) ; as a prophylactic against hem- 
orrhage and to secure firm contraction of the uterus, a good method is to 
grasp the womb through the abdominal parietes with a hand kept cold by 
frequent immersion in a pan of broken ice, while waiting for the expulsion of 
the placenta ; while one hand is kept on the uterus the other may be immersed 
in the ice. Transfusion of milk into veins may be necessary in cases of col- 
lapse (Thomas). 



730 



HEMORRHOIDS. 



Hemorrhoids. 

Galls, as ointment, very useful ; the official Unguentum Gallae, or Galls com- 
bined with Lead and Opium (R). [Formula on next page.] Iron, a solution of 
the subsulphate as wash to bleeding piles, which should then be well oiled (B); 
or an ointment of the same (Basic Ferric Sulphate) gr. xv to the ^.locally night 
and morning, with gr. j of the salt thrice daily by mouth ; gives excellent 
results. Hamamelis, by mouth, also as lotion or injection in bleeding piles (R) ; 
is employed with satisfaction ; Tr^ij— x of tincture several times a day ; also as 
enema or suppository (Pf ). Nux Vomica, emphatically beneficial (P). Sul- 
phur, gr. v-x, with 3j Confec. Sennae, as laxative (R) ; exercises a most soothing 
influence (Wa). Sulphides, especially Blue Lick water (B). Podophyllum, as 
cathartic, for hemorrhoids of recent formation, bleeding from stasis in portal 
circulation (B). Aloes, causes congestion of pelvic viscera, yet Fordyce Barker 
shows it to be curative in piles, especially in recent ones, as after delivery (B) ; 
to greatly relieve bowels (R) ; cures by removing constipation (P). Hydrastis, 
as lotion or ointment to external piles, of great value; tt^v of tincture ter die 
internally at same time (P). Ergot, with or without Nux Vomica, in dilated 
hemorrhoidal veins without new tissue, given by the stomach and used locally 
will often cure (B). [See Diarrhea for formula.] Stillingia, will remove per- 
manently when due to constipation, and temporarily when from hepatic obstruc- 
tion (B). Senna, to procure soft and easy evacuations use the Confectio Sennae 
at bedtime, gr. cxx in a bolus (B). Iodoform, the ointment, and in suppository 
(B). Nitric Acid, as caustic, followed by free use of Olive Oil (B) ; ^ss-,^j ad 
Oss aquas as lotion for bleeding piles (R). Hyoscyamus or Stramonium, leaves 
bruised or ointment, locally for pain (P). Linseed Oil, boiled, in doses of ^ij 
twice daily, has quite a reputation as a remedy for piles (W). Alum, to painful 
bleeding piles, a crystal trimmed and passed into rectum, or as an ointment 
(B). Ice, to. painful, bleeding piles, or cold water injected daily (B) ; locally 
for pain after operation (R). Leeches, directly to swollen, irreducible, and 
painful piles (B). Alkaline Mineral Waters, excellent (B). Carbolic Acid, 3 
parts to 1 of Olive Oil, a few drops injected into the tumor ; a favorite and suc- 
cessful treatment by itinerants (Andrews) ; uncertain in all cases and in many 
fraught with danger (Gross) : a good procedure : use 4 drops each of pure Car- 
bolic Acid and Glycerin, and inject one tumor at a time (Hunt). Grape-cure, is 
used with success (B). Saline Purgatives, notably Epsom salts, combined with 
Sulphuric Acid, will often stop the hemorrhage (B). [See Dysentery for 
formula.] Diet, etc., avoid stimulants, indigestible food and over-eating; 
during an attack use little animal food. Petroleum soap when piles protrude, 
with cold or tepid water ablutions. Injections, Oj of cold or tepid water, are 
very useful. Stool should be at night. Surgical Methods are : the ligature 
for internal hemorrhoids, excision for external ones. Ligation, is the proper 
treatment for the former, all other methods of operating radically being now 
discarded as unsurgical and dangerous to life (Gross). Thermo-Cautery is used 
by Smith of London and many other surgeons, but is apt to leave behind fissures 
and ulcers, which are with difficulty healed. Prevention, soft seats favor the 
production of piles, as also of uterine disorders, by pressure on the arteries as 
they emerge from the pelvis, tending to drive the blood into the interior of that 
cavity (Holden). 



R. Iodoformi, ^j. 

Balsam. Peruv., gij. 

Magnes. Calcin., .... gj. 

Cetacei, gss. 

Ol. Theobromse, . . . . q. s. 
M. et fiant suppositoria xij. Sig. — One 

twice daily. [Potter.) 



R. Ext. Colocynth Co., . . gr. xxx. 
Ext. Nucis Vom., . . . gr. vj. 
Hydr. Chlor. Mitis, 
Ext. Hyoscyami, . . aa gr. xij. 
M. et div. in pil. no. xij. 
Sig. — One pill as required for sluggish 
bowels. [Barker.) 



HEPATALGIA HEPATIC CONGESTION. 



731 



R. Pulv. Gallse, gr. xx. 

Pulv. Opii, gr. x. 

Ung. Plumbi Subacet., . . gr. xl. 

Ung. Simplicis, gj. 

M. et ft. unguentum. Sig. — Ointment 
for piles . ( CEsterlen. ) 

R . Pulv. Gallse, 

Pulv. Opii, 

Plumbi Acetat., . . aa gr. xx. 

Ung. Picis Liquidse, 

Cerati Simplicis, . . aa ^ss. 
M. et ft. unguentum. Sig. — Apply night 
and morning after bathing parts with cold 
water. 



R. Ext. Opii, gr. x. 

Pulv. Stramonii, . . . . gj. 

Pulv. Tabaci, gss. 

Ung. Simplicis, 3 ss * 

M. Sig. — Ointment for piles. 

[Shoemaker.) 



M 



Ac. Carbolici, gij. 

Ac. Tannici, ^j. 

Alcoholis, % iv. 

Glycerini, ^ij. 

Hypodermic injection for piles. 

(Girard.) 



Hepatalgia. 

Ammonium Chloride, 20 to 30 grains every 4 hours, is highly efficacious 
(Anstie). Bryonia, worthy of commendation in many liver affections (P). Nux 
Vomica, has been found of much benefit ; dose should be small, gr. y^- to -^ 
two or three times a day (P). Quinine, would naturally be thought of for 
malarial subjects, but does not afford any relief (Anstie). 

Hepatic Cirrhosis. 

Diuretin, for the dropsy. [See under Dropsy.] Nitric Acid, in long-stand- 
ing diseases, as this will augment flow of bile after liver has struck work from 
mercury (R) ; the mineral acids do not benefit (B). Arsenic, small doses 
perseveringly, give good results in improving the nutrition of the organ (B). 
Aurum, the Bromide of Gold and Arsenic has been used with benefit (Barclay) ; 
the Chloride of Gold and Sodium, in doses of gr. -^, as an hepatic alterative, 
may be used conjointly with Sodium Phosphate (B). Sodium Phosphate is said 
to produce good results (Da C) ; has power to retard the sclerosis, and may 
possibly arrest the changes and restore a state of comparatively normal func- 
tion (B). Iodides, are the best remedies for the first stage (B); Potassium 
Iodide is highly recommended by some authorities (Da C) ; the great measures 
in the treatment of this affection are Potassium Iodide, hydrotherapy, and a 
milk diet (Lancereaux). Stillingia and Alkaline Mineral Waters, are important 
in the first stage (B) ; Alkalies early, especially Carlsbad water, with total ab- 
stinence from alcoholic beverages (Legg). Mercury, Corrosive Sublimate in 
small doses, gr. ^ thrice daily, for a long time, does benefit the condition and 
has possibly cured a few cases (Da C). Tapping becomes necessary for the 
dropsy, though purgation and diuresis may help to lessen it (Id). Diet, should 
be of easy digestibility, especially milk, avoiding starches and fats and quitting 
alcohol (Id). [Compare Ascites.] 



Hepatic Congestion. 

Nitric Acid, in chronic congestion, will augment flow of bile after liver has 
struck work from excessive use of mercury (R). Nitro-Muriatic Acid, is found 
useful in India, with the nitric acid bath, ^iij ad gall, j, to hypochondrium (B) ; 
formerly held high rank but is superseded by Ammonium Chloride ; the acid 
baths being now rarely employed (Fayrer). [See page 566 for formula.] Sul- 
phates, in natural purgative waters, small doses often repeated (R) ; in the shape 
of some bitter water or of Carlsbad salts, generally give prompt relief (Mn) ; a 
good substitute for Carlsbad salts is Sodium Sulphate 2, Sodium Bicarbonate 1, 
Sodium Chloride 1 (Id) ; Potassium Sulphate is occasionally poisonous (R). 
Chelidonium, as deobstruent (P) ; energetically affects the liver (Pf). Iodine, 



732 



HEPATIC CONGESTION. 



tincture and ointment locally for hepatic engorgement after malarial attack; 
also Ammonium Iodide in moderate frequent doses, for functional derange- 
ment from malarial disease (B). Sodium Phosphate, 3j-ij, 3 or 4 times daily, in 
plenty of water, as a purgative (B). Ammonium Chloride, in passive conges- 
tion, and chronic torpidity, is well worthy of attention ; gr. xx every 4 hours 
(Wa) ; an excellent remedy (Da C). Turpentine, epithems, hot, often found 
very beneficial (Wa). Quinine, gr. xv-xx with Morphine, gr. %-%, in the 
acute congestion due to climatic or malarial causes, no remedy so efficient (B). 
Bryonia, is worthy of commendation in liver affections of various kinds (P). 
Iris, really serviceable when stools clay-colored and skin jaundiced (B) ; is one 
of the best aperients in hepatic derangement (P). Mercury, valuable only as 
a purgative ; its use restricted to cases where there is deficiency or excess of 
bile (B) ; a full Calomel purgative is of utility in cases of congestion (Wa). 
Podophyllum, the resin in congestion of the portal circulation, is especially 
useful (B) ; gr. )/(>-% every six hours will speedily relieve symptoms (P). San- 
guinaria, is useful in hepatic engorgement without organic disease (P). Col- 
chicum, in hepatic congestion and dropsy ; an active remedy in congestion of 
the liver (B). Resin-bearing Purgatives, as Rhubarb, Podophyllum, Iris, 
Euonymus, etc., are all actively cholagogue. [See list on page 53.] Ipecacu- 
anha, decidedly stimulant to the flow of bile (B) ; is the Indian treatment now 
for the local liver, given in large doses for a week or two (Da C). Taraxacum, 
has had a reputation, but I cannot recommend it (Id). Aliment, no starches or 
fats; give milk, eggs, oysters, beef-broth, whitefish, etc. (B) ; in chronic hepatic 
congestion (tropical liver), alcohol must be forbidden in every shape, animal 
food used very sparingly, especially beef and mutton, fruit and farinaceous 
substances may be more freely taken, but over-eating in every form must be 
avoided (Mn). Exercise should be taken twice daily, and should provoke 
perspiration (Id). Cold Water Belt around the abdomen, covered with oiled 
silk, gives great comfort in chronic cases (Da C). [Compare Biliousness, 
Jaundice, etc.] 



R . Hydrarg. Chlor. Mitis, . . gr. vj, 

Pulv. Ipecac, gr. j. 

Sodii Bicarb. , gr. x. 

Div. in pulv. no. ij. Sig. — One at bed- 
time, followed by the following : — 
R . Ac. Nitro-hydrochlor. Dil. , 3 iij . 
Elix. Taraxaci Co., . . ad^v]. 
M. Sig. — Dessertspoonful before meals, 
and a milk diet. 



R. Ext. Taraxaci, . . . 


. gr. lxxij. 


Ext. Aloes, 


. gr. xxiv. 


Ext. Colchici Rad., 




Pulv. Ipecac. , . . . . 


aa gr. xij. 


M. et div. in pil. no. xxiv. 




Sig. — 2 nightly in chronic 


enlargement 


and torpidity of the liver. 


{Martin.) 



R . Sanguinariae, gr. viij. 

Podophyllini, gr. iij. 

Ext. Hyoscyami, . . . . gr. iij. 

Saponis, gr. viij. 

M. et div. in pil. no. xx. 
Sig. — 2 to 4 pills daily. In hepatic tor- 
por without organic disease. {Phillips.) 



R. Cinchonidinae Sulph., 

Euonymini, 

Leptandrini, 

Juglandini, 

Irisini, aa 3J- 

Podophyllini, 

Ext. Belladonnas, 

Ext. Hyoscyami, . . . aa gr. x. 
M. et div. in pil. no. lx. 
Sig. — One pill thrice daily. In obstinate 
hepatic torpor. {Blackwood.) 



R . Euonymini, . . 




. . . gr. xij. 


Ext. Hyoscyami, 




. . . gr. vj. 


M. et div. in pil. no. 


vi- 




Sig. — One at bedtime, 


followed next 


morning by a full dose 


of 


an aperient min- 


eral water. 







M 
with 



Potass. Bicarb., 
Potass. Citratis, .... aa^j. 
Syrupi Simplicis, . . . . jf vj. 
Sis:. — A teaspoonful to a tablesp. 



similar quantity of lemon-juice, in 
y z glass of water ; the whole to be drank 
while effervescing. ( Wood?) 



HEPATIC DISEASES HEPATITIS. 733 



Hepatic Diseases. 

Ammonium Chloride is highly serviceable in all cases of liver disease, 
whether due to organic changes or to functional derangement ; especially indi- 
cated after the more acute symptoms have abated (Wa). Nitro-hydrochlorie 
Acid, formerly held high rank, but is now superseded by Ammonium Chloride 
( Wa) ; even the acid baths, so long considered of great importance, are now 
but little, if ever, used in India (Fayrer). Nitric Acid acts in some way bene- 
ficially on long-standing liver-diseases, as in chronic congestion and cirrhosis 
(R) ; with vegetable bitters, long continued, useful in waxy liver (Wa). 
Podophyllum has a high reputation in a variety of liver diseases (P) ; is actively 
cholagogue (R). Mercury, mercurial purgatives are used for both deficiency 
and excess of bile ; harmful in many acute forms of hepatic disease, and gen- 
erally are of doubtful propriety in liver affections (B) ; in hepatic congestion a 
full Calomel purge is of great benefit (Wa). Red Mercuric Iodide, as oint- 
ment, gr. j to 3v, gives best results in malarial enlargement of the liver (W). 
Calomel is used in inflammatory disorders of the liver, but is less suited to par- 
enchymatous than to serous inflammations (Da C). Ipecacuanha promotes the 
flow of bile (B) ; may be used in small doses with great advantage in func- 
tional derangement of the organ (Wa). Resinous Purgatives, as Leptandra, 
Iris, Euonymus, Rheum, etc., are decidedly cholagogue (B). Euonymin is of- 
great value in torpid liver and its accompanying headache (W). Bryonia is 
worthy of commendation in liver affections of various kinds (P). Chelidonium 
powerfully affects the liver (Pf). Taraxacum is highly recommended in all 
chronic affections of the liver, especially in indolent enlargement and incipient 
scirrhus (Watson). Sodium Phosphate is cholagogue, and extremely useful in 
liver affections, especially the jaundice of children and hepatic calculi (Thudi- 
cum). Phosphorus specifically affects the liver, and used early in acute yellow 
atrophy may have an action of antagonism upon the disease (B). Potassium 
Salts, as depuratives, are of decided value, especially the Citrate, in hepatic 
torpor and other affections (W). Sulphur, the sulphurous mineral waters, pro- 
longed, give excellent results in liver disorders (B). Alkaline Waters are very 
serviceable (B) ; especially the sulphur waters ; Glauber's salt in their place 
(Da C). Chlorine Water has been employed with benefit in chronic hepatic 
affections, in doses of 3ss-ij in giij or iv of water (W). Iron preparations, 
long continued, in amyloid degeneration (Da C). Gentian, and other bitter 
tonics, in functional disorder; also Nux Vomica occasionally, but use Mer- 
curials and Podophyllum sparingly (Da C). Iodine and Iodides in waxy en- 
largement, simple hypertrophy and chronic congestion, of great value (Wa) ; 
Potassium Iodide alternately with Ferrous Iodide in waxy liver (Frerichs) ; a 
few drops injected into hydatids (B). Sanguinaria is of great value in hysteria 
from chronic hepatitis, and in hepatic engorgement without organic disease (P). 
Stillingia for torpid liver and jaundice following ague, in the first stage of cir- 
rhosis, and in ascites from hepatic changes (B). Malt Liquors are harmful in 
all chronic affections, especially in fatty liver (B). Galvano-puncture for hy- 
datids, the negative needle into the hydatid (B). [Compare Lists of Agents 
acting on the Liver, page 53 ; also, the articles in this section entitled Bilious- 
ness, Calculi, Cancer, Hepatalgia, Hepatic Congestion, Hepatic Cir- 
rhosis, Hepatitis, Jaundice.] 

Hepatitis and Hepatic Abscess. 

Ammonium Chloride, is almost a specific in hepatitis and abscess of the liver 
(Stewart) ; often preventing the latter disorder, and in many instances curing 
it (Wa) ; 20-grain doses thrice daily, are usually prescribed (Mn). Ipecacuanha, 
in full doses, repeated once or twice daily for 2 or 3 days, if dysentery be 
present (Id). Quinine, in large doses for the acute parenchymatous inflam- 
mation (Da C) ; in medium doses persistently for a long time has done excel- 



734 HERNIA HERPES. 

lent service in chronic suppurative hepatitis without abscess, but with frequent 
exacerbations. Tartar Emetic, gr. %- l /z, every two or three hours, with 
Opium or Calomel as indicated by symptoms; of especial value early in the 
acute attack (Wa). Leeches to margin of the anus in the acute type (B) ; to 
unload the portal system (Wa). Mercury is used, but is better suited to serous 
inflammations than to parenchymatous ones (W). Chelidonium has been used 
with benefit in both acute and chronic hepatitis (P). Alkalies and Colchicum, 
when the affection is of a gouty nature (Wa). Sulphites are recommended in 
chronic forms (Da C). Sinapisms and Linseed poultices over the hepatic 
region in acute hepatitis (Wa). Saline Purgatives, as the Sulphate of Sodium 
or Magnesium, to increase the watery exudation from the mucous membrane 
of the intestines, in acute hepatitis (Wa) ; free purging by the Sulphates, 
massive hot poultices, low diet and rest in bed, the treatment for hepatitis 
which has not proceeded to abscess formation (Mn). Nitro-Hydrochloric Acid, 
for some time, in the chronic form tending to abscess (Da C). Aspiration, when 
pus forms ; early operation the rule of practice ; has induced many recoveries 
(Id). [Compare Jaundice.] 

Hernia. 

Opium, or Morphine hypodermically to narcotism, often obviates the neces- 
sity of an operation in strangulated hernia (Wa). Chloroform, of evident bene- 
fit (Wa) ; inhaled to assist reduction (R) ; has superseded the use of Tobacco 
and Lobelia in strangulated hernia (P). Coffee, large doses, has certainly a 
remarkable influence in aiding or causing reduction of strangulated hernia 
(Wa). Thyroid Extract, causes hernias to vanish in a few weeks or months 
when due to accumulation of myxedematous or fatty material in the abdominal 
cavity, and should be tried in hernial protrusions from any part of the abdomen 
before resorting to surgical means (Parker). Oak Bark extract, as injection 
into the tissues, for a radical cure by stimulating the occlusion of the rings 
(Heaton's radical cure) : a similar operation was patented by Dr. Gage in 1840, 
the Oil of Cloves being the injection used ; Professor Pancoast injected tincture 
of Iodine for the same purpose. Ice Poultice is of use if no strangulation of 
gut or omentum (Wa). Sternutatory, as snuff or Ipecac, to cause sneezing 
while patient lies on his shoulders with elevated hips and legs over the back 
of a chair, frequently successful after taxis has failed to effect reduction ; in 
this position the action of gravity, aided by the sudden action of the dia- 
phragm, tends to draw inwards the posterior portion of the escaped gut, which 
is the part most difficult to manage by taxis. Cold Douche, with taxis properly 
performed and the position above described, will reduce 90 per cent, of the 
cases of strangulated hernia within a few minutes (Raiford). Truss, properly 
adjusted, is the best remedy for a reducible hernia, often curing the disease by 
the pressure of its block (Gross). Surgical, Bassini's operation for the radical 
cure, or some modification thereof, produces very satisfactory results. 



Herpes. 

Ferrum Arsenate, in doses of gr. \ daily, will effect the cure of a herpetic 
affection in the adult, however extensive or long established (Duparc). Mer- 
cury, Calomel ointment, gj to the ^, is one of the best mercurial preparations 
(Pereira), Potassium Carbonate, as lotion, gr. xxx to Oj, to allay irritation 
(Wa); or as ointment, gr. xx to ^j, smeared over eruption at night, and 
washed off in the morning with a solution, gr. xxx to Oj (Neligan). Myrtol, 
is curative of herpes (B) Glycerin, diluted, is a serviceable application in 
herpes labialis (Wa). Ergot, the Oil prepared by the action of Benzin upon 
Ergot, which, upon evaporation of the solvent, makes a valuable application 
in herpes genitalium and other skin affections (Shoemaker). Alum, in herpes 
prseputialis, a solution of Z] to ^j aquae, applied on lint to the glans penis, is 
generally effectual (Wa). Collodion, the flexible form, is applicable to various 



HERPES ZOSTER HICCOUGH. 



735 



kinds of herpes (Wa). Magnesium Citrate, as a cooling laxative, with soothing 
and protective lotions and ointments, and the Liquor Picis Alkalinus, diluted 
10 to 20 times, for the itching (Bulkley). Astringent Lotions, of Tannin or 
Zinc Sulphate, in herpes praeputialis, to render the parts less sensitive (Da C). 
[For Herpes Circinatus see Tinea Circinata.] 



R . Tragacanthae, . . . . g ij-iv. 

Liq. Calcis, J> iv. 

Glycerini, ^j. 

Aquas Rosae, ^iij. 

M. Sig. — Ointment. 



R . Acidi Carbolici, . '. . . 
Pulv. Calaminse Praep. , 

Zinci Oxidi a 

Ung. Aq. Rosae, . . . 
M. et ft. unguentum. 



gtt. v— xv. 



Herpes Zoster. 

Rhus Toxicodendron, very readily subdues, especially when burning or itch- 
ing (P). Aconite and Opium, locally for pain (Wa). Morphine, the oleate ex- 
ternally without friction (R) ; hypodermically to mitigate the pain (Anstie). 
Celandine has been recommended (P). Dulcamara, has an old reputation (P). 
Silver Nitrate, painted on the warning patch of erythema, before or as soon as 
vesicles begin to form (R) ; as a local application is reported on favorably (Wa). 
Veratrine, as ointment, gr. xx-xl to the §, in neuralgia following shingles (R). 
Zinc Phosphide, gr. % every 3 hours, is said to control the pain and abort 
the eruption (Hughes). Grindelia, is reputed to relieve the pain (Stille). Mer- 
cury, the Ung. Hydrarg. Ammoniat. is said to relieve the pain and irritation 
remarkably (Wa). Blisters, for subsequent neuralgia (R). Hot Fomentations 
will often disperse (R). Baths daily, exercise out of doors, abundant nutritious 
food. Flexible Collodion, constantly reapplied to exclude air (Anstie). Gal- 
vanization of the affected intercostal nerves, the positive pole over their points 
of emergence, the negative brushed over the terminal filaments of the skin (B). 
Starch, dusted over the eruption, and on a muslin band sewed tightly around 
the body to protect it from the friction of the clothes, gives the greatest relief 
(Bulkley). Rest, absolute, when eruption is extensive (Fournier). 

R 



Zinci Phosphidi, 
Ext. Nucis Vomicae, . aa gr. x. 
M. et div. in pil. xxx. Sig. — One every 
2 to 4 hours, as a nerve tonic. [Bulkley.) 



R 



Liq. Sodii Hypochlorite ^iv. 

Aquae, ^ij. 

M. Sis:- — Wash for ulcerated vesicles. 



R. Bismuthi Subnitratis, . ^iv. 
Hydr. Chlor. Mitis, 
Zinci Oxidi, . . . . aagj. 
M. ft. pulvis. Sig. — To be dusted on 
cotton-wool, and applied to the ulcerated 
vesicles, after washing with the solution of 
Sodium Hypochlorite. {Fournier.) 



Hiccough. 

Morphine, hypodermically, often arrests hiccough (R) ; an injection of Mor- 
phine and Atropine together has stopped a most violent hiccough in which 
morphine alone and other agents had proved unavailing. Nux Vomica, in 5 
or 10 minim doses of the tincture, with rt\,xv of dilute Nitric Acid ; a short 
course frequently curative (P). Chloroform, combined with Opium (R). Pepper, 
gr. ij-x, to stop hiccough (P). Laurel-water, a useful remedy, rr\,v (P). Cam- 
phor, has been recommended (R). Mustard, Z] infused in ^iv of hot water has 
cured most obstinate cases (R). Pilocarpine, gr. -^ of the Muriate, has cured 
bad cases which resisted all other means (Ortille); Ether, as spray to the epi- 
gastrium for ten minutes, then to the site of the phrenic in the neck (Regoni) ; 
or the spirit, rr^xx-xxx in some aromatic water, given internally, will often 
arrest the spasm immediately (Wa). Zinc Valerianate, gr. %, with a small 
portion of Ext. Belladonnas, cured a severe case of fifteen days' duration 
(Danet). Nitro-glycerin, sometimes arrests (R). In mild cases deep inspira- 
tions, holding breath as long as possible, or a firm belt around epigastrium (T). 



73^ HYDROCELE HYDROPHOBIA HYDROTHORAX. 



Hydrocele. 

Iodine, injection of the tincture 1, water 2, into the sac to excite obliterative 
inflammation, the usual procedure for radical cure after tapping the sac (Wa) ; 
may be used full strength, or with equal part of water ; the latter the safest 
method in ordinary cases, but relapses are not infrequent (Gross). Carbolic 
Acid, gss, with a minute quantity of water or glycerin to render it fluid, injected 
into sac and manipulated to bring all portions under its action, after which 
rest in bed and support to scrotum (Levis) ; a very efficient method for radical 
cure, but may cause erosion of vessels and hemorrhage into sac (Gross). Am- 
monium Chloride, as discutient lotion to the scrotum in hydrocele of children 
(Wa). Galvano-puncture, a current of 20 to 40 elements, by two needle elec- 
trodes, will invariably cure (B). Operations for radical cure include that by 
iron-wire sutures to excite adhesive inflammation (Simpson), and the incision 
of the hydrocele under antiseptic precautions (Volkman) ; the same end may 
be obtained by the simpler methods of injection noted above (Gross). [Com- 
pare Dropsy, Orchitis.] 

Hydrocephalus, Chronic. 

Mercury, holds a high place in the opinion of many ; Calomel gr. X~K 
twice daily, with mercurial inunction to the shaved head, or the latter alone ; 
child to wear a woolen cap ; this treatment for 30 or 40 days (Wa). Ferrous 
Iodide, with Cod-liver Oil, always gives good results among the poor (Wa). 
Iodine, as lotions. [See Meningitis Tubercular.] Potassium Iodide, may 
arrest progress (Wa) ; is of value certainly ; appears to have power of promot- 
ing absorption (Wa). Cod-liver Oil, sometimes improves the condition, espe- 
cially in scrofulous children (Wa). [Compare Dropsy.] 

Hydrophobia. 

Belladonna, in all hyperemic states of the brain and spinal cord, is one of 
the very best remedies (P). Stramonium, is used by Brahmins in India with 
apparent success. Glonoin, may be of benefit (Wa). Nicotine, rightly used, 
will probably prove to be our best remedy (B). Amyl Nitrite, should be fairly 
tried (B). Hydrastinine, is used with benefit, in grain doses of the Hydro- 
chlorate, hypodermically. Curare, is encouraging, gr. y^ injected, 7 doses in 
5^ hours, dispelled the symptoms, but replaced them by paralysis of the limbs 
continuing for over 2 months (Ros) ; has seemed to antagonize the convulsive 
phenomena (B). Morphine, chiefly palliative ; for deep injection into the teta- 
nized muscles (B). [See Tetanus.] Coniine, is indicated ; has not succeeded 
(B). Cauterization, with hot iron or Caustic Potash after cleansing wound, 
which should be kept open by Unguentum Basilicon for 5-6 weeks (Ros ) ; with 
Silver Nitrate sharpened to a point, and applied freely to every sinuosity of the 
wound as preventive (Wa). Excision, the safer practice (Wa). Baths, warm 
and hot, produce calm (Ros). Rabies Toxin, the Pasteur inoculation with a 
modified virus, protects the bitten person from the disease. [See page 517.] 

Hydrothorax. 

Diuretin, has been employed with benefit. [See under Dropsy.] Digitalis, 
in the purely dropsical form, also in passive pleuritic effusions ; used as a diuretic, 
3j-ij of infusion bis die or oftener, of great value (R). Elaterium, unques- 
tionably of value as a derivative, though many fear it (P). Jaborandi, pro- 
duces good results (B). Iodine, 5j of tincture injected in returning hydro- 
thorax (B). Sanguinaria, has been used with the best effects (Wa). Blisters, 
when effusion has taken place, certainly seem to stimulate the absorbents to 
action (Wa). Dry Cupping, over the chest, gives relief (Da C). Thoracentesis, 
if much distress. [Compare Dropsy.] 



HYPOCHONDRIASIS HYSTERIA. 737 



Hypochondriasis. 

Arsenic, in the aged, gives great comfort, especially when combined with 
Opium (B). Ignatia, is useful, the tincture best (P). Cimicifuga, of singular 
value in puerperal hypochondriasis, and that accompanying spermatorrhea, 
etc. (P). Aurum, the Chloride, gr. -fo to -^ ter die gives excellent results, when 
depression, vertigo, cerebral anemia (B) ; Gold is an efficient remedy in hypo- 
chondriasis accompanying hepatic or testicular disease. Valerian, quickly re- 
lieves the flatulence of hypochondriacs (B). Asafcetida, especially indicated in 
cases marked by flatulence and gloom (B). Potassium Bromide, especially 
among female town-dwellers, but also in male (R) ; effects are variable ; re- 
lieves some, not others (Wa). Hyoscyamus, when syphiliphobia (P). Opium, 
stimulant doses of the tincture are of great importance (B). Caffeine, the 
Citrate, gr. j-v, has been used as a cerebral stimulant with advantage (B). 
Alcohol, gives temporary relief in hypochondriasis ; should never be given for 
its narcotic or stimulant effects in these cases (W). Cocaine, especially useful 
in cases marked by debility and nervousness, and in mental affections accom- 
panied by depression ; the fluid extract of Coca may be used, either alone or 
in wine (Br). Turkish Baths, are useful for town-dwellers, with soft, flabby 
tissues and mental depression (R). [Compare Melancholia.] 

Hysteria. 

Antipyrin, for the painful affections of hysteria. Aurum, the Bromide is of 
decided benefit, in doses of gr. % to %. (Rosenbach). Arsenic, lessens mobility 
of the nervous system and improves nutrition (B). Opium, gtt. j of Laudanum 
with gtt. ij of the tincture of Nux Vomica, 3 or 4 times a day, for the flushes, 
weight on the head, depression, etc. (R) ; Opium is a useful agent if its identity 
be concealed from the patient, otherwise the opium habit is sure to follow. 
Ignatia, useful in many forms of hysteria, with feeling of suffocation, sensation 
as of a ball rising to the throat, convulsive crying, flatulence, etc. (P). Cam- 
phor, in hysterical excitement (P). Musk, for many anomalous and distressing 
symptoms (R). Chamomile Oil, in the spasmodic and pseudo-neuralgic 
affections of hysterical women, a very excellent remedy (P). Cimicifuga, in 
hysterical chorea, is rapidly curative (P) ; for the headache (R). Asafcetida, 
in hysterical convulsive affections, with flatulence and cough (P) ; arrests 
paroxysm, valuable for flatulence (B) ; removes headache, peculiar sensations 
in head, and flatulence (R). Valerian, has great value, 5ss doses of fluid ex- 
tract (B) ; useful in most cases, especially those of hysterical dyspepsia (P). 
Zinc Valerianate, especially at the climacteric age, for hysterical symptoms 
which can be traced to no particular cause (R). Ergot, with Iron and tonics 
(formula on next page), in cases depending on sub-involution of the uterus, 
with indigestion and anemia (B). Nux Vomica, of great use in middle- 
aged subjects, when flatulence, weight on head, flushing and perspirations (R). 
Atropine, for hysterical aphonia, gr. T ^ to -^ morning and evening (B). Ether, 
for the flatulence, and for the hysterical paroxysm in sudden seizures (B). 
Ammonia, the aromatic spirit for the acidity and eructations (B) ; the fetid spirit 
for flatulent colic, etc., may be given with great advantage in doses of £>ss-j 
( Wa). Potassium Bromide, gives control and prevents paroxysms ; when 
verging on nymphomania large doses required (R). Iron, a course often use- 
ful, especially when anemia or uterine obstructions (R). Phosphorus, in 
hysterical paralysis (R). Orchitic Extract, is used with benefit. Cerebrinin, is 
employed with good results (Paul). Ovarian Compression, has in many cases 
relieved recent hysterical contractions, and many other similar phenomena 
(Bourneville). Electricity, for aphonia, paralysis and anesthesia, and to 
educate the nervous control ; is the sworn enemy of hysteria. Accessory 
Measures, occupation of mind and body; removal from influence of friends; 
complete abandonment of the use of alcohol ; the shower-bath or cold-bath, as 

47 



738 



ICHTHYOSIS IMPETIGO IMPOTENCE. 



an educator of the will as well as to invigorate the body ; excitement to be 
avoided. The word Hysteria should never be applied to the case in the 
patient's hearing. Disorders of vision are often found at the bottom of hysteria ; 
look for hypermetropia and astigmatism. 

R. Ext. Ergotae, gj. 

Ferri Sulphatis, 3 ss. 

Ext. Nucis Vomicae, . . . gr. viij. 

Hydr. Chlor. Corros., . . gr. ss. 
Fiant pil. no. xxx. Sig. — One pill 
thrice daily. For the indigestion and ane- 
mia of hysterical subjects. (B.) 



R . Tinct. Asafcetidse, 

Tinct. Valerianae Ammon., 
Tinct. Castorei, . . . aa gij. 

Aquae Camph., ^ v ij- 

M. Sig. — A tablespoonful or two every 

hour. 



Ichthyosis. 

Zinc, the ointment or glycerite of the Oxide, especially the latter with a little 
Camphor added to it, is a most useful application (Waj; an ointment of the 
Sulphate, $j to ^j, found very efficient (Wilson). Sodium Bicarbonate, as 
ointment, gr. xv-xxx to the §, or lotion, 3ij-iij to the pint (Devergie). Copper 
Sulphate, gr. x ad %] of Unguentum Sambuci, a useful application (Wilson). 
Ulmus, in decoction, used internally, has cured the disease (Wa). Cod-liver 
Oil, applied locally with friction, has proved promptly curative. Warm Baths, 
may generally be employed with benefit (R) ; alkaline and vapor baths, with 
Sapo Mollis ; and inunctions of oil or simple ointment to prevent Assuring of 
the new skin (Duhring) ; frequent alkaline baths, with internal and external 
use of oily preparations, as Linseed and Cod-liver oils, yield the best results 
(Bulkley). Thyroid Extract, has been given with benefit. 



Impetigo. 

Salol, locally, as an antiseptic and deodorant powder. Arsenic, is very use- 
ful (see under Eczema) ; the Iodide in doses of gr. ^ has been employed with 
great success; or Donovan's Solution, tt^v-x (Wa). Nitric Acid, internally, 
frequently benefits (Wa). Glycerite of Tannin, an excellent application (B) ; 
during the day, with poultices at night to remove scabs (R). Quinine, and 
Mineral Acids, when from imperfect digestion (R). Zinc, the ointment of the 
Oxide, after subsidence of inflammation (R). Sulphur, internally, serviceable 
(R). Calcium Chloride, gr. xv-xxx, daily in some vegetable infusion, is well 
spoken of (Wa). Mercury, Citrine Ointment diluted, locally, is an excellent 
application (Wa) ; a very weak White Precipitate Ointment answers best in im- 
petigo contagiosa, with a little Carbolic Acid lotion, 1 in 20, if it does not yield 
(Bulkley) ; Calomel to cover the floor of the pustules, after opening, evacuating 
and washing them out (Da C). Laurel-water, relieves the itching (P). Grape- 
cure, has proved excellent (P). Flexible Collodion, or Liquor Guttas-perchas, 
to cover the pustules, if located where they are liable to irritation (Da C). 
[Compare Eczema.]' 

Impotence. 

Phosphorus, no remedy more efficient ; the pill of Zinc Phosphide the most 
convenient form (B) ; gr. ^ thrice daily. Phosphoric Acid, full doses, with gr. 
ss of Pulvis Cantharidis, an effective combination, especially in impotence of 
old age (B). Aurum Chloride, prevents decline of sexual power (B) ; Gold 
salts are highly praised by several authorities for decline of sexual power in 
men. Kola, as a general tonic. Cantharis, with Iron is beneficial (B) ; in 
large doses, gtt. xx-xxx, with Iron and Phosphoric Acid or Nux Vomica (R) ; 
of doubtful efficacy (Wa). Cubeb, removes functional trouble (B). Nux 
Vomica, drop doses of tincture in atonic impotence (B) ; in large doses when 
spermatorrhea (R). Sanguinaria, has decided aphrodisiac properties, but is 
useful only in the functional form (B). Serpentaria, in relaxation and feeble 



INFLAMMATION. 



739 



erections, will often restore power; 3ss doses of tincture twice daily (B). 
Ergotin, hypodermically about the dorsal vein of penis, when its enlargement 
and too rapid emptying is the cause of impotence (B). Cannabis Indica, is a 
useful remedy ; the best combination for functional impotence would be one of 
Cannabis, Nux Vomica and Ergot (B). Polygonum Hydropiperoides, is a 
useful remedy in the functional form, erections feeble, semen watery and testes 
soft (B). Ferrum Arsenate, acts as a tonic to the organs, and in full doses often 
benefits cases of the'functional form (B). Damiana, has been brought forward 
as a genital stimulant and a remedy for impotence, but there is probably no 
ground for any confidence in such claims (Stille). [Compare Emissions, Sper- 
matorrhea, also the List of Aphrodisiacs, ante, page 40.] 



R 



. Ferri Arsenatis, gr. v. 

Ext. Ergotae, gr. xxx. 

Ft. pil. no. xxx. Sig. — One twice daily. 



R. Ext. Cannabis Indicse, . . gr. x. 

Ext. Ergotse, gr. xl. 

Ext. Nucis Vom., . . . . gr. x. 
Ft. pil. no. xx. Sig. — One pill night 
and morning;. 



R. Quininae Sulph. , . . . . gr. xxx. 

Strych. Sulph. , gr. ss. 

Ext. Ergotae, gr. xv. 

Mas. Ferri Carb. , . . . . gr. xlv. 
M. Ft. pil. no. xxx. Sig. — One pill 2 
or 3 times daily. 



R . Sanguinarias, 
Ext. Ergotae, 
M. Ft. pil. no. 
thrice daily. 



. . . gr. ij. 

gr. xx. 
Sig. — One pill 



R. Tinct. Sanguinariae, . . . giij. 
Ext. Stillingiae FL, . . . 3 v. 
M. Sig. — 15 to 20 drops in water, thrice 
daily. 



R . Phosphori, .... 


. gr. ss. 


Ext. Nucis Vom., . . 


• g r - V J- 


Mas. Ferri Carbonat., 


. gr. xl. 


Ext. Gentianae, . . . 


. gr. xxx. 


M. Ft. pil. no. xxv. Sig 


— One pill 2 


or 3 times daily. 





Inflammation. 

Aconite, is especially indicated in inflammation of the respiratory organs, in 
the eruptive fevers, and all inflammatory states of high temperature and sthenic 
reaction ; not in adynamic states, or continued fevers, except for hyperpyrexia ; 
may be advantageously combined with Opium (B) ; gives most brilliant results 
in many forms (R) : always indicated in early stages of simple inflammatory 
fevers, in all inflammation of serous membranes, pneumonia, tonsillitis, acute 
rheumatism, erysipelas, etc. ; is especially adapted to the uses for which bleed- 
ing was formerly employed (P). Arnica, is antipyretic, large doses, gss of tinct., 
in sthenic, small doses, tt\,x, in asthenic inflammation (B) ; in inflammation of 
serous membranes it has given good results (P). Belladonna, in many forms 
no remedy more useful, notably scarlet fever, erysipelas, low fevers ; for inflam- 
mation of the eyes, boils, carbuncles, etc., Atropine externally, Belladonna in- 
ternally; when much fever, may be combined with Aconite (B) ; both locally 
and internally in inflammation of the eye; is effectual in inflammation which 
threatens to end in abscess (R) ; in erysipelas, inflammatory sore throat, 
encephalitis, gouty and rheumatic inflammation, cystitis, pneumonia, etc. (P). 
Gelsemium, especially for inflammation of lungs and pleurae, and in pneumonia, 
rt^v-x of fl. ext. every two hours (B) ; in acute stage of gonorrhea is valuable 
(P). Bryonia, exceedingly valuable in pleurisy and other serous inflamma- 
tions, especially pericarditis; after the aconite stage (P). Veratrum Viride, 
when much delirium and arterial excitement, useful at beginning only (B) ; in 
pneumonia, Veratrine is most valuable, also in acute rheumatism and generally 
as an antipyretic (P). Tartar Emetic in frequent minute doses, gr. ^ F , renders 
incontestable service (B) ; in pneumonia, tonsillitis, pleurisy, bronchitis, and 
other inflammatory affections (R); gr. l /e, frequently repeated, has the power 
of completely dissipating early local inflammations (Spender) ; quite as useful 
in arresting local inflammations as Quinine is in malarial fever (Lawrie). Pul- 
satilla, in acute and subacute inflammations with muco-purulent discharges, 



740 INFLAMMATION. 

especially of eyes, ears, and nasal passages (P) ; also with Aconite in epididy- 
mitis (Pf). Mercury, in acute glandular inflammation of throat and neck, in 
ileo-colitis, iritis, syphilitic inflammations of serous membranes, laryngitis (R). 
Silver Nitrate, locally in strong solution, gr. clx to ^j of distilled water, painted 
over surface and beyond, after thorough cleansing and drying ; no agent so 
safe, powerful or efficacious in subduing external inflammation (Higginbotham) ; 
a strong solution in Nitrous Ether is a most efficient application to check in- 
flammation in superficial parts, as boils, felons, orchitis, Synovitis, erysipelas, 
erythema, eczema, etc. (B). Iodine, as liniment in vicinity of local inflamma- 
tion to produce vesication (R). Sulphides, especially that of Calcium, gr. ^, 
appear often to arrest suppuration ; after formation of pus they hasten matura- 
tion and circumscribe inflammation ; in boils, abscesses, and deep-seated sup- 
puration, they improve the condition and promote healing (R). Antipyrin, 
Kairin, and other antipyretics (see under the title Fever). Alkalies, espe- 
cially Ammonium and Potassium salts, are very valuable in the stage of exuda- 
tion (B). Astringents, locally in inflammations of mucous membranes (R). 
Lead, the Liquor Plumbi Subacetatis Dilutus as a soothing and astringent 
application to inflamed and erysipelatous surfaces (Wa) ; to eczema and other 
inflammatory diseases of the skin (Pf ). Digitalis, the German antipyretic, is 
especially useful in pneumonia, bronchitis, rheumatic fever, and scarlet fever 
(B) ; aconite safer and better (R) ; locally and internally Digitalis is useful in in- 
flammations, especially those of the joints, of breast, erysipelatous and varicose : 
a fomentation of a teasp. of the dried leaves in half a pint of boiling water, or 
3j of tincture to the same quantity of water, applied by flannels to the part, 
will quickly subdue (Fairbank). Quinine, in peritonitis (Tr) ; is indicated in 
most acute forms, unless objections occur (P) ; has power to arrest inflamma- 
tion in formative stage ; with Morphine and in full doses, gr. xv-xx, may sup- 
press many forms (B). Chloral, excellent when temperature is high, much 
delirium ; gr. v every 3 hours (B). Opium, is important in most inflammations, 
but especially those of serous membranes ; a full dose, gr. % of Morphine, at 
first, smaller doses after ; is especially curative in inflammation of intestines 
and peritoneum, and in cerebro-spinal meningitis, arachnitis, etc. (R). Saline 
Purgatives, valuable as part of the denutrition treatment, and to diminish 
arterial tension (B). Salicylic Acid is antipyretic, especially in septicemic in- 
flammation, and in acute rheumatism, erysipelas, pneumonia (B) ; Sodium 
Salicylate more soluble (R). Colchicum, often exercises a happy influence 
over certain acute inflammations, as bronchitis, conjunctivitis, etc., especially 
if occurring in gouty subjects (P). Cocaine, locally in commencing inflamma- 
tions of mucous surfaces, to constrict the blood-vessels of the part (R). Pilo- 
carpus, gives good results in the exudative stage of pleuritis, iritis, keratitis, etc. 
(B). pold, by Ice in bags, or cold water, a very useful agent. Ice, in small 
pieces in a bladder, applied to inflamed part (R). Water, cold and hot baths 
and packing very useful in all inflammations (B). Alcohol, is constantly pre- 
scribed, and is of value in low states, if symptoms after its administration are 
ameliorated (B). [See under Fever.] Poultices, useful in many inflamma- 
tory states, but often abused (B) ; to check formation of pus and assist in mat- 
uration (R). Glycerin, as in Unna's Paste or Antiphlogistine, a very efficient 
application in many forms of inflammation. Heat, by hot water, fomenta- 
tions, etc., often much better than cold applications. Dry Heat, applied by 
the Tallerman apparatus, of great value in tendinous inflammations, traumatic 
synovitis, subacute rheumatism, etc. (W). Venesection, when the pulse is 
hard, strong, full and frequent, a plethoric state of the system and great 
intensity of morbid action ; if required, the earlier it is done the better 
(Gross) ; Leeches very useful in many forms where sthenic reaction and ple- 
thora ; value of bloodletting probably due to derivative and counter-irritant 
effects (B); a remedy of great power for good or evil, now much neglected 
(Wa) ; local bleeding by leeches, cups, scarification, etc., should generally be 
preceded by some form of general depletion (Gross). Aliment, when no 
inflammation of the digestive tract use milk and beef-tea alternately every 3 



INFLUENZA. 



741 



hours ; no starches or fats ; in intestinal inflammation milk, eggs, animal 
broths, oysters, fish, but all food must be used with great caution ; skim -milk 
treatment (B) ; Cod-liver oil in many chronic inflammations, as of heart, lungs, 
kidneys, etc. (R). [Compare the various titles, as Bronchitis, Pleuritis, 
etc., also the list of Antiphlogistics on page 37.] 



[See pages 578 and 580 for Liniment and Lotion formulae.] 



&. Tinct. Aconiti, £j. 

Tinct. Belladon., . . . . 31J. 
M. Sig. — Three or four drops in water 
every hour. (B.) 



R 



Ammonii Chloridi, 
Acidi Acetici, 
Alcoholis, . . . 
Aquae, 



. . .. 3 v. 

aa £ x. 
s. ad 5 x. 



M. et fiat lotio. Evaporating and dis- 
cutient lotion. 



R . Antim. et Pot. Tart., . . gr. ijss. 

Magnesii Sulph., . . . . }|ij. 

Morphinae Sulph. , .... gr. j^. 

Ac. Sulph. Aromat., . . gss. 

Tinct. Verat. Virid., . . . ,^jss. 

Syr. Zingiberis, . ■ • . . ;fij. 

Aquae Destill., J x. 

M. Sig. — Tablesp. every 2, 4, or 6 
hours. Antimonial and Saline Mixture. 

( Gross. ) 



Influenza. 

Menthol, dissolved in Chloroform, as inhalation, to abort an attack of influ- 
enza (see under Catarrh, Acute Nasal), is highly efficient as a prophylactic 
(Wunsche) ; Menthol in 5 to 10 per cent, spray, is highly praised. Cocaine, a 
4 per cent, solution snuffed up the nostrils or sprayed into them, is very efficient 
in the early stage (R). Eucalyptus, the Oil, sprinkled on blotting-paper placed 
around a large room, was considered an efficient prophylactic during the Lon- 
don epidemic of 1891, and was much used in offices, shops, etc. Salol, and 
Salipyrin, as internal remedies, were highly extolled during the epidemic of 
1891. Phenacetin, is used with great benefit, both as a prophylactic and a 
remedy. Phenocoll, the Hydrochloride has been used with marked success in 
epidemic influenza and for the neuralgic pains thereof. Acetanilid, 2, with Sali- 
cylic Acid and Ammonium Bromide, each 1 part, forming the mixture called 
Antinervin, was used with much success during the recent epidemic in Scotland. 
Quinine, the Hydrochlorate, gr. viij daily as prophylactic, has specific action, 
as shown by experience with hussars at Bonn during the epidemic of 1889-90 
(Graeser) ; the Hydrobromate in 8 to 16 grain doses, if the fever is high (Huch- 
ard) ; Quinine is used with benefit throughout the disease, and especially for 
the neuralgic pains following the acute stage (Wa). Potassium Bicarbonate, 
is more nearly specific than any other remedy; gr. xxx with ttLxx of Glycerin 
and Liquor Ammonii Acetatis ^ss, every three hours ; it prevents complications 
when given in time and also prevents sequelae (Calvert). Sodium Salicylate 
in doses of gr. v every half hour for six or eight doses, then every hour until all 
pain has vanished, then every two hours for a day or two, is very efficient 
(Parker). Ammonium Salicylate, is even better than the sodium salt ; add 
Liquor Ammoniae Fort., 3j to Ac. Salicylic, gr. lxxx, to make an 8 ounce mix- 
ture for tablespoonful doses (Id). Strychnine, for the underlying weakness and 
depression, the real enemy to fight against in the grippe, Strychnine is the best 
remedy we have (Huchard). Digitalin, crystallized, in dose of gr. ^, in grip- 
pal pneumonia, in which, though the disease is in the lungs, the danger is to 
the heart (Id). Sodium Benzoate, with Quinine and Caffeine (formula on next 
page) in the simple form of grippe (Id). Ammonium, the Liquor Ammonii 
Acetatis, combined with Nitric or Chloric Ether, is often of great service (Wa). 
Sanguinaria, is used with much benefit (Wa). Cimicifuga has been given with 
much success (R). Camphor, in solution, hypodermically (formula on next 
page), 2 to 4 times daily, with 3 to 6 of Caffeine and 2 or 3 of Ether, for grippal 
pneumonia (Huchard). Camphoric Acid, in one dose of gr. xx-xxx, dry on the 
tongue, not over 2 hours before the expected time for sweating, is remarkably 



742 



INSANITY AND DEMENTIA. 



efficient to prevent it. Agaricic Acid, gr. ^~% by mouth, is efficient against 
the sweating of influenza. Bismuth Salicylate, or Naphtol, Betol, Salol, or 
Benzo-naphtol, as intestinal antiseptics, when such are required (Hucha'rd). 
Sulphurous Acid, by fumigation or inhalation, a few drops on boiling water, or 
as a spray, often controls influenza (R). Benzol vapor, is a reliable pulmonary 
antiseptic, and has been employed with very favorable results (Robertson). 
Benzoin, the compound tincture, £»ss-j, inhaled from a pint of hot water fre- 
quently (Da C). Tartar Emetic has been recommended strongly, but is too 
depressant (Wa) ; has extraordinary power of aborting local inflammations, 
especially those of the respiratory apparatus. [See under Inflammation.] 
Spiritus Athens Nitrosi, in doses of 3j-jss, in any convenient vehicle, is a popu- 
lar and efficacious remedy (Wa). Cubeb, £ss or Z] doses of the tincture in y z 
glass of Linseed-tea thrice daily, for the subsequent cough, often curing like a 
charm (R). Opium, best avoided in early stage, but later for the cough, with 
Ipecac, gives great ease ; Dover's powder, with Nitre and Lobelia, is a good 
form (Wa). Potassium Nitrate, largely diluted as lemonade, gj-ij in the course 
of the day, proves highly useful (Wa). Boric Acid, as gargle, also borated 
ointment or vaselin to the nasal cavities, and great care taken to maintain 
a clean mouth; antisepsis of the nose, mouth and pharynx is very important 
and does much to prevent complications and perhaps broncho-pneumonia 
(Plicque). Coca and Kola, the tinctures, a mixture of equal parts of each, for 
the nervous depression (Id). Hot Fomentations, for the headache (R). Turk- 
ish Baths, have been used with marked advantage (Wa). 



R . Quininae Hydrobromat., 

Sodii Benzoat., 

Caffeinse, aa gr. xxx. 

M. et ft. pil. no. xxx. 

Sig. — One pill thrice daily. (Hit chard.' 



I&. Ammonii Chloridi, . . . £jss. 

Morphinae Sulph. , . . . gr. ij. 

Tinct. Sanguinariae, 

Syr. Ipecac. , . . . . aa g iv. 

Mist. Glycyrrh. Co., 

Aquae, aa^jss. 

M. Sig. — Teasp. as required for the 
cough. Each dose has of Morphine Sul- 
phate gr. T L 



R 



R 



Ext. Cimicifugae Fl., . . §ss. 

Tinct. Opii Deodorati, . gj. 

Syr. Tolutani, . . . . £xj. 

M. Sig. — Teasp. every four hours. 



Camphorae, ^ ij ss . 

01. Olivae (steriliz.), , . ^iij. 
M. Sig. — 3 ss hypodermically twice or 
thrice daily. (Htcchard.) 

R. Ext. Ipecac. Fl., .... gij. 

Tinct. Opii Deodorati, . ^iv. 

Tinct. Aconiti, .... ^j. 
M. Sig. — Five to ten drops every two 
hours, for the bronchitis. 



Insanity and Dementia. 

Hyoscine, has strong power as a mental alterative ; is particularly useful in 
that form of mental disturbance which renders the patient violent and abusive, 
restless and domineering, a nuisance to every one who has anything to do with 
him (Weatherly). Duboisine, gr. y^ to y 1 ^ hypodermically twice daily, is 
highly efficient in the treatment of the mental excitability of the insane, induc- 
ing quiet and refreshing sleep, and is not dangerous (Massant). Atropine, pro- 
duced a permanent cure after bromides failed, in a case of periodic insanity 
with delusions of persecution (Hitzig). Opium, especially Morphine, is inju- 
rious in mania, but is useful in melancholia and for climacteric and senile 
cases. Chloral, does as much harm as good, is best suited to wildly maniacal 
and erotic patients. Potassium Bromide, is almost discarded, except for epi- 
leptic cases. Conium, is useful, sparingly, for noisy patients. Colchicum, for 
gouty cases, which are numerous ; cure the gout, and you may cure the insanity. 
Shower-bath, suitable for cases due to self-abuse ; the wet pack in the mania 
of hystero-epilepsy. Stimulants rank high, next to quiet and absence from 
home. Thyroid Extract, has been used with apparent benefit. Tonics and 
Hypnotics, should be employed in cases requiring them. Food of good quality 



INSOMNIA. 743 

is essential to the treatment. Kumyss, is an excellent food in hysterical dys- 
pepsia and anorexia simulating that of insanity. Moral Treatment, is now suc- 
cessfully carried out in many asylums, but is expensive, requiring a large staff 
of trained attendants. With correct management from the start, nearly all 
cases of insanity unattended by paralysis or physical decay may be cured 
(Savage) ; this can be best administered in a well-conducted asylum or hospital 
for the insane, where security and the prospect of recovery will be better than 
in the best home ; the total abolition of any one plan of treatment in favor of 
another would be a great mistake ; more than half of first attacks of insanity 
are recovered from under good management, which is best attained under 
the direction of persons trained in this specialty (H). Recently, efforts have 
been made at the improvement of the condition of the insane by requiring 
them to attend school daily, with remarkably good results. [Compare Deli- 
rium, Hypochondriasis, Mania, Melancholia.] 



Insomnia. 

Chloral, is quite unrivaled, being the most direct and generally useful hypnotic 
(B) ; acts best in cases of purely nervous type (Wa) ; in doses of 20 to 30 grains 
is by far the best hypnotic for many forms of insomnia (R) ; is dangerous in 
old drunkards, in whom the heart and vascular system have undergone fatty 
and calcareous degeneration (B) ; in combination with Opium or Morphine it 
acts splendidly in small dose, each ingredient intensifying the hypnotic action 
of the other (Brodnax) ; children bear it well, especially when given with Pare- 
goric. Chloralamid, 30 grains in £j of whiskey or brandy, in simple or idio- 
pathic insomnia, or that from nervousness, hysteria, chronic alcoholism, but 
not when due to excitement or severe pain. Croton-chloral, is feebler than 
Chloral and less toxic; as a hypnotic Z) maybe given (R). Somnal, is a com- 
bination of Chloral, Alcohol and Urethan, and strikingly efficient in the in- 
somnia of convalescence from acute disease (Myers). Paraldehyde, in doses 
of 3j-3u\ one °f tne most efficient and safe hypnotics, being free from depres- 
sant action on the heart and other unpleasant by-effects. Sulphonal, 15 to 30 
grains in milk, 2 hours before effect is desired ; an admirable hypnotic in many 
cases, but its efficacy decreases with use, and it is of no value in insomnia due 
to pain. Trional, is markedly hypnotic and sedative, acts surely and promptly 
in the insomnia of neurasthenia and organic brain affections ; is better than 
Sulphonal or Chloral in many respects (Schultze). A mixture of Sulphonal and 
Trional, gr. x-xv of each, is an admirable hypnotic, the latter producing early 
sleep and the former later sleep. Tetronal, is somewhat less hypnotic than 
Trional, but more of a sedative; the sleep from either lasts 6 to 8 hours, and is 
generally dreamless; neither is of any use when insomnia is due to pain. 
Potassium Bromide, when from cerebral over-action, gr. xv before each meal, 
and gr. xxx on retiring ; has cumulative effect (B) ; it increases hypnotic effect 
of Hyoscyamus, Belladonna, Cannabis Indica, Ether and Chloroform (R). 
Opium, 15 to 20 minims of the tincture, or l /e to y^ grain of Morphine, the most 
effective hypnotic when insomnia is due to pain ; in combination with Chloral 
(see above) smaller doses of each are efficient. Opiates should be given so as 
to act at the natural time for sleeping (R). Codeine and Narceine are hyp- 
notic in proper doses. Apomorphine, gr. -^ hypodermically is the average 
hypnotic dose, should be given when the patient is ready for bed ; its action 
lasts from one to two hours, but it often starts the patient to a good night's 
sleep (Douglas). Hyoscyamus, an effective substitute for Opium in children, 
5ij-^j of tinct. necessary, and without danger (B) ; when Opium disagrees (R). 
Hyoscine, produces sleep after a brief period of excitement ; gr. y^ of the 
hydrobromate hypodermically is excellent for the insomnia of the insane. 
Duboisine, is even more calmative and hypnotic than Hyoscine, and is espe- 
cially useful when high mental excitement exists ; gr. ^^ to ^ or -^ hypoder- 
mically, may be combined with gr. y% to % of Morphine. Belladonna or 



744 



INTERMITTENT FEVER. 



Atropine, is hypnotic in some conditions, especially when prostration, low 
arterial tension and contracted pupils. Ignatia, for sleeplessness from nervous 
erethism, better than Morphine (Pf ). Gelsemium, in simple wakefulness (B) ; 
and in that of drunkards, mania and over-excitement (R). Coffee, insomnia 
from lowering of nervous power, and from chronic alcoholism (P). Sumbul, 
30 to 40 minims of the tincture, with a little Chloric Ether, is very efficient in 
the insomnia of chronic alcoholism (P). Tartar Emetic, with Opium, is effec- 
tive when insomnia is due to cerebral congestion and when Opium stimulates 
(B). Hypnal is credited with simultaneous hypnotic and analgesic action. 
Methylal is an efficient hypnotic. Hypnone is of moderate hypnotic power, 
but is said to be especially useful in the insomnia of acute alcoholism. 
Urethan, a pure but mild and safe hypnotic, especially useful for children. 
Pellotine, the alkaloid of Anhalonium Lewini, a Mexican cactus, is hypnotic 
in doses of gr. ^ hypodermically (Jolly) ; gr. \ of the Hydrochlorate produced 
dangerous collapse in one case (Langstein). Digitalis, is of great use as a 
soporific in sleeplessness at night with drowsiness during the day, both symp- 
toms depending on want of tone in the vessels (Br). Resorcin, produces 
quiet sleep in general nervous excitability, and in the insomnia of typhus fever 
and pulmonary tuberculosis. Ether or Chloroform, in full dose (R); may be 
used by inhalation when other means of producing sleep have proved unsuc- 
cessful. Phosphorus, when nutrition is inactive, and in the insomnia of the 
aged (B). Humulus, a hop-pillow is said to be effective in many cases (P) ; 
the tincture of Lupulin, 3ss-^ss, as a cerebral sedative. Cocaine has been 
used with some success (Wa). Chamomilla, n\j of the tinct. every quarter- 
hour, an excellent sedative for children (Smith). Cannabin Tannate, in 8-grain 
doses, a good hypnotic (Fronmuller) ; very inefficient (W). Cannabis is very 
uncertain in its action (R). Alcohol, if from cerebral anemia, a full dose of 
whiskey or brandy ; in some a glass of ale or beer answers better (B). Water, 
a tepid bath just before retiring often effective ; when head is hot apply cold 
to it, and a tepid bath to the body (B). [Compare Nervousness ; also the 
title Hypnotics, on page 54, and the sub-title Unofficial Analogues of Chloral 
on page 255.] 



R- . Paraldehyde ....... £ijss. 

Alcoholis (99 per cent.), . ^jss. 

Tinct. Vanillas, gss. 

Aquae, !§j. 

Syr. Simplicis, . . q. s. ad^iv. 
M. Sig. — A teasp. or two every hour 
until sleep is obtained. 

( Yvon's Hypnotic Elixir.) 



$ . Potassii Bromidi, . . . . 5jiv. 

Chloralis Hydratis, . . . Jjiij, 

Tinct. Asafcetidae, . . . . ^iv. 

Syrupi , £ vj . 

Aquae, q. s. ad^v], 

M. Sig — Tablesp. every 2 hours until 
sleep is induced. In the insomnia of hys- 
teria. 



Intermittent Fever. 

Quinine, as prophylactic, gr. v-x each morning in black coffee ; begin with 
gr. v, add gr. j each week (R) ; in ordinary intermittents give 6 or 10 grain doses 
up to 20 or 30 grains, so as to have it all in 4 or 5 hours before the expected 
paroxysm ; give the Sulphate and in solution to get its full action (Da C) ; for 
acute ague, gr. x in sweating stage, and the same dose 5 hours before next 
paroxysm, also gr. x-xv at the septenary periods, until the third has passed ; 
in pernicious form, gr. xx-xl are required, by stomach, rectum or skin, to 
secure safety of patient ; best in combination with Morphine, and with con- 
tinuous administration of Arsenic during intermissions; may be given in solu- 
tion by rectum, or hypodermically (R) ; is almost specific in intermittents when 
uncomplicated and of recent origin (Wa) ; a fever fit, once begun, cannot be 
cut short by quinine, and to give it during the early stages aggravates the 
headache and general distress ; gr. x, preferably in solution, should be admin- 
istered at the commencement of sweating, and thereafter gr. v every 6 or 8 
hours for the next 2 or 3 days (Mn). Chinoidine may be used as a substitute 



INTERMITTENT FEVER. 745 

for Quinine in doses twice as large (B). Cinchonine, Cinchonidine, Quinidine, 
the Sulphates of these alkaloids are scarcely, if at all, inferior to Quinine as 
therapeutical agents (Report of the Madras Commission). Cinchonidine Sali- 
cylate, promises well as an antiperiodic (B). 

Arsenic, the best remedy next to Quinine, especially useful in long-standing 
agues of quartan type (R) ; useful as adjunct to Quinine daily to prevent re- 
lapse ; with Iron, most important in chronic ague ; also as prophylactic small 
doses of Fowler's solution (B). Hydrastine, stands next after Arsenic ; indica- 
tions same as for Quinine (B) ; in doses of gr. ij-ix is strongly recommended 
(P). Tannic Acid, enjoys a certain reputation in malarial fevers which have 
resisted quinine, and especially in hemoglobinuric fever (Mn) ; [see under 
Hemoglobinuric Fever.] Pilocarpine, gr. }i of the Muriate, in the cold stage, 
is strongly recommended by high authority to excite profuse perspiration and 
thus lessen the attack (Da C). Apiol, when prejudice exists against Quinine ; 
gtt. xv during an hour, in divided doses, 4 hours before paroxysm (B) ; is one of 
the minor remedies which often prove successful in mild cases (Wa). Salicin, as 
substitute for Quinine, but inferior (B) ; grs. x-xl, in mild cases (P). Opium, as 
Morphine, gr. J4~X hypodermically, not only lessens the chill, but aids the 
action of the antiperiodic ; is to be strongly urged (Da C) ; is useful in the perni- 
cious variety in combination with Quinine (B). Capsicum, the resins of black 
and red pepper, as adjuvants chiefly (B) ; promotes action of Quinine (Pf). Nux 
Vomica, has been used with success, but is now used as adjunct to Quinine 
(B) ; good in convalescence (P) ; has antiperiodic value not inferior to that of 
Quinine ; gr. -£$ of Strychnine equals gr. j of Quinine Sulphate (Wa). Strych- 
nine Arsenite, is an efficient remedy (see page 394). Methylene Blue is effi- 
cient, and has many advantages over Quinine, especially for very young chil- 
dren (Ferreira). Chloroform, to prevent an impending paroxysm; 3j-3ij of 
the spirit before the chill, or by inhalation (B). Narcotine, gr. ij-v ter die, is 
eminently antiperiodic ; no other drug, except Quinine, cures intermittents so 
rapidly and surely, or with more freedom from disagreeable effects (Wa) ; said 
to be superior to Quinine (R). Nitric Acid, full doses every 4-6 hours (B). 
Sodium Chloride, in large doses during the apyrexia, 3viij-xij, may occasion- 
ally prove efficacious (Wa). Eucalyptus, during convalescence (B) ; has been 
successfully used in treatment of ague, 3j-ij of a tincture (Wa). Carbolic Acid, 
in 4-grain doses with Infusion of Ginger, cured a series of 8 cases which had 
resisted Quinine (Wa) ; its value established ; TT\,ss-ij in mint-water or gr. ^ in 
rr^xx of water, hypodermically (Tessier) ; combined with Iodine is of great value 
(B). Mercury, uncalled for in ordinary cases ; but Hydrarg. cum Creta, Qui- 
nine and Rhubarb are of service in the obstinate intermittents of children in 
tropical regions (Wa). Sodium Hyposulphite, gr. xv-xx every two hours, is 
said to cure (R). Cascarilla, Chamomile, Quassia, are used (R). Gentian, is 
valued chiefly as a vehicle (P). Ammonium Picrate, has proved wonderfully 
effective in India, where 10,000 cases were treated therewith (Clark). Lemon, 
in decoction, exceedingly efficient in preventing recurrence of the paroxysms 
after they have been broken up by the use of Quinine (Crudeli). Emetics, 
may cure many cases ; one each morning will assist the action of Quinine ; 
Ipecacuanha preferred (R) ; only at commencement, inadmissible if gastric 
irritation (Wa). Antimony, at the onset and continuously in mild, uncompli- 
cated cases ; Tartar Emetic, gr. yi~y<o every 2 hours, has been followed by 
complete cures (Moore). Guaiacol, locally to skin, as an antipyretic (see page 
294). Antipyrin, is useless (Falkenheim). Resorcin, and similar agents, have 
no specific action, merely controlling the pyrexia (Wa). Warburg's Tincture 
is a remedy of great power, but produces such severe diaphoresis as to be 
dangerous to adynamic subjects (Maclean). Purgatives, in the intermission, 
before using the antiperiodic, is good practice ; Podophyllum, Colocynth or 
Jalap (Da C). Iron, is valuable in chronic cases ; the system should be thor- 
oughly saturated with it (Da C). Ergot, for the enlarged spleen (Da C). 
[Compare Hemoglobinuric Fever, Malaria ; also the List of Antiperiodics 
on page 37.] 



7 4 6 



INTERTRIGO INTESTINAL OBSTRUCTION. 



R . Acidi Carbolici, . . . 
Tinct. Iodi Comp., . . 
M. Sig. — 4 drops every 
sufficient water. 



. 3 ii]. 
4 hours in 
(B.) 



R 



gr. xxxij. 



Quininae Sulphatis, 

Mucil. Acaciae, . . . 

Syr. Eriodyctii Aromat. 
(Parke, Davis & Co.), vel 

Mist. Glycyrrhizae Co., vel 

Velatine, . . . . q. s. ad ^\). 
M. Fiat emulsum. Sig. — A teasp. 
contains gr. ij of Quin. Sulph. Suspension 
of the Quinine without dissolving it makes 
the bitter taste less perceptible (Squire), 
and the syrup of Eriodictyon covers the 
taste well. {Potter.) 

R • Quininae Sulphatis, . . . gr. xl. 

Ferri Sulph. Exsiccat., . . gr. xx. 

Acidi Arsenosi, gr. j. 

M. Ft. pil. no. xx. Sig. — One pill 
thrice daily. (B.) 

R . Quininae Sulphatis, . . . gr. xxx. 

Capsici, gr. xv. 

Opii Pulveris, gr. iij. 

M. Ft. pil. no. xx. Sig. — One to five 
pills as required. (Piffard.) 



R. Massae Ferri Carb., . . . gj. 

Acidi Arsenosi, gr. j. 

M. Ft. pil. no. xx. Sig. — One pill 
thrice daily in chronic ague. (B.) 



R. Quininae Sulphatis, . . . gj. 

Ac. Hydrobrom. Dil., . . ^ij. 

Aquae, 3 x i y - 

M. Sig. — A teasp. contains gr. iij^ of 
Quin. Sulph. The acid directed prevents 
the unpleasant cerebral action, (B.) 



R . Quininae Sulphatis, 

Pulv. Acaciae, .... aa^ss. 

Syr. Zingiberis, ^ iv. 

M. Sig. — A teasp. contains one grain of 
Quin. Sulph. A good.formula for children, 
the quinine being suspended, not dissolved. 



R . Quininae Sulphatis, . . . gr. lxxx. 

Ac. Sulphurici Diluti, . . q. s. 

Spt. yEtheris Nitrosi, . . % iv. 

Syr. Tolu, Aquae, . q. s. ad^i]. 
M. Sig. — A teasp. contains gr. v. of 
Quin. Sulph. (Da Costa.) 



Intertrigo. 

Acetanilid and Boric Acid, equal parts, dusted thickly over the surface, in 
the intertrigo of infants or adults, separating the surfaces which rub by ab- 
sorbent cotton (Brodnax). Bismuth, the Nitrate or Carbonate, as dusting pow- 
der (R). Tannin, the glycerite, is excellent (P). Camphor, added to dusting 
powders, to allay heat and itching (R). Lime-water, to obviate results of irri- 
tating urine (R). Soap, with free ablution when intertrigo caused by acid se- 
cretions ; use greasy applications afterwards (R). Boracic Acid, as ointment, 
3jss to %} of vaselin, a very useful application (Wa). Glycerin, with Traga- 
canth, etc. [See under Herpes for formula.] Calomel, as ointment, 3j to ^j, 
is especially useful (Wa). Zinc Carbonate, as Calamine, a good dusting pow- 
der ; so also is the Oxide, or Fuller's Earth. 



Intestinal Obstruction. 

Opium, even J^-grain doses every 4 hours, for 2 to 4 days, arrests dangerous 
symptoms, and brings a painless purgation (Brinton, P). Morphine, endermi- 
cally (Wa). Belladonna, often successfully employed (P) ; gr. ]i-]A, every 
few hours, when from want of tone and partial spasm (Tr). Strychnine, occa- 
sionally beneficial ; cautiously in acute cases (Wa). Mercury, a full dose of 
Calomel, followed in a few hours by Castor Oil and a Turpentine enema, af- 
fords relief (Wa). Caffeine acts upon the muscular tissue and often proves of 
the utmost value (Wa). Senna, the infusion, in doses of ^j-iij, is an efficient 
purgative (Wa). Purgation to be refrained from (Brinton). Enemata, insuffla- 
tion and surgical measures are often necessary. [Compare Constipation, 
Intussusception, Hernia.] 



INTUSSUSCEPTION IRRITABILITY. 747 



Intussusception. 

Belladonna, gr. iv of the extract in enema, has been successfully used (Wa). 
Opium, in full doses carried to narcotism, has been successful in many cases 
(Wa) ; must be used freely to prevent inflammation (Macleod). Effervescent 
Enemata, have been employed with success (B). Tobacco Enema, may over- 
come, and has proved exceedingly effective, but is dangerous ; produces most 
depressing nausea ; not safe to use more than §iv of an infusion of 3] in Oj 
(B). Inflation, of intestines with air (Hippocrates), seems a most reasonable 
mechanical remedy. Irrigation, by hydrostatic pressure, is resorted to with 
success ; requires care and gentleness (B) ; hot water (Wa) ; Ox-gall, gr. x-xxx 
in the solution used, is especially efficient in cases arising from partial paresis 
of the bowels (Hawkins) : the knee-chest position is the best during irrigation 
or inflation. [Compare Hernia, Typhlitis.] 



Iritis. 

Belladonna, locally and internally (R) ; TT\,v every 3 hours, also as lotion, 3j 
of extract to ^iv aquas, is of great value (P). Atropine, solution, gr. iv to the 
^, has a wide field of utility as mydriatic (B) ; should never be omitted (C) ; 
is essential in the treatment of every form, should be applied early in the case 
and persevered in throughout its continuance (Lawson). Mercury, when of 
syphilitic origin, as it usually is (B) ; the Bichloride is of great service (R) ; in 
plastic iritis of original severity, or in cases aggravated by improper treatment, 
Mercury is imperative, gr. ij of Blue Pill twice a day, until blue line appears on 
gums (C). Aurum, the Bromide of Gold, Arsenic and Mercury has been admin- 
istered with evident advantage (E. A. Wood). Duboisine, as substitute for 
Atropine, is more rapid for effecting dilatation, less irritating to the conjunctiva, 
and has less permanent after-effects (B). Turpentine, in so-called rheumatic 
iritis is very successfully used ; small repeated doses (P). Opium, when 
much pain, an indispensable adjuvant, or Morphine hypodermically (C). 
Copaiba, 3ij in mucilage, thrice daily, gives excellent results in iritis and 
sclerotitis, diminishing pain in 24 to 48 hours and restoring sight (Hall). Quinine 
and Iron, when the patient is feeble or anemic. Irritants or astringents 
should never be employed (C). Surgical, paracentesis when increased ten- 
sion, corelysis when only one or two adjacent adhesions; iridectomy; com- 
plete functional rest to the eyes, by Atropine and a bandage with compression 
pad, an absolute necessity during the whole period of treatment (C). [Com- 
pare Syphilis.] 



U . Hydrarg. Chlor. Corr. , . gr. j. 
Potassii Iodidi, .... gj. 
Tinct. Calunibae, . . . . ^ij. 
Aquae Destil., . q. s. ad ^vj. 
M. Sig. — A dessertspoonful, in a wine- 
glass of water, 2 or 3 times daily. 

(Lawson. ) 



R. 01. Terebinth., .^iij. 

Syr. Acacias, ,^j ss « 

Aquae Cinnamomi, . . . 5SS. 
M. Sig. — Teasp. 4 times daily. 

R. Extracti Belladon. , . . . 7 t ). 
Ung. Hydrargyri, . . . . ]§vj. 
M. Sig. — For inunction to brow. 



Irritability. 

Ignatia, in small doses diminishes, in large doses excites irritability of cere- 
brospinal axis ; the remedy par excellence (Pf ). Chloral, gr. v, 2 or 3 times a 
day, in irritability with nervousness and restlessness (R). Chamomilla, is an 
excellent sedative for children, in doses of rt\j of the tincture every % hour 
(Smith). Opium, gives calm to the nervous system if used in medium doses. 
Strychnine, in functional irritability of the nervous system. [Compare Insom- 
nia, Nervousness.] 



74-8 JAUNDICE — JOINT AFFECTIONS. 



Jaundice. 

Salol, is one of the most efficient remedies in catarrhal jaundice. Mercury, 
in attacks with depression, sickness and coated tongue, gr. Ye-yi °f Gray Pow- 
der taken at onset, and repeated three or four times a day, very valuable (R) ; 
as purgative in jaundice from both deficiency and excess of bile, singularly 
enough (B) ; Gray Powder with Ipecac, followed next morning by Castor Oil, 
is well adapted to the jaundice of infancy and childhood (Wa) ; Mercurials 
and Podophyllum are better avoided, especially in obstructive jaundice, unless 
very marked indications for them exist (Da C). Celandine, was formerly 
employed as a deobstruent (P) ; energetically affects the liver (Pf ). Hydrastis, 
useful if continued for some time, in jaundice from catarrh of ducts (B). 
Arsenic, used with success in jaundice from catarrh of bile ducts after catarrh 
of duodenum ; better for jaundice of malarial origin (B). Nitro-Hydrochloric 
Acid, internally, and acid bath to right hypochondrium ; temperature of bath 
96 , ^iij to gall, j (B) ; when jaundice depends on torpor of the liver, or is 
catarrhal in origin (W) ; during convalescence, TT\,v-x of the dilute acid in Z] 
of a compound elixir of Taraxacum before each meal (Da C). Quinine, when 
due to malaria, or when periodic (B). Euonymin, an hepatic stimulant of 
especial power (B). Podophyllum, in catarrhal and malarial jaundice (B) ; 
when stools exhibit no trace of bile, one dose has cured (Wa) ; is best 
avoided, unless markedly indicated (Da C). Sodium Phosphate, no remedy 
superior in jaundice from catarrh of gall ducts ; Z) doses every four hours for 
adults ; gr. x-xx for children (B). Manganese, in jaundice from malarial origin 
or catarrh of biliary passages (B). Aloes, for simple jaundice of an atonic 
kind(B); when hypochondriasis (P). Rhubarb, for the above maladies in 
children, white or clay-colored pasty stools, skin jaundiced (B). Saline Pur- 
gatives, as Rochelle salt, to depurate the upper bowel; with alkaline baths, 
diaphoretics and diuretics (Da C). Ammonium Iodide, gr. j-iij in water every 
2 or 3 hours in catarrh of bile ducts and jaundice ; also Ammonium Chloride, 
with fluid extract of Taraxacum (B) ; in 20-grain doses every 4 hours, pro- 
duces a decided change (Wa). Stillingia, relieves jaundice and torpid liver 
following intermittent fever (B). Dulcamara, employed with advantage (P). 
Iris, in malarial jaundice and that from duodenal catarrh (B). AlkalineMin- 
eral Waters, especially in catarrh of duodenum or bile-ducts (B). Potassium 
Salts, the Chlorate in chronic or asthenic jaundice; the Sulphate the most 
useful saline purgative in jaundice (Wa). Aliment, no starches or fats; use 
milk, eggs, oysters, beef broth, broiled or raw beefsteak, or whitefish (B) : plenty 
of green vegetables at each meal ; use cold water freely, avoid high seasoning 
in food and all liquors. [Compare Calculi, Hepatic Cirrhosis, Hepatic 
Diseases.] 

Joint Affections. 

Phenacetin, for the pyrexia of polyarthritis ; is efficiently antipyretic and safe. 
Aconite, for pains in inflamed joints (R) ; the liniment locally in chronic arth- 
ritic swellings (Wa). Mercury, the oleate in chronic inflammation of the knee 
(R) : Ung. Hydrarg. Ammoniat., diluted, 1 to 4 at first, then 1 to 8, by gentle 
friction 2 or 3 times daily, in chronic articular inflammations, by far the best 
application (P). Rhus Toxicodendron, internally and as lotion, is invaluable 
for subacute stiffness and aching of joints after acute rheumatic fever (P). 
Iodine, 3iij- v j ad Glycerini ^iij, Aq. destil. ^iv, in numerous obstinate cases 
of joint affections consequent on rheumatism (Wa). Ferrous Iodide, with 
Iodine, locally, in scrofulous affections of the bones and joints (Wa). Iodoform 
has been used with satisfactory results, in scrofulous affections of the joints and 
bones, by many continental authorities (Wa). Salicylic Acid, Z) with giv of 
Lanolin, and 01. Olivse, q. s. to make a paste, applied locally and covered with 
cotton, or rubbed in once daily for 3 or 4 days, then omitted for a week, and 



KERATITIS LABOR. 



749 



again renewed, is of proven value in many obstinate cases of stiff knees, pains 
from so-called rheumatism, painful ankle and wrist joints, etc. (Aulde). 
Arsenic, often serviceable in rheumatoid arthritis and nodosities of joints ; large 
doses continued are necessary (R). Alcohol, and water, equal parts, an excel- 
lent evaporating lotion (B). Silver Nitrate, a strong solution in Nitrous Ether is 
the most efficient application to check inflammation in small joints if applied 
early to adjacent vascular parts (B). Cod-liver Oil, in strumous subjects (R) ; 
the remedy on which most reliance may be placed in scrofulous joint affections 
(Wa). Cold Douche, Galvanism, Turkish Baths, for stiff joints (R). Digitalis, 
as fomentation, gj of tincture to 0)4 boiling water, applied on flannel, has 
proved very efficient in acute inflammations of joints (Fairbank). Turpentine, 
the liniment a serviceable application in chronic enlargement of the joints 
(Wa). Sulphuric Acid, as irritant ointment, 3j of acid to 3jj of lard, very bene- 
ficial in chronic diseases of joints (Wa). [Compare Arthritis, Bursitis, 
Coxalgia, Gout, Rheumatism, Synovitis.] 



Keratitis. 

Atropine, renders great service by contracting the vessels (B) ; by instillation, 
with enforced disuse, and a protective bandage, should be regarded as meas- 
ures of course (C). Mercuric and Ferric Chlorides, with Cod-liver Oil, will 
accomplish all that medicine can do for interstitial keratitis in syphilitic sub- 
jects (C). Calcium Sulphide, proves most useful in doses of gr. ^to y, thrice 
daily, in sugar-of-milk trituration (Snell). Arsenic, Potassium Iodide or Bro- 
mide, Iron, Quinine, for their constitutional effects in vascular keratitis ; also 
counter-irritation by Iodine painted on the temples until soreness (C). Ferric 
Chloride, successfully employed in panniform keratitis ; a large drop of the 
solution dropped from a quill every second or third day (Wa). Physostigmine, 
lowers intra-ocular tension (B). Astringents or Irritants, as Alcohol in any 
form, Zinc Sulphate, Silver Nitrate, etc., are entirely inadmissible (C). Iridec- 
tomy, is often beneficial in severe vascular keratitis (C). Pressure-Bandage, 
in severe suppurative forms, limits extent. Water, cold when inflammatory 
symptoms marked ; hot, 90-100 F., in non-inflammatory form, to excite in- 
flammatory reaction ; should be discontinued when marked injection occurs. 
[Compare Corneal Opacities.] 



R. Hydrarg. Chlor. Corros., . gr. j. 

Ammonii Chloridi, . . , gr. vj. 

Tinct. Belladonna?, . . . £ij. 

Aquse Destillatae, .... ^viij. 
M. et fiat collyrium. 



Sig. — A teasp. in a winegl. of tepid 
water, to be applied frequently with a 
pledget of lint on the closed lids. In 
phlyctenular keratitis of children. 

[Turn bull.) 



Labor. 

Ergot, only when uterine inertia, and after the first stage has passed ; is 
dangerous if any obstacle in front ; dangerous to child by paralysis of fetal 
heart (B) ; is best given when the head has passed the brim of pelvis (Wa). 
Anesthetics, in protracted and painful labor ; cautiously with primiparas (B) ; 
increase the risk of post-partum hemorrhage (W). Chloroform, not to com- 
plete anesthesia, lest uterine action be interrupted ; usually begin its inhalation 
when os is dilated (Simpson). Chloral, of great value to relieve pain ; does 
not interfere with the exhibition of chloroform; should be given in 15-grain 
doses every X-h° ur till effect produced (Wa) ; the best of all remedies for rigid, 
undilatable cervix, gr. xv every 20 minutes for 3 doses, perhaps a 4th after an 
hour's interval (Playfair). Ethyl Bromide, a rapid, sure and safe anesthetic, 
particularly suited to labor cases (Levis). Opium, facilitates dilatation, pro- 
motes expulsive power of uterus, lessens hemorrhage, stimulates longitudinal 
and oblique fibres of the os (Wa); a full dose of Morphine, gr. X. * n tedious 



750 LACTATION. 

labors, with severe pains, will aid patient greatly and promote progress of the 
child ; no bad results ensue ; for relief of pains and after-pains, or painful com- 
plications (Wa); hypodermically in rigid os and cervix (R). Cimicifuga, exercises 
special action, similar to that of Ergot ; is less dangerous to life of child and 
soft parts of mother (Wa) ; for mental disturbance and suppressed lochia (R) ; 
as partus accelerator in lieu of Ergot, also to allay nervous excitement after 
labor, and to check post-partum hemorrhage (P). Belladonna, topically to 
uterus of great service in long-protracted labors from rigidity of os and cervix 
(H). Gelsemium, quiets the nagging pains of the first stage ; requires physio- 
logical doses (B) ; relaxes spasm in rigidity of the os (Wa). Acetanilid, eases 
pain and brings on profuse sweat which helps to relax muscular rigidity (Brod- 
nax). Quinine, to strengthen uterine contractions ; used by many in place of 
Ergot (R). Cannabis Indica, the tincture gtt. xxx, as stimulant to uterine con- 
tractions, more prompt, less lasting, than Ergot (Wa). Ipecacuanha, after de- 
livery ; to promote natural functions (R). Cotton-root, as excitant of uterine 
contractions, may be more energetic than Ergot (P). Althaea, the decoction, 
as vaginal injection in difficult labor (P). Sodium Borate, excites activity of 
the uterus, and is well employed in tedious labor, where there is deficiency of 
uterine action (Rigby). Amyl Nitrite, has acted admirably in a case of hour- 
glass contraction of the uterus ; seems to antagonize the action of Ergot 
(Barnes). Oil of Eucalyptus is very valuable in effecting antiseptic midwifery 
(Wa). Mercury, the Bichloride, gr. vijss to a quart of hot water gives a 3^0 
solution ; probably the worst of all antiseptics for this purpose ; is too danger- 
ous for obstetrical use (Fleischman). [Compare Abortion, After-Pains, 
False Pains, Hemorrhage Post-partum, Lactation, Puerperal Con- 
vulsions, — Mania, — Fever, — Disorders.] 



Lactation. 

Pilocarpine, as a galactagogue, gr. }£ in brandy on retiring, the patient to be 
covered well in bed; is efficient in direct proportion to its diaphoretic andsialo- 
gogue effects, these being evanescent, but its galactagogue power remains 
for weeks, an occasional dose only being required to spur up the secretion 
when flagging (Minges) : is a galactagogue, and probably the only example of 
this class we possess (M). Antipyrin, is an anti-galactagogue, 4-grain doses 
every 2 hours have proven highly efficient. Belladonna, internally or 
externally or both, in excessive lactation (R) ; Atropine gr. iv to ^j Aquae 
Rosse on lint around the breast to arrest secretion of milk ; remove when 
fauces become dry and pupils dilated (B). Camphor, locally to arrest the 
secretion ; a saturated solution in Olive Oil or Glycerin, is more efficient than 
Belladonna (Wa). Potassium Iodide, in 25 to 30 grain doses internally, for 
the same purpose, is very effectual (Rousset). Calcium Phosphate and Hypo- 
phosphite, in debility from over-lactation (R, Wa). Ammonium Chloride, for 
the intercostal neuralgia of nursing women ; gr. x-xx, every 3 or 4 hours (Wa). 
Quinine, Tannin, are used to arrest the secretion (R). Alcohol, as beer or 
porter, often useful for women weakened by suckling — not always (R). [Com- 
pare Abscess, Agalactia, Mastitis, Nipples, also the List of Galactagogues 
on page 52.] 

Excreted in the Milk, when taken by the nursing women are : the Oils of 
Anise, Cumin, Dill, Wormwood and Garlic, Turpentine, Copaiba, the active 
principles of Rhubarb, Senna, Scammony and Castor-oil, Opium, Iodine, 
Indigo, Antimony, Arsenic, Bismuth, Iron, Lead, Mercury and Zinc. Acids 
given to the mother cause griping in the child. Natural salts, as a rule, and 
the purgative agents above-named, act as purgatives to the child, and Potas- 
sium salts as diuretics. Turpentine, Copaiba and Potassium Iodide given to 
the mother, can be detected in the urine of the child. Opium given to the 
mother may narcotize the child, and Mercurials in the same manner may sali- 



LARYNGISMUS STRIDULUS LARYNGITIS. 



751 



vate it (Br). Atropine, Hyoscyamine, the Salicylates and Potassium Sulphide, 
have been found in the milk after their ingestion by the woman. 



R. Tinct. Aconiti, tt\xx. 

Antim. et Potass. Tart., . gr. ij. 
Spt. ^Etheris Nitrosi, 
Syr. Simplicis, . . . aa 5|j. 
Aquae Aurantii Flor. , . . Jij. 



Misce. Sig. — A teaspoonful in a wine- 
glassful of sweetened water, every two 
hours, for milk fever. {Fordyce Barker.) 



Laryngismus Stridulus. 

Aconite, checks the spasm and relieves the croupous breathing (R). Anti- 
pyrin, has proven very serviceable. Belladonna, promises to be of value (Wa) ; 
Atropine, gr. -3^ in a goblet of water (60 doses), of which a teasp. every hour 
or ^-hour will give prompt relief (Smith). Bromides, when uncomplicated 
except with convulsions (R) ; full doses will suspend an attack, and moder- 
ate doses steadily continued will prevent recurrence (B). Ipecacuanha, an 
emetic dose to cut short an attack (B). Lobelia, has been employed (R). 
Chloroform, quickly cures the paroxysm, a few drops on a handkerchief suffi- 
cient (B) ; may often be used with advantage (W). Nitroglycerin, will speedily 
allay the spasm (B). Chloral, gr. v-xv to prevent or arrest (B). Quinine, 
given between attacks to prevent (B) ; a most valuable remedy, in small, 
repeated doses (P). Emetics, Tartar Emetic ; Mercuric Sulphate, gr. iij-v, safer 
and better (R). Conium, is valuable, carried to a point of physiological effect 
(B). Water, wet pack to neck (B) ; cold sponging twice or thrice daily more 
successful than anything else, with out-of-door exercise ; cautiously if hoarse 
voice indicates laryngitis (R). [Compare Croup, Laryngitis.] 



Laryngitis, Acute Catarrhal. 

Aconite, very valuable (R) ; especially indicated in inflammatory states of 
respiratory parts ; gtt. ss-j every half-hour till an impression is made on the 
fever, then every hour or two (B). Antimony, Tartar Emetic, gr. -^, a very 
excellent remedy internally; larger doses in edematous laryngitis, gr. ^ with 
gr. iij of Dover's powder every 2 or 3 hours (Da C). Iodine, inhaled ; also as 
counter-irritant painted over neck (B). Morphine, small doses to allay cough 
(A). Sulphurous Acid as spray is vaunted (Wa). Leeches to throat are valu- 
able auxiliaries to general treatment in sthenic cases ; or cupping at the nape 
of the neck (Wa). Rumex, has selective action on the laryngeal mucous 
membrane (see page 459). Zinc or Copper Sulphates, as emetics, in large 
quantities of warm water, where edema slight (A) ; a solution of Zinc Sulphate, 
gr. xx to the ^ on sponge to larynx with aid of the laryngoscope if possible to 
use it (Da C). Scarification, by Mackenzie's laryngeal lancet, of great service 
in the edematous form (Da C). A Purgative and Diaphoretic, with mucilagi- 
nous drinks, if given at the start may be sufficient (Da C). Iron, Monsel's 
solution., 1 part to 2 or 3 of water and glycerin, an excellent local application 
(Da C). Heat, by poultices or fomentations (A) ; hot-water stupes may suc- 
ceed (Wa), Inhalations of hot steam, with Benzoin, the comp. tinct. gtt. x-xv 
to the ^, with gtt. x Tinct. Opii, or Hops, or Conium, of great service (Da C). 
Tracheotomy ought not to be delayed, if inhalations, leeches, and fomenta- 
tions fail (Wa) ; is especially indicated in sudden attacks of edematous 
laryngitis, as those occurring in Bright's disease (Da C). Ice, steadily applied 
in bags over the larynx, if tracheotomy refused, has succeeded in bad cases ; 
small pieces may be slowly swallowed (Da C). [For Croupous Laryngitis, 
see Croup membranous ; for Spasmodic Laryngitis, see Croup catarrhal ; 
for Edematous Laryngitis, see Glottis edema of. Compare also Laryngis- 
mus stridulus, Pharyngitis.] 



75 2 LARYNGITIS. 



Laryngitis, Chronic. 

Iodine, painted over neck as a counter-irritant, and inhalation of its vapor 
(B). Sulphur, as Sulphurous Acid by spray in syphilitic laryngitis, or a 
solution of Sodium Sulphite, Z) to the % of water (B) ; by inhalation, spray, 
or fumigation (R). Carbolic Acid, where long-standing hyperemia with 
diminished secretion, 3j-ij to the § of glycerin is a most successful application 
(Mackenzie). Silver Nitrate, powdered or in solution to chronically inflamed 
larynx (R) ; a solution of gr. x or xx to the %, applied with a brush by the 
aid of the laryngoscopic mirror (W) ; formerly much used, but is objectionable 
(B); should be used with great caution, and only when a particular point can 
be seen for it with the laryngoscope (Da C). Ferric Chloride, a solution of gj- 
ij in the ^ of glycerin, as a local application (A). Zinc Chloride, gr. xx-xxx 
to the ^ of glycerin ; alternation of topical remedies is of great value (A). 
Copper Sulphate, gr. xx to the ^ of water, locally twice a week (Da C). Bis- 
muth Subnitrate, by insufflation, is highly recommended in the worst forms of 
laryngitis (Tr). Guaiacum, as lozenges, is useful in mucous laryngitis (A). 
Althaea, as pectoral lozenges to relieve laryngeal irritation (P). Cubeb, the 
berries chewed are very efficient in relaxation of the larynx following a cold or 
prolonged speaking (Wa). Cocaine, a 20 per cent, solution by spray, mop, or 
brush, is efficient in many laryngeal affections (James). Benzoin, in strum- 
ous laryngitis (Wa) ; in chronic, Benzoin on hot coals, or inhaled from boiling 
water, is of great service (Tr). Tannin, in chronic catarrh and ulcerations, a 
solution, gr. x-xx to ^iv, applied by hand-ball or steam atomizer (A). Inhala- 
tions, or spray, of the best agents^very grateful (B) ; air loaded with vapors of 
Ammonium Muriate by inhaler, said to be used successfully (W) ; vapors from 
boiling Tar, Turpentine, etc., placed on hot water, or better by steam atomizer 
(Da C) ; Chloroform, Hops, Benzoin, etc., by atomization (Walker). Insuffla- 
tion, substances to be in small quantity, mixed with some bland powder (B). 
FunctionarRest|of the voice often requisite, especially in phthisical and syphilitic 
laryngeal ulceration (A). Chronic Laryngitis, includes many disorders of the 
larynx, which of late years have been differentiated as thickened vocal cords 
(chronic laryngitis proper), laryngeal ulcers, polypi, cysts, cauliflower growths, 
tubercular and syphilitic laryngitis, etc., in all the voice being similarly affected. 
Dysphagia, as a concomitant symptom is indicative of tubercular laryngitis 
(Da C). [Compare Cough, Dysphagia, Syphilis.] 



Laryngitis, Tubercular. 

Cocaine, as pastilles or by insufflation, to relieve pain and dysphagia, espe- 
cially when much ulceration or perichondritis present ; in the later stages its 
use prolongs life. Resorcin, a strong solution locally, is very beneficial in 
tuberculous and other ulcerations of the larynx (Tymowski). Zinc Sulphate, 
in solution mixed with a 1 or 2 per cent, solution of Cocaine, in the early catarrhal 
stage (Neumann). Silver Nitrate, in powder or solution locally (R). Bismuth 
Subnitrate, by insufflation is highly efficient (Tr). Iodoform, in large insuffla- 
tions has surprising anodyne effect when extensive tubercular ulceration exists 
(Neumann). Iodol, and Boric Acid, equal parts, by insufflation, in less severe 
cases (Id). Antitoxin, Paquin's serum has produced good results (Loeb). 
Menthol, is of great value, relieves pain and is claimed to destroy the local de- 
posits ; a solution of 1 in 10 of pure olive oil brushed freely over the part daily, 
a solution of 1 in 5 being used after the first week. Lactic Acid, is reported by 
many authorities as highly successful, even curative; a solution of 30 per cent., 
gradually increased to 75 per cent., brushed over the affected surface after 
swabbing with Cocaine, or a few drops injected into the larynx by a laryngeal 
syringe ; is excellent, lasting good results having been obtained thereby 
(Whitla). Scraping the ulcerated spots before applying lactic acid, done by me 



LARYNGOTOMY LEPROSY. 753 

in 200 cases with 28 cures (Ehring). Tracheotomy, where deep and extensive ul- 
cerations exist beyond the reach of local treatment. Diet, thick liquids are more 
easily swallowed than thin ones, and if the patient lies on a couch or bed with 
his head hanging down over the side while swallowing, this is rendered easier 
(Wolfenden) ; feeding should be done by the soft rubber tube when much dys- 
phagia exists which does not yield to cocaine. Dysphagia, as a constant symp- 
tom of chronic laryngitis is indicative of the tubercular form (Da C). 



Laryngotomy. 

Laryngotomy is more quickly and easily performed on the adult than trache- 
otomy, being further from the lungs and less dangerous. It is usually directed 
to be performed by cutting longitudinally through the skin, then horizontally 
through the crico-thyroid membrane, which may be felt as a soft depression, 
an inch below the pomum Adami. In urgent cases, however, Professor Wood 
recommends a narrow-bladed knife to be passed horizontally through both 
skin and membrane at once, and then to enlarge the opening laterally to the 
required extent. The advantage of having a horizontal incision in the skin is 
the greater openness of the wound when the patient throws up his head under 
a sense of dyspnea (D). In Laryngo-Tracheotomy, the deep incision is 
carried downwards from the crico-thyroid membrane, through the cricoid carti- 
lage and one or two upper rings of the trachea (CI). 



Leprosy. 

Anacardium Orientale, Oil of Cashew, has been much lauded ; investiga- 
tion established that much of its success was due to hygienic measures and 
use of fresh meat as food (P). Arsenic, with 5 or 6 times the quantity of black 
pepper, in esteem in India (Wa). Sarsaparilla, as tonic and alterative is valu- 
able (P). Gurjun Balsam, Wood Oil, as ointment and emulsion, has been 
used with success in alleviating the disease, by Dr. Dougall, Port Blair, Anda- 
man Islands ; the ulcers of 24 lepers healed thereby. Ferri Arsenas, gr. ^ 
daily, is used with success (Wa). Mercury, the Oint. of the Red Iodide, diluted 
1 to 10, or gr. j of the salt to 3 V of unguentum, gives very good results (Wa). 
Europhen, 5 per cent, in oil, cured a case some years ago on the island of 
Madeira (Goldschmidt). Chaulmoogra Oil [see page 252], is credited with a 
few cures and many cases improved ; the oil is mixed with Psoralea corylifolia 
as a liniment, and is also used internally (Wa). Hoang Nan, is considered of 
utility by a number of writers on leprosy, and is given in combination with 
Alum 1, Realgar 2 or 1, and the drug 2 parts, the whole being made into 3- 
grain pills, one pill daily being given at first and gradually increased (Pf ).. 
Argenti Nitras, is said to act as a tonic and alterative, and to control leprosy 
for a limited period (Pf). Ichthyol, used internally in increasing doses, with 
vigorous rubbing of the arms and legs twice daily with a 10 per cent, oint- 
ment of Pyrogallic Acid in Lanolin, and the cheeks and trunk with Chrysaro- 
bin, 10 per cent, in Lanolin, also applying to the forehead and chin a plaster 
of Chrysarobin, Salicylic Acid and Creosote, changed every day. This treat- 
ment, continued for a month, and followed by a course of warm baths before 
being resumed, has cured several cases (Unna). Sodium Salicylate, in doses 
of gr. xv four times a day, gradually increased for six months or a year, 
if commenced early in the disease, sometimes effects a cure (Danielssen). 
Thyroidin, caused marvelous improvement in a case of nerve leprosy during 
3 years of its use (Mn). Goto Treatment, consists in bathing daily in hot 
water in which are placed bags containing hichiyon bark, taifunshi, sulphur and 
yoku yaku ; internally are given seiketsuren pills, tincture of the chloride of 
iron, quinine, strychnine, potassium iodide, gentian, columbo, carbonate'of 
soda and potash, and Epsom salts (Alvarez) ; but proof is lacking that cure has 



754 LEUCOCYTHEMIA LEUCORRHEA. 

been obtained in any case (Emerson). Toxins and Antitoxins, are being tried 
in various parts of the world, but are not trustworthy, as the bacillus has never 
been cultivated and animals are quite refractory thereto (Goldschmidt). Diet, 
nutritious food, with frequent baths and great cleanliness, will do much to pre- 
vent the manifestations of the disease (R). 



Leucocythemia — Leukemia. 

Arsenic, in as full doses as can be borne, may be of service, though hitherto 
ineffectual (Gowers) ; produced rapid improvement in a severe case, conjoined 
with Oxygen inhalations, 5 minims of Liquor Arsenicalis being given thrice 
daily, increased by 2 minims every 4 or 5 days until the dose reached 45 
minims (Fred'k Taylor) ; is of the greatest value and great improvement has 
resulted from its use in many cases (Muir). Oxygen, 30 litres by inhalation 
daily with the conjoined use of Arsenic, has been successful in the early stages 
in some cases, but in many it has failed (Muir) ; 4 litres daily for 2 months 
cured one case, the spleen being of normal size after the treatment (Koster). 

Alkaline Hypophosphites, have been used with more or less benefit (Wa). 
Digitalis, in young subjects (B). Nitro -muriatic Baths, should not be neglected, 
with tonics and nutrients (A). Iron, is of little value (B) ; large doses may do 
good in the early stage, with careful diet, and Ergot to contract the spleen (Da 
C). Phosphorus, gr. ^ increased to gr, 3^, has proved successful in several 
cases (Wa) : good results have been reported in one or two cases, but the gen- 
eral experience is that it is of no value (Muir). Quinine, in large doses, is 
considered of value by some, but it is distinctly inferior to Arsenic (Id). 
Thymus Extract, has been used with benefit. Bone-marrow is worth a fair 
trial. Galvanization of the spleen, is curative in uncomplicated cases (B) ; 
causes improvement of the blood, increasing the number of its red corpuscles 
(Gowers). Splenectomy has been performed in a number of cases, almost 
invariably with fatal result ; is absolutely unjustifiable and is also useless 
(Muir). [Compare Anemia, Lymphadenoma.] 



Leucorrhea. 

Hydrastis, the fluid extract undiluted, applied topically, quickly improves in 
uterine and vaginal leucorrhea (B). Pulsatilla, 5-drop doses ter die for a few 
weeks ; also a teasp. of the tinct. in a pint of cold or tepid water, as vaginal en- 
ema daily, when pain in the loins, depression of spirits, loss of appetite, etc. (P). 
Silver Nitrate, in solution locally, also tampon saturated with Z) each of Alum 
and Bismuth, when leucorrhea due to granular vaginitis (Parvin). Balsams 
of Peru and Tolu, internally (P). Glycerin, is largely employed for vaginal 
leucorrhea, and for erosions and ulcerations of the cervix uteri (B) ; the best 
vehicle for other agents (E). Glycozone, applied on small rolls of lint or 
absorbent cotton, after thorough washing of the vagina with solution of Hy- 
drogen Dioxide, 1 to 4 of water, and repeated twice daily (Edson). Borax, 3j 
to Oj of water, as vaginal wash for the leucorrhea of pregnancy (Parvin). 
Cimicifuga, is said to be useful (P). Copaiba, has been used with success (P). 
Cocculus Indicus when sero-purulent discharge, pain in lumbar region (P). 
Carbolic Acid, diluted, as injection (B) ; for vaginal leucorrhea (R). Bismuth, 
with mucilage, as injection ; or with cacao-butter as suppository (B). Copper 
Sulphate, in solution, as injection (R). Tannic Acid, in chronic cases service- 
able as injection, 3ss in ^viij of claret wine (B) ; if os ulcerated, a suppository 
of tannin and cacao-butter to mouth of uterus (R). Iodo-Tannin, is an excel- 
lent application, 3j of iodine to %j of tannic acid, a sufficient quantity to be 
packed dry around the cervix (B). Alum and Borax, make a useful injection 
in vaginal leucorrhea (R). Belladonna, with Tannin as bolus when neuralgia 
or ulceration of the os ; when disease due to over-secretion of mucous glands 



LICHEN PLANUS LITHEMIA. 755 

about the os and much pain present inject Sodii Bicarbonat., 3j ; Tincturae 
Belladonnae, ^ij ; Aquas, Oj (R). Potassium or Sodium Bicarbonate, Z] in 
Oj aquae as injection, especially when discharge alkaline and copious (R). 
Pareira, Uva Ursi, are successfully used (P). Sumbul, recommended in 
atonic form (P). Myrrh, with Iron or Aloes, beneficial (P). Ergot, said to be 
useful in some cases (R). Potassium Permanganate, has no special advan- 
tage ; is used in solution, gr. ij to the § (B). Potassium Chlorate, 3j to Oj of 
water as injection in simple cases (Parvin). Iron, the Iodide, internally and 
externally has proven serviceable ; the Mistura Ferri Composita, when anemia 
and general debility (Wa) ; the styptic preparations locally (R). Phosphates, 
for the cachexia (B) ; Calcium Phosphate, gr. j-ij several times daily, of great 
value in checking profuse discharge (Wa). Injections, water at 6o° F. to 
prevent recurrence (R) ; hot water injections are the best tonic for the pelvic 
vessels to relieve venous congestion ; use with elevated hips (E). [Compare 
Endometritis, Uterine Ulceration, Vaginitis.] 

R. Aluminis, £j. 

Zinci Sulph., £ss. 

Sodii Boratis, gr. iv. 

Aq. Rosse, o v "J* 

M. Sig. — Injection. (B. 



R- . Liq. Plumbi Subacet., . . ^jss. 

Ac. Carbolici, ^ss. 

M. Sig. — One-fourth to be added to a 
pint of water and used as an injection. 



Lichen Planus. 

Arsenic, is the only remedy which exercises anything like a specific effect, 
and it not infrequently fails (Brooke). Antipyrin, internally for the itching, is 
efficient. Aconite, sometimes useful (R). Mercury, Calomel and Mercuric 
Nitrate Oint. mixed, also Tar Oint. may be added, in patches of obstinate 
lichen (R). Silver Nitrate, the Nitrous Ether solution painted over the patch 
every day or two (R). Quinine, with Belladonna and Ergot, as in urticaria 
(Brocq) ; large doses in an effervescing mixture (Crocker). Potassium Chlorate, 
gr. xv before meals, also dilute Nitric Acid, tti,x after meals, thrice daily, has 
given very good results (Bulkley). Lead-water as lotion, thickened with zinc and 
starch powder or calamine, with the addition of a few drops of Carbolic Acid 
or Liquor Picis Carbonis, has a very sedative effect in very acute cases 
(Brooke). Mercury, as in Unna's ointment, composed of Hydrarg. Chlor. 
Corr. gr. iij-v-xx, Ac. Carbol. gr. xx, Ung. Zinci %} ; the smallest quantity of 
the mercurial for extensive cases, the larger for local caustic effects in stubborn 
patches. If used early and efficiently this ointment alone will remove the 
threatening general symptoms of lichen neuroticus (Unna). Excision may be 
required to remove the horny accumulations of lichen corneus (Brooke). 
Cautery for the same purpose, even superficially applied it sometimes removes 
the itching permanently (Van Dort). Formerly used to denote many spreading 
papular eruptions, the term Lichen is now restricted to one specific form of 
disease, that described by Erasmus Wilson as Lichen Planus, of which Hebra's 
Lichen Ruber is a rare and aberrant acute manifestation (Brooke). [Compare 
Eczema, Strophulus.] 

Lithemia. 

Piperazin, by far the best agent to promote the elimination of uric acid and 
urates, with which it forms one of the most soluble of uric acid compounds : 
relieves the pruritus of the uric diathesis. Lithium Salts, especially the Citrate, 
gr. xx thrice daily, is very efficient (Da C) ; the Carbonate invaluable (Wa) ; 
the Bromide, in solution of Potassium Citrate given after stomach digestion is 
completed, one of the very best agents (Aulde). Strontium Salicylate, in 
chronic gouty conditions and in lithemia with intestinal indigestion, the most 
valuable drug that we have (W). Salicylic Acid, or its salts, are most powerful 
solvents and excretents of uric acid (Haig). Lysidin, is still more solvent of 



756 LOCOMOTOR ATAXIA. 

uric acid than is Piperazin [see page 430]. Cascara Sagrada, is believed to 
promote the excretion of uric acid. Colchicum, 15 minim doses of the wine 
twice or thrice daily, are very useful (Wa) ; the combination of Colchicine with 
Oil of Wintergreen in capsules [see page 284] is a useful remedy. Coffee, a 
tincture of green coffee is anti-lithic. Pichi, of great value in lithemia with 
cystitis (Wyman). Arsenic, in small doses, is also useful (Da C). Nitric Acid, 
10 mimim doses of the dilute acid in half-glass of water thrice daily, with an 
occasional dose of Pil. Rhei Compos, at bedtime, is the most efficient treatment 
for patients who will not diet themselves (Hughes). Purgatives, especially alka- 
line mineral waters, to clear the portal system (Da C). Sodium Phosphate, in 
laxative doses, Z] thrice daily, gives good results. Alkalies, in biliousness ; 
also the continued use of alkaline waters rich in potassium salts, for solution 
of calculi (B). Acids, Hydrochloric often of great service ; also Lactic, when 
faulty digestion and assimilation (Br). Potassium Permanganate, prevents 
calculi by converting uric acid into urea (B). Buchu, combined with an alkali, 
has been beneficial (P). Chimaphila is believed to check the secretion of uric 
acid (P). Aliment, farinaceous vegetables and acid fruits are suitable (B) ; 
Alcohol in any form is poison to a lithemic (Da C) ; succulent vegetables and 
fruits, occasional abstinence from animal food ; milk diet, and frequent draughts 
of pure water are recommended; removal to a locality where pure soft water 
can be procured, is often curative ; high living, alcoholic liquors, and sedentary 
habits are injurious. [Compare Calculi, Dyspepsia, Gout.] 



R. Lithii Bromidi, o 55- ]- 

Liq. Potassii Citrat. , . . ^ iv. 
Syrupi Simplicis, . , . . 3 i j . 



R . Tinct. Belladonna;, . . . n\xviij. 
Vini Colchici Rad., . . . ^ij. 
Liq. Potass. Citrat., q. s. ad^'w. 



M. Sig. — A teasp. in a wineglassful or 1 M. Sig. — A dessertsp. well diluted, 



more of water, 2 hours after each meal. 
Reduce the dose after a week. 



R . Potassii Nitratis, 
Ext. Pichi FL, . 
Elixir Simpl., 
M. Sig. — A teasp. 



every 3 hours. 



R . Vini Colchici Rad., . . . 3 ij. 
Ext. Phytolacca; Fl., . . 3J. 
Potassii Acetatis, .... giij. 
Aqua;, ... . q. s. ad jjfyj. 
M. Sig. — A tablesp. four times daily. 



Locomotor Ataxia. 



Antipyrin or Phenacetin for the lancinating pains ; the former relieves them 
remarkably : the use of Morphine for the pains should be avoided as long as 
possible (Osier). Acetanilid, is admirable for relief of the pains (B). Bella- 
donna and Ergot are highly efficient (Brown-Sequard). Silver Nitrate, when 
motor disturbances are very marked ; improved 1 case in 20 (R) ; gives the 
best results in doses of gr. % to gr. y z thrice daily, withholding it after a few 
weeks to prevent argyria (Da C) ; the only remedy which has done good in 
progressive locomotor ataxia ; gr. j^-J two or three times daily, with Sodium 
Hypophosphite, both to be discontinued when blue line appears on gums 
(Althaus). Silver Oxide, may be used instead of the nitrate, in half-grain 
doses (Da C). Aurum, is especially curative in all forms of sclerosis ; the 
Bromide of Gold and Arsenic has been of special service in this form (E. A. 
Wood). Potassium Iodide, Corrosive Sublimate, or Gold and Sodium Chloride, 
all in full doses, often retard the progress of the disease (Da C). Physostigma 
has proved beneficial (R). Phosphorus, useful, but may not cure (B). Hyos- 
cyamine, ameliorative, gr. -^ gradually increased to gr. y 1 ^ (B). Electricity, 
the galvanic current relieves pain; faradic stops wasting of muscles (B) ; in 
the stage of irritation the constant current (ascending) through spinal column 
(R). Water, one of the most efficient agents ; friction with a cloth dipped in 
water of 60-65 F., a cold compress to head ; 4-8 minute bath of 7°-75° 
gradually lowered to 6o°, then shower-bath and frictions (R). Rest, as com- 
plete as possible, must be insisted on ; with good, nutritious diet, milk being 



LUMBAGO. 



7S7 



desirable (Da C). Pilocarpine, produces general improvement if given in the 
incipiency, gr. j to %j of water, of which ttlxxx thrice daily (B). Strychnine, 
gr. ^j in Z) of Syr. Hypophosphitum, thrice daily, when the system is saturated 
with silver (Da C). Suspension daily, by head, has seemed to give relief to 
pain and improve condition ; is known as Charcot's treatment, but originated 
with Matchoukowsky of Odessa, and was carried out systematically by Hessing 
of Pesth, before Charcot took it up : is now abandoned. Morphine, sooner or 
later becomes necessary for the lancinating pains ; in one case, personally 
known to the author, which had been treated ineffectually by every known 
method, including suspension by Charcot himself, and was rapidly progres- 
sive, the abandonment of the hypodermic syringe for Morphine by mouth, gr. 
xv daily in divided doses, has seemed to result in complete cessation of pro- 
gress, which has now lasted over six years; the patient is free from pain, 
eats and sleeps well, and attends to business, getting around by aid of a stick 
and some slight assistance from friends when crossing a crowded street. 
Orchitic Extract, also Spermine, have been used with some success. Cere- 
brinin, is reported beneficial [see page 164]. 



Lumbago. 

Cimicifuga, is said to be more effectual that any other remedy (R) ; has some- 
times wonderful success ; no indications can be given for it ; 3ss-ij of fluid 
extract (B) ; is curative (P). Rhus Toxicodendron, in subacute muscular or ten- 
dinous rheumatism, worse at night; completely relieves some cases (Pf). 
Veratrum Viride, the tincture useful (R). Aconite, in % tri, doses of tincture 
every two hours, with Linim. Aconiti locally (Wa). Iodides, if referable to 
syphilis, mercury, copper, tin, or lead poisoning (B). Ammonium Muriate, is 
very efficient in myalgic lumbago, gr. xx thrice daily for 2 days or until signs 
of congestion of the nasal mucous membrane appear, then to be replaced by 
Quinine, gr. v, thrice daily for a week (Waugh). Antipyrin, gr. vij, hypo- 
dermically, completely banished it in a very bad case at the Hotel Dieu, Paris. 
Morphine, hypodermically, to relieve pain (R) ; gr. l /e with Atropine gr. -g 1 ^, 
hypodermically, will frequently cure lumbago in two or three hours (Da C). 
Capsicum, a strong infusion applied on lint, and covered with oiled silk, very 
efficient in recent lumbago (R) ; a Capsicum plaster is a very efficient applica- 
tion. Potassium Nitrate, in ten-grain doses hourly or every two hours, when 
urine scanty and high-colored (R). Belladonna, as plaster, very valuable for 
persistent lumbago remaining in a small spot (R). Turpentine, in doses of 
rti,xx-xxx, carefully lest strangury and nephritis, of greatest value when the 
bowels are regular and urine clear and abundant (Wa). Ether Spray, externally 
as freezing mixture (R). Guarana, in 20 to 40 grain doses, removed severe 
chronic lumbago (Rawson). Chloroform Liniment, affords relief (Wa). Canada 
Balsam, gr. v-xx, is useful, or Burgundy Pitch, as plaster (P). Acupuncture, 
occasionally gives instant relief (B) ; not when high fever (R). Aquapuncture, 
has been employed with extraordinary success (B). Heat, by hot douche to 
seat of pain (B) ; or by very hot poultices for three hours, then the skin covered 
with flannel and oiled silk ; or a hot flat-iron (R). Galvanism, the constant cur- 
rent (B) ; is highly useful ; faradization almost as successful as acupuncture (R). 
Strapping from the thigh upwards with layers of adhesive plaster which overlap 
each other; nothing is so instantaneously beneficial. Diet, should be gener- 
ous and nutritive ; Lemon-juice as a beverage. Absolute rest is of great im- 
portance. [Compare Lithemia, Myalgia, Rheumatism.] 



R- . Collodii, 

Tinct. Iodi., 

Spt. Ammoniae, . . aa part. 9eq. 
Sig. — Paint over the part with a camel's- 
hair brush. (Burggraeve.) 



5t. Ammonii Chloridi, . . . gj. 
Ext. Cimicifugse Fl., 
Syr. Simplicis, . . - . aa^j. 
Aq. Laurocerasi, q. s. ad %v]. 
M. Sig. — A dessertsp. every four hours. 



75 8 LUNG DISEASES LUPUS. 



Lung Diseases. 

Aconite, is indicated in most acute congestions (P) ; is especially indicated 
for inflammatory states of the respiratory organs (R) ; Belladonna, in doses of 
rr\j of the tincture frequently, is of great benefit in pulmonary edema, to retard 
exudation of serum and to counteract the failure of the heart (Smith). Tere- 
bene, is very valuable in many conditions. Terpin Hydrate, is still more effi- 
cient and more easily administered. [See under Bronchitis.] Ammonium 
Acetate, serviceable not only in bronchitis, but in the whole range of acute 
pulmonary complaints occurring in children (Dessau). [See under Bron- 
chitis, for formula.] Veratrum Viride renders important service in acute 
parenchymatous congestions (B) ; gr. l /e of resin in pill when temperature and 
pulse are high ; it tends to induce prostration, collapse, etc. (A). Blisters, fly- 
ing blisters to chest, and perhaps along the pneumogastric in hypostatic con- 
gestion (R). Copaiba, exercises a powerful influence over the pulmonary 
mucous membrane, and is beneficial in lung diseases generally, when attended 
with excessive secretion (Wa). Jaborandi, is serviceable for the attacks of 
breathlessness attendant on lung affections, but must be watched lest collapse 
ensue (Berkart). Liquor Potassae, in doses of ttlx-xv added to an ordinary 
expectorant mixture, is often attended with good results in congestions of 
bronchi and lungs, chronic bronchitis, plastic bronchitis, etc. (Walshe). Cimi- 
cifuga, is a useful sedative in many irritative affections of the lungs and bron- 
chial tubes, relieving cough, improving appetite, and ameliorating the general 
condition (Wood). Croton Oil, as liniment, is a highly useful counter-irritant 
in many chronic lung diseases, and even in the bronchitis of infancy (Park). 
Cubeb, in small and oft-repeated doses, is efficient in chronic bronchitis and 
other lung affections of old persons, checking the excessive secretion and 
gently stimulating the system (Wa). [Compare Bronchitis, Emphysema, 
Hemoptysis, Phthisis, Pleuritis, Pleurodynia, Pneumonia.] 



Lungs, Gangrene of. 

Creosote, by inhalation, to obviate the fetor (R). Carbolic Acid inhalations, 
are used with marked benefit (Wa). Mineral Acids, especially Nitro-hydro- 
chloric, with Quinine, the main reliances in chronic pulmonary gangrene (A). 
Stimulants, as malt liquors, with general tonic treatment, are necessary (A). 
Ammonium Carbonate, one of the most reliable remedies ; is best given in 
decoction of Cinchona (Wa). Eucalyptus, the Oil with Alcohol, equal parts of 
each, of which 3j as inhalation by steam atomization, is useful (Wa). Turpen- 
tine, the spirit on boiling water inhaled for fifteen minutes every two hours, 
successfully employed (Skoda). [Compare Pneumonia, Phthisis.] 



Lupus. 

Arsenic, in chronic cases not of syphilitic origin. Fowler's solution long 
continued exerts a curative influence, also Arsenous Acid locally (B) ; the best 
remedy in lupus of the head and face (Wa) ; the Oleate in ulcerating forms, 
constantly applied, will destroy cell infiltration in a mild and comparatively 
painless manner; it is also well employed in the tubercular variety (Id). 
Phosphorus, as an internal remedy, may be used as a substitute for arsenic (B). 
Aurum Arsenate, internally, is said to be serviceable. Aurum salts, locally 
and internally, have proved curative ; the Chloride has been used as a caustic 
(P). Iodine is useful in lupus, whether syphilitic or scrofulous, the tincture or 
a glycerin solution locally (Hebra) ; the tincture or liniment applied to the 
edges and around them (R) ; it may also be employed internally. Aristol, has 
given excellent results locally as a dressing (Eichoff). Strontium Iodide, has 



LUPUS. 



759 



been used in lupus vulgaris with varied results. Calcium Chloride internally, 
has proved curative, but must be taken for a long time. Mercury, in small 
doses, is one of the constitutional remedies which should receive a fair trial 
(Whitla) ; as ointment in lupus erythematosus, and in form of Calomel oint- 
ment in scrofulous and tubercular lupus of children (R) ; internally Calomel in 
doses of i to 2 grains increased to 4 grains, will quickly check it (Wa) ; the 
Emplastrum Hydrargyri is very efficient in lupus erythematosus and allied 
affections (Kohn). Salicylic Acid, is the most typical member of the group of 
agents which have selective action on the new growth and destroy it with the 
least amount of injury to healthy tissue (Whitla) ; used as a paste, made by 
rubbing it with an equal part of Creosote, applied daily after using a strong 
solution, 10 to 20 per cent, of Cocaine over the part; or Unna's plaster mulls, 
containing these two ingredients, may be used (Id) ; as dressing, Salicylic Acid 
5, Creosote 5, Glycerinum Saponatum 90, after destruction of the growth, has 
given good results where no scraping nor any other operation was performed 
(Hebra). Lactic Acid, seeks out the diseased tissue, as a dog does game, 
surely finds it and effectually destroys it (Hortmann) ; the concentrated acid 
should be used, either alone or as a paste made with Kaolin. Lead, the Liquor 
Plumbi, with 1 or 2 of glycerin, in the milder forms, applied warm after the 
removal of the crusts (R). Jequirity, is a good application to destroy the dis- 
eased tissue by setting up the jequirity inflammation (Shoemaker). Sodium 
Ethylate, on absorbent cotton, is the best of the caustics, followed by Bismuth 
Oleo-palmitate as a soothing and astringent application (Id). Carbolic Acid, 
the crystals melted by heat, as a mild escharotic (B) ; its action is very superfi- 
cial. Zinc Sulphate, dried, freely dusted over the surface as a caustic, followed 
by a poultice to remove the slough (B). Silver Nitrate, a weak solution grad- 
ually strengthened, may be used in superficial forms (R). Chromic Acid, in 
solution, 100 grains to the § of distilled water, is an efficient escharotic (B). 
Thyroid Extract, has been used as a stimulant of the cutaneous functional 
activity with most satisfactory results. Tuberculin, in this disease has excited 
great interest, but the best authorities deny that its use has produced a single 
absolute cure; yet combined with surgical methods it will give good results 
(Whitla). Scraping off the diseased tissue with Volkmann's spoon under 
anesthesia, is the most radical and satisfactory of the mechanical procedures 
(Id) ; the Paquelin cautery is better than the spoon for removing the morbid 
tissue (Unna). Electrolysis, has given good results in Jackson's hands, who 
reports that the electrolytic action of the current seems to expend itself only on 
the diseased tissue. Cauterization, with the actual cautery at white heat, after 
scraping out as much as possible of the diseased tissue, so as to destroy the 
lupus cell. Seek to replace the lesion by a cicatrix, to prevent relapse in situ, 
and the development of the disease elsewhere. Internal remedies are only 
useful for the general health, and have no specific action on the disease. 
Phototherapy, by bringing the concentrated chemical rays of solar or electric 
light upon the lupus patch, thereby destroying the tubercle bacilli (Finsen) ; 
has given striking results in some cases, but is uncertain, slow and very ex- 
pensive (Anderson). 



R. Iodi, 

Potassii lodidi, . . . . aa ^ ss. 
Glycerini, 55 j. 

M. Sig. — Locally in lupus. 

[McCall Anderson. 



R • Ung. Arseni Oleat. , 
Ung. Simplicis, 
M. ft. unguentum. Sig.- 
over the affected surface. 
Opium may be added. 



■ ■ 5j. 

-Use constantly 
If pain sets in 
[Shoemaker.) 



R- . Hydrargyri Bromidi, . . ^jss. 

Adipis, 5 v. 

M. ft. unguentum. Sig. — To cover the 
part affected, using Cod-liver Oil freely, 
and the following solution internally. In 
tubercular lupus of the face. [Hardy.) 



R- . Potassii lodidi, gr. lxxv. 

Sodii Chloridi, ^ ss. 

Aq. Destil., ^viijss. 

M. Sig. — Teasp. before meals, night 
and morning. [Hardy.) 



760 LYMPHADENOMA MALARIA. 



Lymphadenoma — Hodgkin's Disease. 

Arsenic is by far the most successful remedy, both in acute and chronic 
cases, several having been recorded in which the glandular swellings have 
disappeared and the patients have recovered under its influence (Murray) ; 
large doses, rr\,xv-xx of Fowler's solution, arrived at by gradual increase, should 
be maintained until some physiological effect is produced (Ty) ; injected into 
the lymphoid masses has given good results, especially when not well borne by 
the stomach (Id). Phosphorus, has had good effects in a few cases, and should 
be used if arsenic is not well borne (Gowers). Iodine and Potassium Iodide, 
have been used but with little benefit ; the latter may be distinctly harmful 
(Murray). Quinine, Iron and Cod-liver Oil, as tonics ; every means must be 
employed to support the patient's strength (O). Organic Extracts, of spleen, 
thymus and other glands, are being tried but with no very decisive results as 
yet (Murray). Bone-marrow is perhaps worthy of trial, ^j of fresh ox marrow 
thrice daily for an adult (Id). Local Treatment, by applications to or injections 
into the diseased glands, has reduced their size but has no influence on the 
progress of the disease (Id) ; is of doubtful benefit (O). Extirpation of the dis- 
eased glands, in suitable cases, especially where the enlargement is confined 
to one group, when the spleen is not greatly enlarged and when there is neither 
fever nor marked anemia, may arrest the disease and is the proper treatment 
(Murray) ; if the number of red corpuscles is below 60 per cent, removal should 
not be attempted (Gowers). [Compare Anemia, Leucocythemia.] 



Lymphangitis. 

Belladonna, the extract softened with glycerin and freely applied, is of great 
service ; when pain is severe a poultice may be applied over the extract for a 
few hours only (Wa). Lead, Liq. Plumbi Subacet. Dilutus, as an external ap- 
plication, constantly applied, to soothe and restrain the inflammation (Wa). 
Iodine, in strong tincture, applied around the glands, to prevent suppuration 
(Roberts). Quinine, or Salicin, with alcoholic stimulants freely, in septic cases 
(Id). [Compare Bubo.] 

Malaria, Chronic. 

Arsenic plays an important role in chronic malarial disease (B) ; diminishes 
splenic engorgement, and combined with Iron is rapidly curative of many af- 
fections due to malaria (Boudin) ; is a powerful prophylactic against malaria, 
and in chronic malarial poisoning, with frequent return of fever and neuralgia, 
its continued use is of great benefit (Fayrer). Quinine, is less curative than 
when the infection is recent, but in periodical affections depending on the 
malarial cachexia it is of specific value, large doses being required (B) ; the in- 
discriminate use of quinine as a prophylactic in malarial countries is attended 
with'great danger, seriously weakening the action of the heart and so inuring the 
subject to its action that it has no longer any value of importance as a remedy 
(Koch). Salicylates, of Quinine and Cinchonidine are especially effective in 
chronic malarial disease (B). Iron, the Sulphate has decided antiperiodic 
power, and is particularly successful in anemic subjects and in those with en- 
largement of the spleen (Wa) ; it improves the anemia of chronic malaria, and 
should generally be combined with Arsenic (B). Iron and Manganese Iodide, 
the syrup in doses of rr^xx-xxx, is a successful remedy for chronic malaria (B). 
Manganese Sulphate, gives excellent results in jaundice of malarial origin 
(B). Cornus, Calumba, and other bitters are highly efficient, especially the 
first named, in chronic malarial poisoning and in convalescence after malarial 
fever (B). Carbolic Acid and Iodine combined, are of great value in chronic 



MANIA. 



76 



malarial infection ; both are highly antiperiodic, and the latter is the best sub- 
stitute for Quinine and the most active reducer of splenic enlargement (Gim- 
well). Eucalyptus, is of high utility to reconstruct damages in the organs of 
assimilation (B). Nuclein, has been used with benefit (Vaughn). Baths, the 
vapor-bath and Turkish baths are efficient aids to medicinal treatment in break- 
ing up chronic cases, and may of themselves cure such by inducing profuse 
perspiration (Da C). [Compare Hemoglobinuric Fever, Intermittent 
Fever, Remittent Fever. 1 



R- . Cinchonidinae Salicylat., . gij. 

Acidi Arsenosi, gr. j. 

Ferri Sulph. Exsiccat., . . gr. xx. 
M. ft. pulv. no. xx. Sig. — One powder 
in wafer thrice daily. 



aa^vj. 



Bt • Cornus, 

Calumbae, 

Liriodendri, 

Pruni Virginians, 

Eupatorii, 

Capsici, aa^iv. 

Pulv. et misce. Sig. — A teasp. in cold 
or warm water, three or four times daily. 
A good tonic tincture may be made from 
the above combination. (B.) 



XI. 

xx. 



R- . Quininse Sulph., . . . . gr. 

Ferri Sulph. Exsic, . gr. 

Acidi Arsenosi, gr. j. 

M. ft. pil. no. xx. Sig. — One pill thrice 
daily. 



R. Tinct. Iodi, . . . . 31'j. 

Acidi Carbolici, gj. 

M. Sig. — Two or three drops three or 
four times a day, in water. 



H • Acidi Arsenosi,' gr. j. 

Mass. Ferri Carbonatis, . gj. 
M. ft. pil. no. xx. Sig. — One pill thrice 
daily. 



Mania. 

Stramonium, of value ; allays irritation and induces tranquil sleep ; in wild 
and furious but intermittent delirium, also in nymphomania (P) ; many facts 
seem to confirm its reported value (Tr). Daturine, gr. x^y-sV hypodermically 
in acute mania, but is less useful than Atropine or Hyoscyamme (Wa). Duboi- 
sine, gr. -^ hypodermically in acute mania (Gubler) ; is more sedative and 
hypnotic than the other alkaloids of the group and acts well in doses of gr. 
y^Q at first, gradually increased to gr. ^. Belladonna is useful, especially in 
monomania with fixed hallucinations, though a large dose causes a temporary 
insanity (Tr) ; one of the very best remedies in all hyperemic conditions of the 
brain (P). Hyoscyamus, in violent intermittent forms, to procure sleep and 
calm violent delirium (R) ; delirium with hallucinations but not congestion ; in 
milder and less inflammatory forms, also in hypochondriacal monomania (P). 
Hyoscine, finds its greatest and most useful application in the treatment of 
maniacal violence and noisiness, and is a drug for emergencies of this kind 
(Weatherly). [See under Insanity.] Veratrum Viride, successfully combats 
the excitement in acute mania (B). Camphor, has been used successfully ; its 
action is uncertain (P). Opium with Tartar Emetic is satisfactory for many 
cases ; also Morphine hypodermically to induce sleep (R) ; its narcotic effect is 
of doubtful utility, better in insanity with depression (P) ; will not produce nar- 
cotism in many such cases, even in 2-grain doses. Bromides are used in 
puerperal mania, that of pregnancy, nymphomania and other forms (R) ; the 
combined use of Potassium Bromide and Tinct. of Cannabis Indica, equal 
parts, Z] of each thrice daily for weeks and months, has proved very efficient 
in acute and periodical mania, senile mania, and other forms (Clouston). 
Chloral, as calmative and hypnotic, has induced mental improvement (B). 
Paraldehyde, as a hypnotic, in doses of o'ss-j, is often decidedly useful (R) ; 
larger doses are necessary, an average one is £>iss. Conime, most suitable to 
acute mania, quiets muscular- action ; doses of rr^ss-iij, or hypodermically, 
beginning with gr. ■^ u ; with Morphine conjointly injected, is very successful 
(R). Digitalis, 3ss-gj of tinct. valuable in acute and chronic mania, espe- 



762 MASTITIS MASTODYNIA. 

daily when complicated with general paresis and epilepsy (Maudsley) ; caution ! 
watch the pulse for any marked intermittence (B) ; a very valuable palliative 
in acute mania (Van der Kolk). Ergot, large doses, 3ss-j of fluid extract, to 
reduce excitement, shorten attacks, widen intervals between them, and prevent 
exhaustion, hence is very useful in recurrent and epileptic forms, and in chronic 
mania with lucid intervals (Crichton Browne). Iron, as a restorative, is fre- 
quently used in chronic mania with benefit, the tincture of the Chloride in 5- 
10 minim doses (B). Gelsemium, is useful in mania with great motor excite- 
ment and wakefulness ; large doses required, Tt^xv-xx of tincture. Croton Oil, 
as a purgative, ^\,%-Yi every hour, as revulsive in mania from cerebral con- 
gestion (R). Cimicifuga, is often efficiently used in cases of mania occurring 
during the puerperal or pregnant condition (R). Chloroform, may be neces- 
sary to control very violent cases temporarily ; its inhalation need not be carried 
to complete anesthesia. Galvanism, of the head and cervical sympathetic, has 
produced distinct improvement (B). Cold Douche, in maniacal delirium, the 
patient being in a warm bath during the application of the douche to the head 
(R). Removal from home, from sympathetic friends, and from surroundings 
connected with the origin of the malady, is a prime necessity to a cure. [Com- 
pare Delirium, Insanity, Puerperal Mania.] 



Mastitis. 

Belladonna, Atropine locally [see Lactation], or combined with Morphine 
and Chloral, when much pain (B) ; especially as liniment to check secretion of 
milk when inflammation is imminent (R) ; or when breasts are distended by 
milk (P) ; when inflammation has set in, continuous application of Belladonna 
for 24 hours often arrests it ; also useful when abscess has formed ; fomenta- 
tions in addition, but skin must be dried well before the Belladonna is rubbed 
in (R) ; rr\,v-x of tinct. internally as well (P). Camphor, a saturated solution 
in glycerin locally, in mammary congestion threatening abscess (Wa). Phy- 
tolacca, has power to arrest inflammation of the mammae and to prevent sup- 
puration ; the fluid extract in 10-minim doses internally, and the solid extract 
to the inflamed breast (B). Conium, the extract in small doses several times 
a day, of striking benefit in mastitis and impending abscess of breast (Wa). 
Calcium Sulphide, internally in mammary abscess ; occasionally increases pain 
(R). Hyoscyamus, as plaster, to relieve painful distention from milk (P). 
Stramonium, fresh leaves as cataplasm to discuss indurated milk (P). Iodine, 
tinct. and ointments to remove indurations of breasts after inflammation (B). 
Mercury and Morphine, the Oleate locally in mammary abscess (R). Tobacco 
leaves, as poultice in abscess (R). Digitalis, the infusion locally as fomenta- 
tion in severe inflammation of the breasts, causes it to yield speedily (Fairbank). 
Ammonium Chloride, 3j m Spt. Rosmarini Oj, as lotion on linen cloths, 
constantly applied, especially in induration after the abscess has suppurated 
(Wa). Tartar Emetic, in small and frequent doses, given early, is beneficial 
(Wa). Oil frictions in first stage of inflammation of breasts, from circumfer- 
ence towards the nipple (L). Rest, by supporting mammas with strips of plaster, 
and bandaging the arm to the side, to prevent motion (T). Alcohol, over 
proof, applied by sponging until part is cold ; renew if high heat returns. Heat, 
applied by a basin lined with flannel saturated with hot water, to relieve pain 
and prevent suppuration. [Compare Abscess, Lactation.] 



Mastodynia. 

Conium, has specific anodyne action on the mammas and generative organs. 
Cimicifuga, relieves infra-mammary pains of uterine origin in spinsters. Olive 
Oil, 2 parts, to 1 of Tinctura Opii, may be used by gentle friction to painful 
breasts after parturition (Parvin). Non-interference is best in simple cases of 



MEASLES MELANCHOLIA. 763 

enlargement and tenderness, which will spontaneously subside if let alone ; 
in severe cases support by strips or bandage, if breast pendulous ; Belladonna 
ointment or liniments ; amputation of the breast has been necessary (T). 



Measles. 

Aconite, for febrile symptoms, and especially to arrest the catarrhal pneu- 
monia (R) ; a valuable remedy (P); the best drug when fever is very high, 
j^-drop doses of the tincture every 2 hours (Da C). Jaborandi, with a hot 
bath, as a diaphoretic in cases of delayed eruption (Da C). Asclepias, an 
infusion or decoction freely as a diaphoretic to promote the eruption (W). 
Veratrum Viride, has been employed (R). Pulsatilla, for the catarrhal oph- 
thalmia, nasal and intestinal catarrh ; 3j-ij of tincture to ^iv water as wash 
(P). Ammonium Carbonate, dissolved in a solution of the Acetate, is much 
vaunted ; when feeble circulation, cyanosis, delirium, gr. v-x to ^ss-^j Liq. 
Ammonii Acetatis (B) ; gr. iij-vj or vij, every hour or two, in Cinnamon-water 
or milk; one of the reliable remedies (W). Camphor, the water with Liq. 
Ammon. Acetatis, excellent when cough and catarrh the most urgent symp- 
toms (A). Ipecacuanha, for cough and catarrh, gr. j-ij every 4 or 6 hours (A). 
Antimony, preferred to Ipecac by some (A). Quinine, in small doses, gr. j- 
iij, for the adynamia, or large, gr. xv, for hyperpyrexia and catarrhal pneumo- 
nia (B). Carbolic Acid, has been employed in several hundred cases with 
decided advantage; most useful at early stage (Wa). Cod-liver Oil and Iron, 
to scrofulous children, a long course of such medication after convalescence 
(Da C). Purgatives, must be given with caution (R) ; the milder purging salts, 
as Magnesium Sulphate, to be preferred (A). Mustard, as bath on sudden retro- 
cession of rash (R) ; often increases the fever without benefiting the pneumonia 
or other complications (A). Water, cold affusion at commencement; packing, 
especially when retrocedent (R) ; hot foot-baths for convulsions (A) ; tepid 
bath with cold douche to head, if cerebral symptoms are severe (Da C). Oil 
Inunctions, Cacao-butter is very grateful and reduces temperature ; also in the 
roseola (B); hands and feet to be rubbed with a firm fat to remove heat and 
tightness produced by rash (R). Aliment, low diet and slops ; no animal food 
during the whole course (A). Hygiene, dark room, complete disuse of eyes, 
strict cleanliness (A). [For Sequelae see Bronchitis, Cough, Ophthalmia, 
Otorrhea, Pneumonia, etc.] 



R- . Acidi Carbolici, 

Acidi Acetici, . . . . aa ^j-^jss 

Tinct. Opii Deodorati, 

Spt. Chloroformi, . . . aa 7,]. 



R . Tinct. Tolutanae, . . . . Zij. 
Syr. Senegae, . . . . . 3SS. 
Acidi Acetici, ^ jss. 



A F , J ... Syr. Pruni Virg., q. s. ad 1 iv. 

Aquas, . . . . q. s. ad 5vni. ,, 3 a . . . & ' >, • j r 

»«■ o- **.uiri° M. Sisr. — A teaspoonful as required for 

M. big. — A tablespoonful every 4 , r & , v ^ 

cough after convale^"™'^ 



hours, until fever abates. {Keith.' 



lescence. 



Melancholia. 

Aurum, gives excellent results, gr. -^ to ^ of the Chloride thrice daily, 
especially when cerebral anemia coexists (B) ; the Bromide of Gold and 
Arsenic has rendered good service in many cases, tr^x hypodermically thrice 
daily: Gold is highly recommended in suicidal melancholia. Bromides, 
sometimes afford relief which no other agent will ; no indications (B) ; Potas- 
sium Bromide for townspeople, especially women with unendurable despon- 
dency (R). Arsenic, gives great comfort in the melancholia of aged persons, 
is best when combined with small doses of opium, thus — Liq. Potas. Arsenit. 
rr\Jj, Tinct. Opii, mjij-v ter die (B). Opium, in stimulant doses of tincture, 
gives good effects (B) ; especially when paroxysms of acute anguish and des- 



764 MENINGITIS, CEREBRO-SPINAL. 

pair, or when suicidal impulse (Wa) ; Morphine hypodermically is of great 
benefit in some persons who have a peculiar idiosyncrasy therefor (R). Cam- 
phor has been highly recommended (R). Musk and Castoreum are employed 
in melancholia with benefit (R). Cannabis Indica, sometimes relieves (B). 
Phosphorus, depression from overwork (R). Chloral, as hypnotic, has been 
followed by marked amelioration and cure (Wa). Valerian, in hysterical or 
suicidal melancholia, is often beneficial (Wa). Caffeine has been useful (B). 
Iron, as restorative, the tincture of the Chloride (B). Cocaine, a useful tonic 
and especially beneficial in nervous affections accompanied by depression (Br). 
Cimicifuga, in puerperal or uterine despondency, of singular value (P). Ignatia, 
has soothing effect in great mental depression (P). Orchitic Extract, has been 
used with benefit. Water-cure, shower-bath for 15-20 seconds, or warm-bath, 
95 F. for 30 minutes ; the shower or cold douche may be usefully employed 
in cases where reaction takes place after it (W). [Compare Hypochondriasis, 
Hysteria, Insanity.] 

Meningitis, Cerebral. 

Aconite, is as serviceable in this as in the other acute inflammations ; during 
the stage of excitation, the tincture, gtt. ij with gtt. v of the tincture of Opium, 
every 2 hours, gives admirable results (B). Belladonna, in all hyperemic 
conditions of brain and spinal cord one of the very best remedies, especially 
during the period of excitement (P). Hyoscyamus, valuable in subacute form 
(P) ; for nervous irritability during convalescence (A). Gelsemium, extremely 
useful ; rr^v of fluid extract every 2 hours (B). Mercury, as ointment gives 
good results in children (A) ; Calomel in small, frequent doses, so as to bring 
the system under it quickly, a most valuable remedy apart from its purgative 
effects ( W) ; the Unguentum Hydrargyri rubbed for 30 minutes into the skin 
on the front of the abdomen, groins and arm-pits, repeated after 12 hours if 
no evidences of improvement or salivation ; such unmistakable benefits follow 
the free use of mercury that to withhold this remedy in desperate or apparently 
hopeless cases is unjustifiable (Whitla). Potassium Iodide in large doses 
where vomiting and gastric derangement are absent, and in the later stages 
of syphilitic meningitis may be very valuable (Id) ; has cured (Niemeyer). 
Ergot, the fluid extract in gss doses with an equal quantity of Potassium Bro- 
mide, every four hours, to diminish the vascular excitement (B). Potassium 
Bromide, in the convulsions following simple meningitis (R). Opium, in small 
doses ; by clinical evidence proved to be the best remedy, especially for acute 
stage before exudation, or during the stage of excitation (B) : when collapse, 
it may sustain the vital powers ; with Tartar Emetic has proved most benefi- 
cial, but should be used with caution, as it may do great harm (Wa). Bryonia, 
exceedingly valuable for serous inflammations in stage of effusion (P). Pulsa- 
tilla, valuable in the acute form (B). Purgatives, as soon as possible, unless 
exhaustion ; Calomel and Jalap the most active and searching (A) ; Croton Oil 
as a derivative and revulsive, also locally to the shaven scalp is productive of 
the best results (Wa). Venesection, or arteriotomy (temporal artery) gives 
good results (B) ; when high cerebral excitement . and vascular action (A). 
Blisters, on nape of neck if coma, after active symptoms are subdued (A) : 
useless, and cause needless suffering (O). Water, cold water for hyperpy- 
rexia (C) ; pounded ice in bag or bladder, as a cap to the head (R). There are 
no remedies which in any way control the course of acute meningitis (O). [Com- 
pare Meningitis, tubercular.] 



Meningitis, Cerebro-Spinal. 

Opium, in small doses is the most effective remedy ; its utility ends when 
effusion occurs and stupor and coma ensue (R) ; large doses (Valleix) ; gr. j 
every hour in very severe cases (S) ; has been used in France and Germany 



MENINGITIS, SPINAL. 765 

with much success (Tr) ; is the best remedy of all, gr. j every hour for 4 days, 
even such doses will not narcotize (Da C). Antipyrin, has rendered good ser- 
vice. Aconite, is useful combined with Opium (B) ; affects the cranio-spinal 
axis from 3d nerve to phrenics, the region where this disease is most manifest 
(Harley). Gelsemium, extremely valuable, n^v of fluid extract every 2 hours, 
to maintain constant physiological effect (B) ; is efficient for the delirium. Bel- 
ladonna, in all hyperemic conditions of brain and spinal cord, especially dur- 
ing stage of excitement (P). Iron, the tincture of the Chloride, in 20-30 minim 
doses, every two hours, suggested by the similarity of the disease to erysipelas, 
has made many successful cures without leaving any sequelae (Klapp). Bro- 
mides, to guard the Opium and enable the latter to be pushed, 20-grain doses 
every 4 hours (Da C). Hydrocyanic Acid, dilute, rir\J — ij , with gr. iij-v of Sodium 
Bicarbonate, every 3 or 4 hours for severe vomiting (Delafield). Quinine, in 
large doses at the commencement (B) ; has been exhaustively tried in this dis- 
ease and failed (Da C). Potassium Iodide for the sequelae, a long course of 
Iodides during convalescence is the best treatment (Da C). Cold to the spine, 
the most satisfactory treatment (Radcliffe) ; to head and upper spine for 5 
minutes only at a time, for the headache and tetanic symptoms (Da C). Vene- 
section, or arteriotomy (temporal artery), probably of service, but cautiously 
(B) ; leeches at back of neck and on temples, to relieve the terrible headache, 
if patient is strong and vigorous (Da C). Digitalis, in early stage (Rummel). 
Ergot, one of the best remedies (B). Turpentine, enema, as derivative (B). 
Stimulants, in small quantities (A). Counter-irritation, by actual cautery freely 
applied to back, alleviates pain (A). Water, cold baths or wet pack for hyper- 
pyrexia (B) ; hot-water bottles or sand-bags to trunk and extremities to keep up 
warmth ; bath of 102-106 for short time only, then wrap in blankets (A). 
Heat to the body, except the head and neck (Da C). Aliment, nutritious and 
suitable food at short intervals, day and night (A) ; tonics with fresh air and 
good diet during convalescence (A). Ventilation, of dwellings, the best sanitary 
precaution when the disease is epidemic (Simon). 

R . Morphinse Sulpb., . . . gr. ss. ! & . Potass. Iodidi, giv. 

Ac. Sulphurici Aromat., gj. Tinct. Gentian. Comp., 

Tinct. Cinchonse Co., ad Jvj. Syr. Sarsaparillse Co., . aa ^ij. 

M. Sig. — Tablesp. every 2 hours, for a j M. Sig. — Teasp. thrice daily, to pro- 
boy 12 years old. (Meigs & Pepper.) mote absorption during convalescence. 



Meningitis, Spinal. 

Aconite, is very useful (B) ; with an Ergot and Opium impression to reduce 
the amount of blood in the vessels of the cord (Da C). Potassium Iodide, in 
the chronic form, with the Bichloride of Mercury when a specific history present 
(Hammond). Belladonna, strongly to be relied on, even when brought on by 
external violence (P). Bryonia, in serous inflammations when effusion, is 
extremely valuable (P). Purging, by Magnesium Sulphate, combined with 
Tinct. Hyoscyami (A). Quinine, when paralysis occurs, in 3-grain doses 
thrice daily, with % -grain doses of Ext. Belladonnas, or 20-30-grain doses of 
Potassium Iodide, and flying blisters along the spine (Da C). Opium, in some 
form, must be used for pain (Bastian). Mercury, gr. ^ E of the Bichloride, with 
increasing doses of Potassium Iodide, to promote absorption of inflammatory 
products, if the inflammation subsides (Bastian) ; a mercurial impression often 
benefits the paralysis (Da C). Mercury is the only drug which has any influ- 
ence on the acute process ; it is best given by inunction (Risien and Russell). 
Cold, by ice to spine is deemed necessary, and no doubt alleviates the pain, 
though heat would be a more rational application for the inflammation 
(Bastian). 



766 MENINGITIS, TUBERCULAR MENORRHAGIA. 



Meningitis, Tubercular. 

Potassium Iodide, is the routine remedy, to be administered in ordinary typi- 
cal cases, full and frequently repeated doses are necessary, gr. j every 2 hours 
for a child of 2 years (Whitla). Iodine, lotions to scalp, or inunction of Iodine 
ointment together with Ferrous Iodide and Cod-liver Oil internally, offer the 
best chance of success, although most remedies often fail (Wa). Potassium 
Bromide, combined with the Iodide in double the dose of the latter, is advan- 
tageous (Whitla). Tartar Emetic, the oint. as counter-irritant to scalp in tuber- 
cular meningitis (R) ; in large doses internally was formerly employed (Wa). 
Croton Oil, is said to have removed the excess of fluid from the ventricles (R) ; 
as a derivative and revulsive, also locally to the shaven scalp, is productive of 
the best results (Wa). Mercury, Hydrarg. Chlor. Corr., in doses of gr. -^ to ^, 
has proved successful (Wa). Mercury by inunction should be used heroically 
as long as there is any reason to doubt the diagnosis, in the hope that the case 
may be one of simple meningitis (Whitla). Magnesium Carbonate, 5j-ij sat- 
urated with Lemon-juice, every 2 or 3 hours, a useful purgative in hydrocephalus 
(Wa). Turpentine, in doses of tt^v-x with n^xx-xl of Castor Oil, or terebin- 
thinate enemata, in incipient hydrocephalus (Wa). Purgatives, in small doses, 
every 4 or 6 hours after having overcome the constipation, to maintain action 
for some days ; a single dose of Calomel, followed up by Magnesium Sulphate 
at short intervals ; their value can hardly be overrated (Wa). Leeches, on crown 
of head rather than on temples, when much febrile action ; inadmissible if patient 
is much debilitated ; sometimes serviceable (Wa). Cases of recovery have 
been reported by reliable authorities, but they are extremely rare, and there is 
always a reasonable doubt as to the correctness of the diagnosis. I have 
never seen a case recover which I regarded as tuberculous (O). 



Menorrhagia. 

Opium, has specific action in reducing the uterine circulation and should be 
pushed, even to inducing habit, in severe cases (Lutaud). Ipecacuanha, in full 
emetic doses (Wa) ; is excellent (B) ; Ergot is better (P). Savine, enlarged, 
relaxed, and passively congested uterus (B) ; in 5-10 drop doses of tinct. in 
water every half-hour to three hours, has proved useful (P) ; when menorrhagia 
due to want of tone in uterus (R). Ergot, large spongy uterus ; Bromides bet- 
ter (B) ; Ergotin, gr. j or ij in glycerin and water, undoubtedly efficacious as 
hypodermic injection (P) ; in all forms (R) ; minim doses of the fluid extract 
are very beneficial (Smith). Hydrastinine, a powerful uterine vaso-constrictor ; 
successfully used in grain doses of the Hydrochlorate in 10 per cent, solution 
hypodermically, for a few days before the expected term. Hamamelis, has 
decided influence on venous system ; of high repute (Pf ). Arsenic and Iron, 
when from anemia (B). Cannabis Indica, often successful (R) ; gtt. v-x of 
tinct., thrice daily, productive of extraordinary success (Wa) ; has a stimulant 
action on the uterine muscular fibre, and may be given in combination with 
Ergot (B). Iron, when dependent on anemia (B). Rue, low vascular tonus ; 
should never be used in the pregnant state (B). Erigeron, the Oil, in 10-drop 
doses, is efficient (Wa). Gossypium, a favorite uterine hemostatic in many 
hospitals, 30-minim doses of the fluid extract every four hours (Parvin). 
Quinine, has been recommended (R) ; after Ergot it is the best agent, in 6-grain 
doses every 3 hours (Parvin). Digitalis, very useful, especially when from 
heart disease, in plethoric subjects (R); ^j-jss of infusion will arrest menor- 
rhagia when unconnected with disease (P, R). Aloes, with Iron in debilitated 
and relaxed subjects (B). Cimicifuga, passive, coagulated and dark (P) ; for 
accompanying headache (R). Gallic Acid, is very efficient (R). Potassium 
Chlorate or Bromide, in doses of gr. xv thrice daily, combined with Ergot, has 
an almost infallible influence over uterine hemorrhage, unless caused by cancer, 



METRITIS, ACUTE. 767 

polypi, adherent placenta, or other similar affections (Tait). Bromides, usually 
arrest promptly (B) ; that of Potassium most useful in young women if loss 
occurs at period only ; commence the Bromide a week before and discontinue 
when discharge ceases till a week before the next term ; if loss occurs every 
two or three weeks give Bromides continuously in 10-grain doses, but more 
when organic changes in womb (R, Wa). Ammonium Chloride, for headaches 
(R). Calcium Phosphate, in anemia from excessive menstruation (R). Mag- 
nesium Sulphate, very smalfrdoses with a little dilute Sulphuric Acid and syrup, 
is exceedingly useful (Wa). Cinnamon, the Oil, in drachm doses (R). Mam- 
mary Extract, gave signal satisfaction as an internal remedy in two cases of 
menorrhagia with dysmenorrhea and enlarged uterus (Bell). Water, hot water 
bag to lower dorsal and lumbar vertebras (R) ; cold sitz-bath, feet in warm 
water, especially valuable; 6o°-65° F., for 5-15 minutes, patient then quickly 
dried and put to bed. [Compare Metrorrhagia.] 

& . Ext. Ipecac. Fl., . . . . gij. 1 R. Ext. Ergotae (Squibb). . gr. xij. 

Ext. Ergotse FL, . . . . 3 iv. Ext. Opii, gr. vj. 

Ext. Digitalis Fl., . . . . ^ij. M. et div. in pil. no. xij. 

M. Sig. — A half teasp. to a teasp. as Sig. — One pill every hour, in profuse 

required until emesis occurs. (B.) menstruation of atonic type. 



Menstrual Disorders. 

Aconite, gtt. j of tinct. every half-hour or hourly promptly restores the dis- 
charge when suddenly suppressed from chill (P, B, R, Wa) ; as emmenagogue 
(Tr). Pulsatilla, often of the greatest value when menses scanty or delayed, or 
suppressed by fright or chill (P, B). Ignatia, in the suppression of hysteria (P). 
Savine, a powerful uterine tonic; as emmenagogue certain, powerful, safe (P). 
Ferrum, in anemic subjects (B). Aloes, as emmenagogue [see Amenorrhea]. 
Cocculus Indicus, for irregular menstruation with colicky pains and scanty dis- 
charge ; should be given for a few days prior to and during period (P) ; tt(,ij-iij 
of a saturated tincture thrice daily. Opium, in suppression from violent mental 
emotions, a valuable remedy (Wa); in many menstrual disorders it proves 
invaluable, but must be cautiously administered lest the habit be formed. 
Cimicifuga, relieves heat and pains in the head, flushings of the face, pains in 
back and limbs, etc., when occurring as the result of menstrual perversion 
(Wa). [Compare Amenorrhea, Dysmenorrhea, Menorrhagia, Climac- 
teric Disorders.] 

Mentagra. 

Mercury, the Oleate, or the Bichloride, gr. ij to ^j of water, applied as lotion 
after each epilation (R) ; Citrine oint. extensively employed (Wa). Sulphu- 
rous Acid, with an equal part of glycerin, an efficient application (Jenner). 
Arsenic, has powerful influence, used internally in doses of n^v of Liquor 
Arsenicalis thrice daily (Wa) ; the Oleate of Arsenic is an efficient local applica- 
tion. Sulphur Iodide, as ointment, gj to ^jss.is efficient, with Donovan's solu- 
tion internally (Sir E. Wilson). Copper Sulphate, as lotion, Z] to ^ xvj of water, 



Metritis, Acute. 

Opium, by suppositories or enema is more effectual than if administered 
internally (Wa), Aconite, is invaluable in early stage of simple inflammatory 
fevers (P). [Compare Puerperal Fever.] Heat, to the feet, and by large 
poultice to the abdomen ; also hot water vaginal injection literally for hours if 
possible, repeated at short intervals ; the only means of aborting an attack. of 
cellulitis (E), which is the condition generally present in cases which are 



?68 



METRORRHAGIA MILIARIA. 



usually supposed to be ones of acute metritis (Playfair). Turpentine, as hot 
epithems ; few measures are more generally serviceable (Wa). Linseed Poul- 
tices, produce great relief to pain and favorably affect the course of the disease 
(Duncan). Leeches, to the hypogastric region, may be required in patients of 
full habit. [Compare Puerperal Fever, Puerperal Metritis.] 



Metrorrhagia. 

Opium, has specific action on the uterine circulation [see page 402], and 
should be given freely in intractable cases of metrorrhagia from uterine fibroids 
or cancer, in which the establishment of the opium-habit is often advisable 
(Lutaud). Hydrastinine, a powerful uterine vaso-constrictor ; successfully em- 
ployed ingrain doses of the Hydrochlorate in 10 per cent, solution hypodermi- 
cally. Atropine, gr. y^ to ^ hypodermically, in profuse metrorrhagia after 
abortion or of obscure origin ; may require as many as four injections to cause 
cessation of the flow (Squibb). Salipyrin, in doses of gr. xv thrice daily, em- 
ployed in fifty cases of metrorrhagia from various causes, with best results in 
cases following labor or abortion (Orthmann). Ipecacuanha, possesses con- 
siderable energy in arresting flooding (P) ; in full emetic doses, gr. xx in even- 
ing, followed by an acidulated draught in the morning (Wa). Hamamelis, 
when persistent oozing (R). Ergot, the most valuable remedy in full doses 
repeated every hour or so (R, P). [See Menorrhagia for formula.] Savine, 
5 to 10-drop doses of tincture in cold water every }4 hour to 3 hours (P). Iron, 
styptic preparations as injections (B). [See Hemorrhage, Post-partum.] 
Cannabis Indica, often arrests metrorrhagia especially when at climacteric ; 
tincture gtt. v-xx ter die (P) ; has had extraordinary success in number and 
rapidity of cures (Wa). Sulphuric Acid, sometimes very effective, especially 
when due to fibroid or polypus ; Ac. Sulphurici Dil., gtt. v-xx, well diluted (B) ; 
long and extensively prescribed (Wa). Cinnamon, is used with good effect 
(P) ; has specific action on the uterus (T). Digitalis, in plethoric subjects ; the 
infusion best, a tablesp. bis die (P) ; the effect is prompt and decided (Wa). 
Magnesium Sulphate, often succeeds (B). Senegin, in 2-grain doses, is suc- 
cessfully employed (P). [Compare Amenorrhea.] Ice, to abdomen, or within 
the uterus (B) ; Ice in every way the first thing to try (Wa). Rest, absolutely 
necessary. Dry Cupping, over the sacrum, is found useful (R). [Compare 
Menorrhagia, Uterine Tumors.] 



R. Ext. Ergotse FL, . . . . gss. 
Ext. Senec. Aur. Fl., 
Ext. Viburn. Prunif. Fl.,aa Jj. 
01. Myristicse, ..... Tt^xx. 

Syr. Simplicis, . . q. s.ad^v]. 



M. Sig. — A dessertsp. every )( hour 
until relieved, then reduce the dose. Keep 
the head low, and apply cold over the hypo- 
gastrium. 



Miliaria — Prickly Heat. 

Carbolic Acid, a 4 or 5 per cent, solution in water, adding a little glycerin, 
is the best local application for the itching and prickly sensations. Baths, 
warm or containing Sulphides (R) ; sponge-baths with alkaline lotions, diluted 
lead-water, fluid extract of Grindelia well diluted, or a solution of Copper Sul- 
phate gr. x to the %, with dusting powders of Lycopodium, Zinc Oxide or Starch, 
singly or combined (Hughes) ; fine rice powder makes an excellent application. 
Diet in severe cases should be simple, nutritious but not stimulating, alcohol is 
most deleterious (Pringle) ; it is most important to avoid all causes of perspira- 
tion, as the copious consumption of fluids, excessive exercise, close rooms and 
warm clothing (Mn). Prickly heat is a form of miliaria, not of lichen, and is 
due to the excessive sweating incident to the heat of tropical climates (Id). 
Inunction of the body after the morning bath, with vaselin or some fatty ma- 



MILIARY FEVER MUSCLE MYALGIA MYELITIS. 769 

terial, is a valuable prophylactic in persons who are subject to the affection 
(Pringle). 

Miliary Fever. 

Aconite, for the hyperpyrexia (R, P). Cooling Drinks, purgatives and anti- 
phlogistics, in mild cases; malignant ones sometimes occur, and are dangerous 
(A). Lime-water applied by sponging, is very useful ; or a lotion of Zinc Oxide 
suspended in Lime-water, gr. xl to ^ j, painted on the affected parts of the skin, 
and permitted to dry thereon (E. Wilson). 



Muscae Volitantes. 

Potassium Iodide, very effectual in curing muscae depending upon hepatic 
derangement (Wa). Valerian, often found curative (Wa). Muscae Volitantes 
are due to shadows cast on the retina by fibrillae floating in the vitreous body, 
and are most visible to myopic persons; they do not merit attention unless very 
abundant, or steadily increasing (C). Rest of the eye necessary. Neutral-tint 
glasses may be worn to render the muscae less visible, if troublesome. 



Myalgia. 

Arnica, the best agent for contused muscular fibre ; also for shake, concus- 
sion, shock ; rr^v-x every 2 or 3 hours in water (P) ; a few drops of tincture in- 
ternally, removes stiffness, after packing with cold, wet sheet (R). Cimicifuga, 
often succeeds wonderfully, as often fails ; no indications for its use (B) ; general 
bruised sensation (R). Ammonium Chloride, in 10 to 20-grain doses, the most 
efficient remedy (Anstie) ; is effective (R). Veratrine, the ointment externally 
may control (B). Belladonna, as liniment, is often successful (R). Gelsemium, 
frequently cures, but large doses are necessary, itlv-xx of the fluid extract every 
3 hours (B). Coca, to relieve the sense of fatigue (P). Opium, by frictions or 
poultices (R). Iodine, ointment for pain and tender muscles of the chest, when 
skin may be pinched without pain (R). Xanthoxylum, externally and inter- 
nally, has a deserved reputation (B). Chloroform Liniment, with friction, often 
affords great relief (Wa). Firing, sometimes very beneficial (B). Packing, 
with dripping wet sheet (R). Counter-irritation, by firing, aquapuncture, acu- 
puncture (B). Electricity, the constant current (B). Baths, Turkish, in aching 
muscles, from over-exertion (R). Poultices, very hot, followed by applications 
of lint and oilskin (R). Rest, is the remedy, of course (Wa) ; rest and support 
to weak muscles are important until they regain tone ; especially in painful 
muscular affections following prolonged or excessive exertion, or in the sore- 
ness or stiffness which occur during convalescence from any long illness, or 
accompanying general debility, and generally better after repose, but increased 
with fatigue. [Compare Lumbago, Pleurodynia.] 



Myelitis. 

Belladonna, is decidedly effective, especially when disease is brought on by 
external violence (P). Ergot, most successful: large doses are necessary (B). 
Electricity, in chronic, not in recent form (B). Silver Nitrate, in chronic inflam- 
mations of the cord, one of the few remedies which are ever of service; gr. 
%~Yz (W). Silver Phosphate, of special value in myelitis with disturbance of 
bladder and rectum (Wa). Sodium Phosphate, hypodermically, was employed 
with great benefit in a case of syringo-myehtis [see page 421]. Phosphorus, of 
marked benefit in myelitic paraplegia from excessive venery (W). Water-cure, 
Ice-bag to spine, feet in hot water; or better, hot douche to spine (B). Cold, 
externally, by ice-bags along the spine, with cupping or leeching if much 

49 



y/O MYOPIA MYXEDEMA NAILS NASAL AFFECTIONS. 

localized pain or tenderness ; spoon feeding and a sparing amount of stimulants, 
also copious warm enemata to relieve the bowels and act as derivatives. Little, 
if anything, is to be done with drugs. Posture should be prone, or on side ; 
absolute rest (Bastian). [Compare Meningitis spinal, Paralysis.] 

Myopia. 

Atropine, by daily instillation, systemically, for the purpose of sacrificing 
either the convergence or the accommodation, in cases where failure of the 
internal recti occurs, the disability assuming the form of muscular asthenopia 
(C). Glasses, properly adjusted, should be worn from the commencement. 
Extraction of the Lens, produces the happiest results in extreme myopia, 
especially when progressive, since by removal of the crystalline lens the refrac- 
tion of a very myopic eye is brought back nearly to emmetropia (Valude). 



Myxedema. 

Thyroid Extract, or the thyroid gland itself, fed to the patient daily, is now 
the recognized treatment, and produces the best results (see page 157). Tonics, 
as Iron, Arsenic and the Hypophosphites, with diaphoretic drugs, as Jaborandi, 
and daily baths, formed the early treatment of this affection (Ord). Exposure to 
Cold, aggravates all the symptoms and causes great weakness and depression, 
even though the patient is not conscious of any discomfort from the impact of 
cold air, by reason of the thickened and insensible condition of the skin. Even 
while reaping so great a benefit from the use of the thyroid, we are still bound 
to shield our patients from exposure to cold (Ord). 



Nails, Ingrowing. 

Liquor Potassae, a solution, gij to ^j, on cotton- wool, applied to margin of 
nail at ulcerated surface, to soften the nail in ingrowing toenail (B). Glycerin, 
or Silver Nitrate, on a fold of lint, to the ulcerated surface (C). Lead Carbo- 
nate, a piece softened between the fingers, and applied as plaster beneath the 
fungous cushion, cures in a few days (Tr). Paring the nail, after softening in 
warm water, and cutting a V-shaped incision in centre of nail ; the ingrowing 
portion should not be cut. 

Nasal Affections. 

Ammonia, by inhalation, in pain and inflammations of nose and frontal 
bones (R). Potassium Iodide, large doses, gr. xxx-lxxv daily, valuable in 
syphilitic affections of the nose (Wa). Glycerite of Tannin, to excoriations of 
inside of nose, after measles, scarlatina, etc. ; also for impetiginous eruptions of 
inside, most severe where hair grows ; epilation sometimes needful; also in dis- 
charge of greenish, black, stinking mucus (R). Glycerite of Starch, or Zinc 
Ointment, applied often, a good supplementary application (R). Hydrastis, 
in chronic catarrhal conditions and nasal ulcers, used internally and externally 
with great benefit (P). Pulsatilla, may be employed both internally and exter- 
nally in nasal inflammations (P), and in acute inflammation of nose (B). Cod- 
liver Oil for chronic discharge (R). Injections, by nasal douche, are used with 
benefit in catarrhal states (Wa). Zinc Chloride, gr. ij to the g, or the Sulpho- 
carbolate, gr. v to the ^, as solutions locally by cotton-wrapped probe to di- 
minish sensibility of the nasal mucous membrane (Sajous). Cocaine, has many 
applications in treatment of nasal affections ; a 4 per cent, solution by mop or 
spray will empty the engorged venous sinuses, and is very useful in acute catarrh, 
hay fever, etc., also for posterior and anterior rhinoscopy (R). [Compare Acne. 
Catarrh, Epistaxis, Hay Fever, Influenza, Ozena, Polypus, Sneezing.] 



NAUSEA NECROSIS NERVOUS AFFECTIONS. J*]\ 



Nausea. 

Carbolic Acid, or Creosote, is very useful in reflex nausea. Hydrocyanic 
Acid, rr\,i-iv of the dilute acid in ^j of water, is useful (Beale). Ammonia, 
nrhj-iv of Liq. Ammonise in a winegl. of water when the feeling of nausea is 
most troublesome, may cure the ailment (Id). Hydrargyrum, a small dose of 
Blue Pill or Calomel will sometimes cure very obstinate nausea, although many 
other remedies have failed (Id). Cocaine, a 2 per cent, solution sprayed high 
into the nasal passages, so as to reach the terminal filaments of the olfactory 
branches, is specific against nausea, its influence lasting several hours (Ingra- 
ham). Chloroform, rryi-v on sugar, will relieve some kinds of nausea (B). 

Ipecacuanha, has no rival in sickness of pregnancy, scarcely less useful in 
that of chronic alcoholism ; very small doses, gr. ^ of powder or Try of wine 
(P). Pulsatilla, in dyspeptic nausea, with coated tongue, flatulence, sick head- 
ache (P). Cocculus Indicus, in cephalic nausea, violent but ineffectual efforts 
at vomiting (P). Calumba, in nausea of languid stomach with flatulence, has 
considerable reputation (P). Cinnamon or Cloves, will check nausea (P). 
Nutmeg, the simple powder in wine (P). Pimenta, Pepper, Peppermint, re- 
lieve nausea (P). Tartaric Acid, as effervescing draught, with a few drops of 
Tinct. Opii, Tinct. Calumbse, or Dilute Hydrocyanic Acid added, when from 
morbid gastric irritation (Wa). Bismuth Subnitrate, or the Liquor Bismuthi, 
when the salt in substance disagrees, is a remedy of established value in nausea 
and vomiting arising from gastric disorders; maybe combined with Hydro- 
cyanic Acid (Wa). Counter-irritation, by a mustard poultice applied over 
the region of the stomach and liver for 20 minutes every 3 or 4 days (Beale). 
Heat, hot water on spongio-piline, worn for an hour or two, will frequently 
be found efficacious (Id). Cold, by a compress or ice-bag, over the stomach, 
is often very useful. [Compare Dyspepsia, Headache bilious-sick, Sea- 
sickness, Vomiting of Pregnancy.] 



Necrosis. 

Sarsaparilla, a very useful medicine in diseases of the bones (P). Rest, in 
a Salter's swing, with poultices, water-dressings or stimulating lotions, to aid the 
work of repair (CI, Hilton). Tonics, nutritious food, baths, good hygiene, all 
are necessary adjuncts to local treatment (Andrews). Acid Solutions, of no 
use as solvents, may be employed with benefit for detergent and alterative 
effects to expedite the sloughing and restorative processes (Gross). Operation 
to remove sequestrum is generally necessary ; or resection of the devitalized 
bone, the latter in young subjects greatly exhausted, where delay would 
endanger life (Gross). Potassa cum Calce introduced into fistulse, to convert 
them into large openings, permitting the removal of diseased bone (Kirk- 
patrick). [Compare Caries, Bone Diseases, Syphilis, Scrofulosis.] 



Nervous Affections. 

Nux Vomica, in one-drop doses of the tincture every 5 minutes, is promptly 
efficient in relieving many affections of reflex neurotic origin, as cough, 
dyspnea, syncope, palpitation, flatulent dyspepsia, eructations, etc., especially 
when occurring in hysterical subjects (Macfarlan). Arsenic, of especial value 
in nervous affections resulting from malaria, in which large doses are required ; 
nr,x of Liq. Arsenicalis, increased to rr\,xxx thrice daily (Wa). Asafcetida, is a 
remedy of much value in nervous affections connected with uterine derange- 
ment, also in dyspeptic hypochondriasis and other nervous affections ; may be 
combined with bitter tonics and mild aperients (Wa). Potassium Bromide, 
takes precedence in epilepsy, epileptiform convulsions, hysterical convulsions 



772 NERVOUSNESS. 

and spasms, tetanus, etc. ; is of great value in chorea, insanity, acute mania, 
insomnia, delirium tremens, some forms of neuralgia, and the numerous 
symptoms of vaso-motor disturbance, such as numbness, coldness, deadness, 
pricking sensations, indefinable but distressing sensations in abdomen, hypo- 
gastrium or epigastrium ; feelings similar to rigors, with anxiety, palpitation or 
fluttering of the heart — all due to interference with the local circulation (Rey- 
nolds). Valerian and Valerianates, are thought to exercise some special 
influence over nervous affections, especially Zinc Valerianate, in half-grain to 
grain doses in pill, or the Ammoniated Tincture of Valerian, from which every 
good that can be expected from the valerianates will be more certainly 
obtained (W). Sumbul, acts as a nervous stimulant, and is especially effi- 
cacious in neurotic migraine, also in hysteria and the obscure paralytic affec- 
tions associated therewith (Wa). Caffeine, is of signal value in neuralgia, 
hemicrania and other nervous affections (Shaffer); grain-doses in solution 
hypodermically afford great relief in dorso intercostal neuralgia attending 
shingles, insomnia, etc. (Anstie). Cocaine is a powerful nerve stimulant, 
destroying the sense of fatigue, and often evincing marked analgesic power in 
neuralgias ; is effective in melancholia, hypochondriasis, etc., as well as locally 
in nerve pain over a limited area ; it acts as an excitant upon the central 
nervous system (R). Opium, is a remedy of marked value in insanity, melan- 
cholia, mania, and all nervous affections accompanied by pain (W) ; gives 
general repose to both body and mind, is of decided value in diabetes, and pro- 
duces marked improvement in melancholia and despondency (R). Lupulin, 
is peculiarly useful in nervous affections when Opium cannot be tolerated, 
especially in chronic hysteria attended with morbid vigilance, 10 grain doses 
every 6 hours afford great relief, without causing any unpleasant symptoms 
(Eberle). Santonin, in convulsions, epileptiform seizures, and affections 
regarded as choreic, etc., the result of reflex irritation from worms (Wa). 
Phosphorus, of occasional utility in affections of the nervous system induced 
by mental exertion or over-excitement; the danger from its use is its liability 
to produce fatty degeneration of the internal organs (Wa). Sodium Phos- 
phate, hypodermically, employed with great benefit in a case of syringo- 
myelitis, also in one of unilateral astasia-abasia : is considered by Luton to be 
possessed of reconstructive power equal to that of the animal extracts. Orchitic 
Extract, has been used with benefit in several affections of the nervous system 
[see page 162]. Physostigma, given for six months or longer, in small doses, 
gr. ^jj of the extract every 3 hours, is useful in many nervous affections, as 
locomotor ataxia, writer's cramp, and paraplegia due to myelitis (Murrell). 
Silver Phosphate, is of special value in sclerosis of the nervous substance and 
in myelitis (Wa). Shower Baths, cold, are often beneficial in nervous affec- 
tions unconnected with disease of the brain. [Compare Diabetes, Hemi- 
crania, Headache nervous, Hemiplegia, Hysteria, Insomnia, Loco- 
motor ataxia, Mania, Melancholia, Myelitis, Neuralgia, Neuras- 
thenia, Neuritis, Nervousness, Paralysis, Paralysis agitans, Spinal 
paralysis, etc.] 

Nervousness. 

Opium, calms the nervous system and gives general repose to both body and 
mind (R) ; small doses, identity of drug to be carefully concealed lest the opium- 
habit be formed. Antipyrin, is efficient for nervous irritation. Ignatia, in small 
doses better than Morphine for mental excitement and nervous erethism (P) ; 
for the nervous exaltation of cinchonism (Pf ). Strychnine, affords relief in 
functional irritability of the nervous system, manifested by restlessness and 
wandering neuralgic pains (B) ; especially useful as a tonic in nervousness 
from over-use of tobacco (H). Potassium Bromide, especially for women who 
are despondent, irritable, and sleepless, from overwork, grief, worry, etc. ; often 
connected with migraine (R) ; gr. ss-j of any Bromide every % hour, is very 
efficient for the nervous disturbances of children (Smith). Valerian, extremely 



NEURALGIA. 773 

useful as a sedative to reflex excitability, calms nervousness, does much good 
in fevers where restlessness, fidgets, anxiety, etc. (P). Aconite, gtt. j of tinct. 
at bedtime, repeated if needful, for restlessness and " fidgets" of men as well 
as women (R). Caffeine, for restlessness due to great lowering of nervous 
power (P). Chamomile, lowers reflex excitability (P); minim doses of the 
tincture every 15 minutes an excellent sedative for children (Smith). Resorcin, 
produces quiet sleep in general nervous excitability. Conium, where a great 
deal of motor agitation, especially in the typhoid-like condition with insomnia, 
exaggerated nervousness and delirium, often resulting from mental overwork, 
acts charmingly in securing sleep, by removing the motor agitation ; TT^x of a 
fluid extract of the unripe fruit, every y z hour, carefully watched (Madigan). 
Musk, serviceable in nervous affections when due to uterine derangement (Wa). 
Sumbul, often invaluable in restlessness of pregnancy ; n^xxx-xl of tinct. with 
a little Chloric Ether as a draught (P). Camphor, a powerful subduer of reflex 
excitability (P). Chloral, where restlessness, debility (R). Chloroform, the 
Spirit internally (R). Hop, the hop-pillow is deserving of trial. Lupulin is 
peculiarly useful when Opium cannot be tolerated (Wa). Water, warm spong- 
ing to induce sleep and calm restlessness in convalescence; also, cold spong- 
ing (R). [Compare Insomnia, Irritability.] 



R. Strychninse Sulphatis, . gr. j. 
Quininae Sulphatis, . . 3J. 
Tinct. Ferri Chloridi, . 3 v. 
Ac. Phosphor. Dil., 
Syrupi Limonis, . . aa !|ij. 
M. Sig. — A teasp. in water thrice daily. 



R . Potassii Bromidi, . . . ^ j. 

Ext. Guaranas Fl., . . ^jss. 

Syr. Tolutani, .... ,^iij. 

Aquae, . . . q. s. ad ^ vj . 

M. Sig. — Teasp. to a dessertsp. three or 

j four times daily. To relieve nervousness. 



Neuralgia. 

Antipyrin, is prescribed in all forms of neuralgia (M) ; is highly efficient in 
neuralgia of the 5th nerve associated with neuritis (B). Acetanilid, is used with 
success in facial and intercostal neuralgias (M) ; is highly useful against pain 
due to inflammation of nerves (B). Phenacetin, is especially useful in the 
fugacious and variable neuralgias so common in the hysterical and neurotaxic 
(M) : of the three drugs named Phenacetin is probably the safest and most effi- 
cient in doses of 8-10 grains. Salipyrin has been employed with excellent 
results ; a dose of gr. viij being often sufficient. Phenocoll, is used successfully, 
especially for the neuralgic pains of epidemic influenza (grippe). Salol, is 
very efficient in some forms. Salicylates, in large doses, cured a case of tic 
douloureux of 12 years' standing (Dercum). Opium, internally, or Morphine 
hypodermically, in the vicinity of the affected nerve, the best treatment; cau- 
tion ! morphine-habit (B) ; gr. ^ to X often relieves and frequently cures after 
a few repetitions (P) ; no remedy promises more speedy and permanent relief 
than Morphine by subcutaneous injection in sciatica, lumbago, tic douloureux 
and other neuralgic affections (Wa). Aconite, when arterial excitement (B) ; 
in congestive neuralgias, and acrodynic of extremities ; has important role (P) ; 
as ointment or liniment, especially when fifth nerve affected ; also in neuralgic 
headache (R) ; a remedy of great value (Wa) ; a perfect physiological remedy 
against neuralgia, especially those forms which are based on congestive or sub- 
inflammatory affections ; but its action is often slow, so that Morphine must be 
given with it as a palliative. Aconitine, with Veratrine as an ointment locally, 
a good application (Da C) ; internally the best agent of all in essential neu- 
ralgia ; should be combined with Quinine in intermittent forms and those which 
resist quinine alone. [See formula, p. 776.] Belladonna, must be persisted 
with in full doses ; gr. -£$ of Atropine internally, or gr. ^ to -^ hypodermically 
in vicinity of nerve, has special utility in tic douloureux and sciatica; also in 
peri-uterine and dysmenorrheal neuralgias (B) ; rr\j of solution of gr. j in 3ij 
of water hypodermically (P) ; for spinal irritation, intercostal neuralgia; the 



774 NEURALGIA. 

Liniment or Ointment of Atropine in facial (R) ; gr. ijss of the extract every 
hour till giddiness, then lessen the dose and continue for several days (Tr). 
Veratrum Viride, tincture, said to be very useful (R) ; Veratrine Ointment for 
facial neuralgia and sciatica (R) ; the Oint., gr. viij to gj, frequently of much 
benefit (P). Quinine, large doses, gr. v-xx in sherry, just before the attack in 
periodical neuralgia, whether malarial or not ; useful also, in small, frequently 
repeated doses, in other types, especially of supra-orbital nerve (P); has selec- 
tive action upon supra-orbital form (Spender). Arsenic, cures by its influence 
on bodily nutrition ; directly so in neuralgia of malarial origin, though inferior 
to Quinine (B) ; in various neuralgias, also in angina pectoris (R) ; the Bromide 
of Gold and Arsenic rendered good service in an obstinate case of trifacial 
neuralgia diagnosed as due to syphilis, after other treatment besides anti- 
syphilitic had failed (E. A. Wood). 

Nux Vomica, is most useful in visceral neuralgias, as gastralgia, hepatalgia, 
etc., the tincture with carminatives in the former affection ; or Strychnine, gr. 
two t0 3*2 twice or thrice daily : in all forms of neuralgia this remedy should be 
used in small doses (P). Ignatia, in hysterical and intercostal neuralgia with 
nervous erethism, is valuable (P). Phosphorus, gr. T ^ every few hours, has 
made very effective cures (B) ; gr. T j^y to -^ every 3 hours ; very useful in all 
forms, especially when uncomplicated (R) ; always a good remedy, except for 
cases due to cold or inflammation, and those not depending on depraved nutri- 
tion (H). Ammoniated Copper, in neuralgia of the 5th, used with remarkable 
success ; ^ -grain doses pushed (Fereol). Physostigmine, very efficient in neu- 
ralgia of the eyeball, a solution of gr. ij to the % by instillation. Cannabis In- 
dica, %-Yz gr. doses of extract 2 or 3 times a day ; especially for neuralgic 
headache (P) ; found useful (R). Cod-liver Oil, when low nutrition, faulty 
assimilation (W). Iron, when from anemia; tincture of the Chloride rt\,xxx-xl 
ter die, also chalybeate waters (B) ; only moderate doses required (R) ; in 
chlorotic subjects, of whom nearly all will have neuralgia (Tr). Iodides, for 
neuralgia of fifth, dependent on syphiloma of the nervous system, pain noc- 
turnal chiefly (B). Bromides, benefit some kinds, especially ovarian (B) ; 
Potassium Bromide occasionally relieves (R). Ammonium Chloride, half- 
drachm doses in facial and other neuralgias, is much used (R) ; a very efficient 
and diffusible stimulant, gr. xx-5j at first, repeated every hour during the 
attack (H). Chloroform, as anesthetic to relieve pain, is occasionally useful 
locally, also as spray for uterine neuralgia (R) ; nvv-xv of pure Chloroform by 
deep injection into vicinity of affected nerve, a very efficient method of dealing 
with long-standing cases (B) ; used in one case it caused symptoms so severe as 
to imperil the life of the patient (W). Theine, hypodermically, is promptly anal- 
gesic, and has prolonged influence, but must be aided by remedies to improve 
the nutritive state of the affected nerves, or agents which are capable of remov- 
ing the diathesis upon which the neuralgias depend (Mays). [See formula, 
p. 776.] Caffeine, hypodermically has been found useful, especially in cervico- 
brachial neuralgia (P). Cocaine, as a hypodermic injection, a 4 or 5 per cent, 
solution is very effective if administered in the vicinity of the aching nerve 
(R) ; also by instillation in neuralgia of the eyeball, and whenever it can be 
applied to the mucous surface in the vicinity of the pain. Croton Chloral, very 
effective, especially in tic douloureux and sciatica, gr. ij-v every hour till gr. 
xv are taken (B) ; in facial, that from carious teeth, that of neck and back of 
the head, tic douloureux, etc. (R) ; gr. j every >£-hour is a very efficient dose 
(Smith) ; rarely of any value, but when used it is best given in 20-grain doses 
twice daily (H). Chloral and Camphor, equal parts, triturated together, and 
painted over surface (R) ; also with Morphine (B). Amyl Nitrite, inhaled in 
dysmenorrheal neuralgia (B) ; and when of 5th nerve (R). Nitro-glycerin, 
has often afforded great relief (Wa). 

Sumbul, for certain types, of more value than any other remedy ; facial, 
sciatic, or ovarian neuralgias, in women of nervous constitution, often yield to 
it at once (P). Cimicifuga, in neuralgia of the 5th from cold, and in ovarian 
(B). Gelsemium, successful in neuralgia of 5th (B) ; especially dental branches 



NEURALGIA. 



775 



(R) ; of value in trigeminal, ovarian, etc. (W); in suitable cases small doses 
answer as well if not better than large ones (Pf ) ; TT\^iij of the tincture every l / % 
hour often succeed miraculously with no ill results in neuralgise about the head 
and face (Smith); no better remedy in tic douloureux, but must be given in 
large doses, rtv.x-xv of a strong tincture or fluid extract (H). Zinc Valerianate, 
extremely beneficial in neuralgia from reflex irritation of female pelvic organs 
(B). Spigelia Anthelmia, is useful in the facial form (P). Ammonium Valeri- 
anate, or Zinc Valerianate in neuralgia of face or head (R) ; the latter in ner- 
vous cases, and uterine (Wa). Chamomile, in neuralgia of the 5th nerve (R). 
Staphisagria, internally and externally often curative in obstinate facial and 
cervical neuralgia (P). Ergot, much employed in visceral forms, especially 
gastralgia (P) ; is said to be useful (R). Digitalis, is strongly recommended in 
sciatica, also locally in earache (P). Valerian, serviceable in facial neuralgia 
of hysterical type (P). Bibiru Bark, in intermittent forms (P). Pyrethrum, 
the root is chewed with benefit in facial neuralgia (P). Capsicum, a strong infu- 
sion on lint covered with gutta-percha (R). Coccus Cacti, has been very suc- 
cessful in 20-30 minim doses of a 1 to 8 tincture twice daily, the larger doses 
in the paroxysms (W). Peppermint, the Oil, painted over the part in facial 
neuralgia (R) ; especially the Chinese oil, which contains a large excess of 
Menthol, a very useful application in superficial neuralgiae (W). Turpentine, 
has cured tic douloureux and sciatica (B) ; often of wonderful service (P). 
Potassium Chlorate, for facial neuralgia (B). Alcohol, containing much volatile 
ether; care must be taken in prescribing it (R). Piscidia, almost specific in 
many forms, useless in many cases (W). Tonga, is efficient in facial neural- 
gia, Tr^x-xx every two hours (H). Osmic Acid, a one per cent, aqueous solu- 
tion with glycerin to prevent change, of which 5 to 10 drops hypodermically, 
has made striking cures of inveterate neuralgiae, with no ill effects resulting 
(Shapiro). Carbonic Acid Gas, injected into vagina for neuralgia of uterus. 
Aquapuncture, strangely relieves pain in a superficial nerve, so much so, that 
some hold the curative effects of morphine injections to be dueto the water alone 
(B). Counter-irritation, Mustard poultices in neuralgic pains (P) ; blisters to a 
posterior branch of the spinal nerve-trunk from which the painful nerve issues 
(Anstie). Wet Pack, is of great benefit, especially in sciatica. Intense Cold, 
produced by a spray of Methyl Chloride, or concentrated Carbonic Acid gas, 
directed along the nerve from special apparatus, immediately relieves the pain, 
and usually cures (Jacoby). Compressed Air, by insufflation into the middle 
ear, in cases of persistent and paroxysmal temporo-occipital neuralgia, due to 
chronic follicular pharyngitis and inflammation of middle ear ; if these insuf- 
flations result in diminution of the pain, treatment should be directed to the 
naso-pharynx and Eustachian tubes (Masucci). Galvanism of the affected 
nerve, one of the most important curative measures ; a continuous current of 
4 to 8 cells down the nerve generally answers best, though some cases are 
helped more by a rapidly interrupted faradic current : Electricity is of no value 
in cases dependent upon organic lesions, and in any individual case is purely 
experimental (W). Diet, animal fats necessary, as cod-liver oil, butter, cream, 
etc., in as large quantity as can be digested. Rest often needed, with protec- 
tion from cold and damp, also flannel clothing, bathing and shampooing. 
[Compare Gastralgia, Hemicrania, Hepatalgia, Otalgia, Ovarian Neu- 
ralgia, Sciatica, Tic Douloureux, etc.] 



M 



For Internal Use. 

Quininse Sulphatis, 
Ferri Pyrophosphatis, aagj. 
Strychninae Sulphat, . gr. ss. 
Ac. Phosphor. Diluti, . £ij. 
Syr. Zingiberis, . . . ^ij. 
Aquae, . . . . q. s. ad % iv. 

Sig. — A tablespoonful twice daily. 



For Local Use. 

R . Aconitinae (Duquesnel), gr. v. 
Veratrinae, ... gr. xv. 

Glycerini, ^ij. 

Cerati, . . . . gvj. 

M. Sig. — To be rubbed over the part, 
carefully avoiding any abraded surface. 

[Da Costa.) 



776 



NEURASTHENIA. 



For Internal Use. 

R . Phosphori, gr. ss-jss. 

Alcoholis, q. s. ad solv. 
Spt. Menthae Piperitae, . q. s. 
Glycerini, . . q. s. ad ^iv. 
M. Sig. — A teasp. after each meal. 

(H.) 

R . Cupri Ammonio-sulphat. ,gr. j-iv. 

Syr. Aurantii Flor. , . . ^j. 

Aquae Destil., .... ^iij. 
M. Sig. — One-third as a dose, thrice 
daily. [Prof. Fereol.) 



R 



Aconitinae Crystal., . , gr. J^. 

Quininae Hydrobrom., . gr. xx. 
M. ft. massa, et div. in pil. no. xij. 
Sig. — One every 4 or 5 hours. {Potter.) 



R . Tinct. Aconiti, 

Tinct. Colchici Sem., 

Tinct. Cimicifugae, 

Tinct. Belladonnae, . aa part. aeq. 
M. Sig. — 6 drops every hour until re- 
lieved. {Metcalf. ) 



For Local Lse. 



R 



M 



Chloroformi, 
Tinct. Aconiti, . 
Linim. Saponis, 
Sig. — Apply on 



. aa £ ss. 

• • • th 
flannel and cover 



with oiled silk. For superficial neuralgia. 



R. 



Mentholi, gr. xlv. 

Cocainae Hydrochlor., . gr. xv. 
Chloralis Hydratis, . . gr. x. 

Vaselini, 5 v. 

M. ft. ung. Sig. — For local use. 

{Potter: 



. Veratrinae, 

Adipis; vel Unguenti, 
M. Sig. — Local use. 



gr. xl. 

[Da Costa.) 



R 



Theinae, 

Sodii Benzoatis, . . . aa^j. 

Sodii Chloridi, ... gr. x. 

Aquae Destil., . . . . ^ j. 
M. Sig. — 3 to 20 drops hypodermically 
at central seat of disturbance. TT\,vj]= gr. ss 
of Theine. {Mays.) 



Neurasthenia. 

Ammonia, the Aromatic Spirit has proved very serviceable ; ^ ss-j in water 
thrice daily (Wa). Hypophosphites of Lime or Sodium, or Iron, are actively 
tonic in cases of nervous depression and torpor, with occasional shooting pains 
(Wa) ; the Syrup of the Hypophosphites with Strychnine is of service as a 
general tonic, in connection with other remedies. Arsenic, is often very 
serviceable ; Fowler's or Pearson's solution, in doses of mjij-v, in water, after 
each meal. Aurum, the Bromide of Gold and Arsenic (Barclay), gave excel- 
lent results in 3 out of 4 cases of marked neurasthenia, in doses of x\y of the 
solution 4 times daily (Love). Strychnine Acetate, a remedy of great promise, 
when combined with a rigid system of diet, mental discipline, etc. (Marshall 
Hall). Zinc Oxide, often excellent as a tonic and sedative, in nervous irrita- 
bility and depression from anxiety, over-study, etc. (Wa). Phosphorus, of 
occasional utility in nervous breakdown from over-study, etc. (Wa). Caffeine, 
gr. j or more in a cup of coffee, to relieve brain weariness and nervous 
exhaustion (Wa). Cocaine, in ^-grain doses proves serviceable in nervous 
exhaustion (R) : danger of cocaine-habit if identity known to the patient. 
Coca, as a 'Stimulant has been used with benefit, but only for a short time, 
and acts deleteriously unless given in small doses (W). Kola-nut is used in 
France, contains Caffeine, is subject to the same remarks as Coca, above. 
Musk, is a valuable remedy in such cases, being stimulant and antispasmodic ; 
it stimulates the nervous centres when exhausted, without producing any very 
pronounced symptoms (W). Orchitic Extract, has been used with benefit. 
Nuclein, is useful in many cases (Vaughn). Cerebrinin, has been used 
with advantage (Paul). Artificial Serum, in cases of lowered arterial tension 
(lessening of first sound, tachycardia embryocardia), an injection hypo- 
dermically of n\xv of the solution formulated on next page, 2 to 4 times a day 
{La France Med.). Diet should be chosen from the most readily assimilable 
food, calling for a minimum amount of digestive work. As a rule, neurasthenics 
eat too much and drink too little ; plenty of water, at least a liter and a half 



NEURITIS NEVUS. 



777 



per day, is the best drink ; it maintains the arterial tension, irrigates the tissues 
and assists the excretion of debris. Milk should be prohibited, also vegetable 
soups, peptones and extracts of meat. The albuminoid element of the food 
should not exceed one-fifth of the total (Vigoreaux). Counterirritation, the 
actual cautery along the spine has rendered excellent service in several cases 
of neurasthenia accompanied by neuralgia of the superficial branches of the 
spinal nerves ; its action is doubtless often a mental one, and it renders the 
carrying out of the rest-cure more thorough than when attempted without some- 
thing to enforce quiet. Rest-cure, with forced alimentation and systematic 
massage to keep up the muscles while holding the nervous system as inactive 
as possible, will do more than medicine in these cases. Many such will recover 
under the discipline and quiet of a hospital or sanitarium alone ; while others 
are greatly benefited by removal from home influences and cares, and from 
association with certain persons who irritate them. [Compare Adynamia, Ex- 
haustion, Gout, Hysteria, Spinal Irritation.] 



Artificial Serum. 
$. Sodii Phosphatis Pur., . giij. 

Sodii Sulphatis Pur., . . gr. lxxx. 
Sodii Chloridi Pur., . . gr. xxx. 
Ac. Carbol. Cryst. , . . gr. v. 
Aq. Destil. Bullient., ad |iv. 



Dose, TT\xv hypodermically. 



R 



Strychninae Acetatis, . . gr. j. 
Ac. Acetici Diluti, . . n\xx. 

Alcoholis, gij. 

Aquas Destill., . . . . £vj. 
Sig. — Ten drops thrice daily. [Hall.) 



Tonic and Stimulant. 



. Tinct. Kolse, . 


. . . . ^jss. 


Ac. Citrici, .... 


. . . . gr. xx 


Sodii Arseniat., . . 


. . . . gr. j. 


Tinct. Cocse, . . . 


. q. s. ad £ iv. 


Dose, gj at each meal. 





M. 



Ac. Phosphorici Dil., . . . 3j. 
Elixir Calisayae (U. S. Disp.),^vj. 
Elix. Ammonii Valerian., . t ^ij. 

Glycerini, §tij. 

Vini Xerici, . . . q. s. ad Oj. 
. Sig. — ^j thrice daily. 



Neuritis. 

Strychnine, internally, is of value, and may be given in increasing doses (O) ; 
hypodermically, in multiple peripheral neuritis, is of great advantage ; no case 
remembered in which it failed to cause improvement (Walker). Acetanilid, 
is so effective that it seems to have specific action (B). Antipyrin and Salicy- 
lates, are recommended in the acute cases with fever (O). Arsenic may be 
employed (O) ; the Bromide of Gold and Arsenic cured a case of neuritis with 
partial hemiplegia lasting five years, with inability to walk and considerable 
pain along the spine and in right arm and leg (Barclay). Potassium Iodide 
and Mercury, if there is a history of syphilis (O). Massage is probably the 
most reliable means at our command in the later stages, when the atrophy is 
marked and the pains have lessened. Contractures may be gradually over- 
come by passive movements and extension. The interrupted current is useful 
when the acute stage has passed (O). [Compare Alcoholism, Neuralgia, 
Spinal Irritation.] 



Nevus. 

Ferrum Chloride, injected, is effectual ; but dangerous when applied thus to 
nevi about the head (Wa). Creosote, pencilled over twice a day, may remove 
nevi (Wa). Chromic Acid, as escharotic, or local application, gr. c ad ^j aquae 
destil. (B). Electrolysis, or galvano-cautery, to remove nevi (B) ; 40 cases so 
treated ; the process is certain and safe, leaving a faint cicatrix and no after- 
pain (Knott) ; in my hands has answered well during ten years' use in these 
cases (Marshall). Nitric Acid, strong, as escharotic for small superficial nevi, 
followed by Oleum Olivse (B). Zinc Chloride, Iodide and Nitrate, locally, 
especially the first named (R). Setons, threads passed across the growth in 



77% 



NIGHTMARE NIPPLES NODES NYMPHOMANIA. 



various directions, to produce suppuration ; when pus appears the threads 
should be removed. Sodium Ethylate, prepared by adding the metal Sodium, 
piece by piece, to absolute alcohol in a wide-mouthed bottle ; the crystalline 
substance found deposited after effervescence ceases is an excellent caustic for 
nevi ; painted over them it rapidly causes an eschar, and usually gives but little 
pain (Richardson). Mercury, the Acid Nitrate, an excellent caustic for remov- 
ing moles from the face (Thomas). 

Nightmare. 

Potassium Bromide, in nightmare of adults, and children's attacks of night- 
screaming often associated with squinting : the digestive organs may also 
require attention (R). Camphor-water, a teaspoonful or two the most suitable 
medicine (H). Sleep, in abundance, may prevent nightmare (H). Diet, light ; 
avoid late meals and indigestible food. 



Nipples, Sore, Fissured. 

Benzoin, an admirable local application (P) ; the tincture locally for slight 
erosions (Parvin). Silver Nitrate, touched lightly, is effectual (Wa). Sulphur- 
ous Acid, solution neat or diluted, constantly applied, or with equal quantity of 
glycerin as lotion (R). Collodion, sometimes used (R) ; useful for protection 
(P) ; better applications are Arnica cerate, the glycerite of Starch, or 2 parts of 
eau-de-Cologne to 1 of glycerin (R). Lime-water, is a useful application for 
cracked nipples. Alcohol, Brandy and water as a lotion before delivery and 
after each suckling to prevent cracking (R). Borax, saturated solution, bene- 
ficial (Wa). Iron, the solution of the Subsulphate diluted with 3 parts of glyc- 
erin, and applied with a camel's-hair brush, an effective application for fissured 
nipples (B). Tannin, the Glycerite, one of the best applications to fissured 
nipples (B). Lead Nitrate, in glycerin, or ointment Z) to ^j, for fissured nip- 
ples (B). Zinc Shield, constantly worn (R). Balsam of Peru or Tolu, valuable 
as an application, with Oil of Almond, gum arabic, and rose-water (P). Rhat- 
any, as wash or cerate, has had great success in fissure (Tr) ; 1 part of extract 
to 15 of cacao-butter (Wa). Nipple-shield, to give the nipple rest while the 
child sucks, gives great comfort. [Compare Lactation, Mastitis.] 



R. Balsam. Peruvian., . . . 3jij. 

Olei Amygdalse, .... ^jss. 

Mucil. Acaciae, sjij. 

Aquae Rosae, q. s. 

M. Sig. — Apply to the nipples after 
each nursing. (Phillips.) 



K. 



Dil. 



Liq. Plumbi Subacet. 

Ext. Opii, 3J. 

Aquae Rosae, S"J SS - 

M. Sig. — Lotion to be used after a 
bread-and-milk poultice, for inflamed nip- 
ples. (J 7 . Barker.) 



Nodes. 

Mercury, the Oleate of Mercury and Morphine externally, is very valuable 
(R). Potassium Iodide, as ointment in conjunction with internal use, in syph- 
ilitic nodes of children ; also in non-syphilitic periosteal thickenings (R) : in 
syphilitic nodes it holds the first place, especially when pains are worse at night 
and increased by heat of bed ( Wa). Stramonium leaves, locally, relieve (Wa). 
[Compare Exostosis, Periostitis.] 



Nymphomania. 

Potassium Bromide, when from plethora; not useful when relaxation, or 
from cerebral lesion (B) ; large doses required, at least gr. xx ter die (R) ; an 
abundance of evidence testifies to its value (W). Tobacco, to nausea, effect- 



OBESITY ODONTALGIA. 779 

ually cures, but is horribly depressing (B). Camphor, in considerable doses 
said to control inordinate sexual desire (R) ; at present not much relied on 
(Wa). Lupulin, seems worthy of fair trial (Wa). Sulphur, or dilute Sulphuric 
Acid internally, when arising from hemorrhoidal congestion, not an infrequent 
cause (Wa). Orchitic Extract, has given satisfaction. Cerebrinin, has been 
used with benefit (Paul). 

Obesity. 

Iodoform is highly efficient, but causes wasting and anemia, the latter by 
injuring the red blood corpuscles (B). Iodol, in 2-grain doses thrice daily, is 
equally effective (B). Alkalies, as solutions of Oxides or Bicarbonates (R) ; 
alkaline mineral waters, with exercise and dietary (B) ; serviceable (Wa) ; 
Liquor Potassse 3ss in milk, thrice daily, of established value (Wa) ; generally 
fails (R). Ammonium Bromide, sets up gastric catarrh (B) ; but lessens 
corpulency (Wa). Sulphurous Waters, especially Blue Lick, Jiv before each 
meal (B). Potassium Permanganate, for attendant dyspepsia and flatulence ; 
also useful for the obesity ; gr. X~j ter die, in distilled water (B). Vinegar, 
only successful at expense of serious injury to the body (R). Fucus Vesic- 
ulosus, has power to reduce adipose tissue ; an extract is sold under the title 
Antifat as a proprietary medicine (W). Phytolacca, has been long known as 
a reducer of adipose tissue; a resinoid preparation, named Phytoline, is on 
the market as an " anti-fat," the dose of which is tt\,x, six times daily, before 
and after each meal. Thyroid Extract, has been employed in several cases 
with uniformly good results [see page 159]. 

Banting Dietary is alone sufficient to improve the condition ; its chief feature 
is the exclusion of the two elements, starch and sugar, from the food ; there- 
fore bread (except toast, or the crust of a common loaf), potatoes, sweet roots, 
butter, sugar, cream, beer, porter, and champagne, should be avoided. In one 
year, on this diet, Mr. Banting reduced his weight 46 pounds, and his girth 
about 12 inches; at the same time, his numerous corporeal infirmities were 
greatly mitigated or altogether removed ; but it cannot be recommended indis- 
criminately. This was the method of Hippocrates, avoiding all fats, starches, 
and sugars ; in fact, all roots or vegetables which grow underground (B). Meat 
Diet, very successful in 42 cases, the diet being confined to rump-steak, hot 
water and codfish, for 14 days, absolutely excluding everything else (Smith). 
The Schweninger or Oertel method is similar, using chiefly albuminous food, 
excluding fat and carbohydrates, limiting the fluids drank, especially at meals, 
and enforcing exercise. Peanuts, are an excellent article of food for the cor- 
pulent (Furbringer). [See under Diabetes Mellitus.] Exercise, daily, in the 
open air, is necessary, and if carried on systematically is the most efficient and 
least injurious method of reducing an excess of adipose tissue. 



Odontalgia. 

Aconite, as ointment or liniment for facial neuralgia due to diseased teeth, 
will succeed quickly if at all (R, Wa). Arsenic, gr. J^, as escharotic to destroy 
pulp ; when used for pain may be mixed with Opium ; it sometimes at first 
aggravates pain (R, W). Staphisagria, the alcoholic solution dropped into the 
cavity (P). Alum, a solution in Nitric Ether, gij to gvij, is said to be an effect- 
ual application (B) ; Alum and salt powdered and placed in the cavity, excellent 
when nerve exposed. Chloral, rubbed up with an equal weight of Camphor, 
and placed in the cavity (R) ; these two, with Glycerin and Carbolic Acid, equal 
parts of each ingredient, applied on a little cotton after cleaning the cavity, will 
relieve the pain, and makes an excellent mixture for " toothache drops " (Brod- 
nax). Chloroform or Croton-Chloral, equal parts of the former and Creosote, a 
good application (R). Tannin, a solution in Ether is a good application to a 
carious tooth (B). Creosote, with Tannin or Opium or Chloroform, placed in 



y8o 



ONYCHIA AND PARONYCHIA. 



the cavity of a decayed tooth, often gives relief (R). Sodium Salicylate, gr. xv 
every 4 hours, is highly efficient for toothache started by taking cold, also for 
the periostitis in which the tooth becomes loosened and projects so as to be ex- 
quisitely tender when eating (Coley). Cocaine, a 5 per cent, solution on cotton 
applied to a cavity will often bring instant relief. Coniine, a solution in alco- 
hol placed into a hollow painful tooth (R). Collodion and Carbolic Acid, equal 
parts, as jelly for filling carious teeth (R). Opium, mixed with Tannin or 
Creosote inserted in cavity of painful tooth (R). Morphine, hypodermically 
for severe toothache (R). Oil of Cloves, inserted into cavity (P). Camphor, 
with Morphine and Flaxseed, as a cataplasm to the cheek (B). Xanthoxylum, 
a domestic remedy (B). Capsicum, a strong infusion on lint (R). Gelsemium, 
useful in some forms (R). Zinc Chloride, to destroy exposed painful pulp (R). 
Ginger, Mezereon, Pyrethrum, are useful masticatories in toothache (P). [Com- 
pare Gums.] 



R. Linim. Aconiti (B. P.), 

Chloroformi, .... aa^iij. 
Tinct. Capsici, . . „ . 3J. 
Tinct. Pyrethri, 
Olei Caryophylli, 
Pulv. Camphorae, . . aa^ss. 
M. Sig. — A few drops to be placed on 
a pellet of cotton and applied to the cavity. 

(Mason. ) 

R . Acidi Tannici, . . . . gr. xx. 

Mastiches, gr. x. 

^Etheris, ^ ss. 

M. Sig. — On cotton to cavity. (D.) 



R 



Creosoti, gij. 

01. Caryophylli, . . . giv. 
01. Menth. Piperit., . . ]f j. 

Camphorae, % ijss. 

Alcoholis, . . . q. s. adO). 
M. Sig. — Toothache Drops. 



R. Morphinae Sulph., . . . gr. iv. 

Atropinae Sulph., . . . gr. j. 

Aquae Destill., . . . . %). 
M. Sig. — A few drops on cotton, placed 
in the cavity. (B.) 



Onychia and Paronychia. 

Silver Nitrate, a strong solution in Nitrous Ether, painted over the adjacent 
tissue, will abort if applied early (B) ; frequently causes resolution of the 
inflammation (Wa). Lead Nitrate, dusted over night and morning (R) ; 
relieves pain and hastens healing process (B). Turpentine, applied on a piece 
of lint or other absorbent material, stops the pain at once, and seems to abort the 
felon. Mercury, as ointment, for 10 minutes in every hour ; poultices in interim 
(R). Arsenic, gr. ij ad ^j Adipis, as ointment, almost specific in onychia 
maligna (Wa). Tartar Emetic, will shorten course and render it milder (R). 
Iodoform, oint. or powder dusted on (B) ; or 1 part to 9 of Ether applied by a 
dropper, in syphilitic onychia (Fox). Iodine, a strong alcoholic solution locally 
will often subdue the disorder (Wa). Chloral, a solution locally, as antiseptic 
and to promote healing (B). Sodium Chloride, common salt roasted until the 
chlorine is driven off, equal parts of this, Castile Soap and Venice Turpentine, 
as a poultice, is a very efficient application. Carbolic Acid, to benumb surface 
during incision (R) ; which should be carried down to the bone, especially in 
tendinous whitlow (D). Cocaine, hypodermically, will accomplish the local 
anesthesia more thoroughly, if delivered deeply into the tissue. Morphine, 
powdered, as local application to relieve pain. Heat, by poultices, is a very 
beneficial application. In Opening a felon avoid the lines of the arteries on 
the sides of the fingers, and that of the flexor tendons, which is the median line 
on the palmar surface ; the incision should be made midway between these lines. 
If the sheath of the tendon be opened the tendon may slough, and the finger 
be rendered useless (Ashhurst). Removal of the nail may be necessary in ob- 
stinate cases of onychia, the raw matrix being dressed with powdered Lead 
Nitrate. 



OPHTHALMIA OPIUM HABIT. 78 I 



Ophthalmia. 

Silver Nitrate, a strong solution, gr. xx to the ^, in granular lids ; cautiously 
when corneal ulcers exist (B) ; a solution, gr. ij-x to the ^, painted over the 
everted lids, which should be washed with a solution of common salt, and then 
with water before being replaced (C); in solution, gr. v to gj aquae destillatae, 
locally once a day in purulent ophthalmia of the new-born, washed off with a 
weak solution of common salt (Noyes) ; in solution, gr. iij to the ^, to abort 
the discharge in catarrhal ophthalmia (Fox). Boroglyceride, in many catarrhal 
affections, especially ophthalmia neonatorum, is a most efficacious application, 
the solutions used being of 10, 25 and 50 per cent, strength (Fox). Alum, gr. 
viij to ^j aquae, applied every % to x /z hour in purulent ophthalmia of children ; 
success depends on the frequency of the application (R) ; a crayon formed of 
a crystal of alum, a mild and occasionally useful application (C). Mercury, 
Calomel dusted over membrane in phlyctenular ophthalmia ; or after detach- 
ing scales rub in Brown Citrine Ointment every night, for eczema of margin of 
lids (B). Pulsatilla, as a lotion to conjunctiva 8 or 10 times in 24 hours, also 
internally (P) ; much used by homeopaths (B). Spigelia, useful in rheumatic 
ophthalmia (P). Antimony, as Tartar Emetic, gr. ^ F to ^, three or four times 
a day in strumous ophthalmia, with sharp purgation at commencement (R). 
Belladonna or Atropine locally, of great service in strumous ophthalmia to 
relieve pain ; constitutional treatment also required (Wa) ; Atropine, gr. ij of 
the neutral sulphate to the § of aqua destillata, twice or thrice daily, as soothing 
application (C). Arsenic, invaluable in inveterate cases of strumous ophthal- 
mia, especially when complicated with cutaneous eruptions (Wa). Copper 
Sulphate, gr. j to 5jj aquae camphorae as collyrium in purulent ophthalmia of 
infants; in substance to inner part of lids in granular conjunctivitis (Wa). 
Tannin, powdered or in solution, gr. j-x to the § , produces remarkable results (B). 
Lead Acetate, gr. j ad ^j aquae destillatae, applied by camel's-hair pencil to sur- 
faces of everted lids, washed away before the lid is replaced ; or the Tannate 
of Lead 1)4 to 3 parts fine Oil and 1 of fresh Lard, a very small piece as ointment 
to lid (C). Carbonic Acid Gas, said to relieve the pain and photophobia of stru- 
mous ophthalmia, when locally used (R). Physostigmine, locally, to reduce pu- 
pil and shut out the light (P). Iodine, is employed locally in scrofulous ophthal- 
mia for its alterative stimulation (W). Iodoform, in gonorrheal ophthalmia, and 
purulent conjunctivitis, of very great value locally, but should be pulverized 
very finely (Grossmann) ; does not bear out the claims made for it (Keyser). 
Zinc Chloride, gr. j ad Jjj aquae, as collyrium in gonorrheal ophthalmia is used 
with marked benefit; also a stronger solution, gr. ij-iv to the ^, effectually 
arrests the muco-purulent discharge remaining after subsidence of purulent 
ophthalmia, and has succeeded admirably in diphtheritic conjunctivitis and 
pustular ophthalmia (Wa). Zinc Sulphate, as collyrium, gr. j-iv to the ^ , is 
very serviceable in ophthalmia of infants or adults ; Liquor Plumbi added 
improves it (Wa). Staphisagria, especially in tarsal ophthalmia (P). Colchi- 
cum, when gouty diathesis (P). Cod-liver Oil, in strumous subjects, tends to 
remove the manifestations of the disease (R). Cold Wet Compresses, or iced, 
are held to be essential in the early stage of acute purulent and gonorrheal 
ophthalmia (C). [Compare Blepharitis, Conjunctivitis, Keratitis.] 



Opium Habit. 

Sodium Bromide, in large and increasing doses, 3] twice daily, increased 
by 20 grains each day, to a maximum of 100 to 120 grains twice in twenty-four 
hours, with simultaneous gradual reduction of the opiate dose, so that from the 
8th to the 10th day it is entirely abandoned; each dose of the salt should be 
given in 6 or 8 fluid ounces of cold water; this drug, with Codeine and Trional, 
form a combination of unrivalled efficacy, if properly used in proper cases, arid 



782 OPIUM HABIT. 

combined with minor aids make a method far in advance of any yet presented, 
to secure the minimum duration of treatment and maximum freedom from pain 
(Mattison) : a combination of Bromides [formula on next page], commencing 
with 40 grains, increasing to 100 grains twice daily, at 10 a.m. and 4 p.m., 
freely diluted with water, does not depress vitality, or produce the injurious re- 
sults of the bromides as commonly administered; this, with 3j of Warburg's 
Tincture before breakfast each morning, Spt. ^Etheris Nitrosi to eliminate the 
bromides rapidly, electricity, a mixture of Iron and Strychnine, and an occa- 
sional hypodermic of 5 or 10 minims of a 4 per cent, solution of Cocaine for 
nervous restlessness, is the general line of my treatment (Mann) : by acute 
bromidism it is possible to obliterate quickly and permanently the desire for 
morphine without the usual suffering, but requires careful nursing (Macleod). 
Bromides may do great harm, if recklessly administered, paralyzing the mus- 
cular system and causing prolonged delirium. Cocaine, or the fluid extract of 
Coca, has been used to relieve the depression caused by the withdrawal of the 
drug (B) ; has been, by many careful observers, pronounced of great benefit, 
restoring appetite, inducing sleep, promoting digestion, while soothing the brain 
and inducing a feeling of contentment and calm (R) : should never be entrusted 
*to the patient, lest he jump out of the frying-pan into the fire. In the treat- 
ment of the combined morphine and cocaine habit, the latter drug may be 
withdrawn entirely at once without any suffering, and the former may be re- 
duced one-half at the same time. Codeine, in doses of a grain or more, is very 
useful in combating the nervous agitation which succeeds to the final with- 
drawal of the opium. [See under Sodium Bromide above.] Trional, in dose 
of 30 to 40 grains as a hypnotic, is of special value in these cases. Paralde- 
hyde, in dose of 3jss— ij , as a hypnotic, is efficient, but its sleep is of briefer 
duration than that produced by Trional or Sulphonal. Gelsemium, subdues 
the restlessness and motor excitement; proved of great value in one case where 
30 grains of morphine were used daily ; n\j of tincture every y z hour (Pennoyer). 
Conium, in 10-drop doses of a good fluid extract, to check motor activity and 
relieve the wandering pains. Sparteine, in doses of gr. Y 2 to ^ hypodermi- 
cally, at moment of systolic cardiac depression which answers to the period of 
craving, and corresponds to the truncated curve of the sphygmographic trace, 
characteristic of the period when the stimulant effect of morphine has passed 
(Jennings). Nitroglycerin acts in the same manner, but its effect is more rapid 
and ephemeral (Id). Atropine, used with great benefit in one severe case, re- 
pressing the copious exudation from the air-passages, bowels and skin, and 
moderating the distressing symptoms due to the withdrawal of the morphine 
(W. Koch). Physostigmine, gr. -j-j^ acts remarkably well at the crisis as a 
substitute for the drug. Duboisine, injected daily succeeded in destroying the 
craving for morphine in a case of long standing (Birnabee) ; is an excellent 
calmative and hypnotic at the crisis. Hyoscyamine, Merck's amorphous, use- 
ful as a hypnotic, and is perfectly safe in patients of good general condition, 
in whom the disuse of opium produces unusual insomnia and motor activity 
(M). Hyoscine, the Hydrobromate, in doses of gr. y^ to -^, hypodermically, 
is very efficient for the same purpose, but must be used sparingly, as it excites 
high delirium in most subjects for a time. Cannabis Indica, may be required 
in full doses, for restlessness after withdrawal of the opiate, 3-doses of Squibb's 
fluid extract, repeated every hour or two, as required (M) ; or increasing doses 
of Hering's solid extract, beginning with one or two grains. Chloral, as a hyp- 
notic, fails in the first few days of abstinence ; later in full doses, 45 grains at 
once, rather than three 15-grain doses, alone or with a Bromide, it can be re- 
lied on (M). Galvanism, is very efficient for the neuralgic pains in various 
parts ; a strong faradic current sometimes acting better (M). Baths, if hot, 
105 to 112 F., are of great value to relieve disquiet; warm baths are worth- 
less (M). Lavage of the stomach with a solution of Sodium Bicarbonate, or the 
drinking of such a solution to neutralize the hyperacidity of the stomach, which 
is the cause of most of the distress (Erlenmeyer). 

Strychnine, is invaluable, especially when the cure is nearly completed (Barr). 



ORCHITIS. 



783 



Aurum, the Bromide of Gold and Arsenic, tt^x hypodermically, as a tonic, 
thrice daily, to complete the cure. Capsicum, is serviceable as a stimulant to 
the stomach and a cerebral sedative ; removes the sinking sensation at the epi- 
gastrium, and tones up the intestines. Catechu, the tincture in 3 doses, for the 
diarrhea. Ergot, in full doses, for the headache. Lupulin, with Phosphoric 
Acid [see formula below], helps to sustain the patient, lessens the force of his 
suffering, and shortens its duration (Fleming). Zinc and Iron, as blood tonics, 
administered for a month at least, are valuable restoratives, and are best 
given on alternate days (Fleming). Piscidia Erythrina, has been proposed as 
a substitute, and highly recommended, but is worthless, as are also Avena 
Sativa and many other falsely termed substitutes (M) ; there is no specific for 
the opium habit (Da C). Zinc Oxide, for the vomiting and diarrhea, begin- 
ning with gr. j once daily and increasing to tolerance (Da C). Withdrawal of 
the drug suddenly and completely, is the method of Levinstein and other Ger- 
mans, and is preferred when we can have absolute control and surveillance of 
the patient (Da C) ; entails horrible suffering, and is utterly inexcusable (M) : 
a more gradual reduction is the method usually employed, taking off one-third 
the first day, one-fourth the second day, and then gradually reducing the 
amount until the sixth or seventh day, when it may be withdrawn entirely. ' No 
agent is of any value unless strengthened by moral courage and perseverance 
on the part of the patient (Squibb). Useless to try to cure a patient while he 
is pursuing his ordinary avocations ; failure will result unless there is complete 
seclusion and entire giving up to the treatment (Mann). It is very important 
to keep the patient in total ignorance of the rate of reduction. 



U . Ammonii Bromidi, 

Sodii Bromidi, .... aa5ss. 
Potassii Bromidi, . . . . §j. 
Liq. Potass. Arsenit., . . %]. 

Syr. Tolutan., 3J. 

Aquae Menthae Piper., . . ,|jss. 
Syr. Hypophos. Comp., . 3 iij. 
M. Sig. — 3J to ^ij in water thrice 



daily. Has of total Bromides, gr. 2] 



each 3, 



R 



{Mann. 



Tinct. Capsici, 

Potassii Bromidi, . . . aa^iv. 

Spt. Ammonias Aromat. , . ,^iij. 

Aquae Camphorae, . q. s. ad^vj. 
M. Sig. — A dessertsp. several times 
daily, in the depression of alcoholism and 
the opium-habit. Instead of the bromide, 
Fowler's solution, VC\\, may be added ; or 
Tinct. Nucis Vomicae gij, or Tinct. Aur- 
antii Amari 3 v. (Ringer.) 



R . Codeinae, gr. xvj. 

Alcoholis, . . . q. s. ad solv. 

Cocainae Hydrochlor. , . . gr. xvj. 

Elixir Simplicis, . q. s. ad^\j. 
M. Sig. — 3J in water, occasionally, 
when great restlessness. Formula never 
to be given to the patient. (Potter.) 



R. Tinct. Cannabis Ind., . . ir^xl-lx. 

Spt. Athens, ?jj. 

Aquae, q. s. ad'Zy). 

M. Sig. — One dose, if insomnia is very 
protracted. (Fleming.) 



R 



Tinct. Nucis Vomicae, . . sjiij. 

Ac. Phosphor. Diluti, . . % v. 

Syr. Pruni Virg. , . . . . t ^ij. 

Aquae, q. s. ad% iv. 

M. Sig. — gij twice daily as a nerve 
tonic. (Potter.) 



Orchitis. 

Pulsatilla, mj or less of the tincture every hour, relieves the pain rapidly, 
though not the edema (St). Belladonna, int., and as oint. ; extract j ad iij 
Adipis, when inflammation has subsided (Wa). Sodium Salicylate, in gonor- 
rheal orchitis, subdues the pain in a few hours. Iodine, tinct. locally to 
remove swelling after the acute stage has passed (B). Mercury, the Oleate 
locally (B) ; Calomel gr. iij with Ipecac gr. x, at once, followed by a saline 
next morning, and smaller doses of Calomel and Ipecac every 6 hours, with 
Morphine gr. ^ hypodermically into cellular tissue of scrotum (McElroy). 
Ammonium Chloride, makes a good evaporating lotion in solution with alcohol 
and water (R). Silver Nitrate, a strong solution to the scrotum, with gentle 



;8 4 



OTALGIA OTITIS OTORRHEA. 



pressure (Wa). Tartar Emetic, in acute orchitis (R). Digitalis, locally, is 
found most useful (P). Guaiacol, pure, as a local application for the pain. 
Alcohol, with equal quantity of water, as evaporating lotion (B). Ice, bene- 
fits the inflammation and relieves pain (B). [Compare Epididymitis.] 



R- . Ammonii Chloridi, . . . gr. xl. 

Alcoholis, Aquse, . . . aa ^ij. 

M. Sig. — Lotion, to be applied on 
thin cloths to the part. 



R. Hydrarg. Ammoniat., . . £j. 
Cerati Simplicis, .... 3J. 
M. ft. unguent. Sig. — Apply locally, 
with gentle friction. 



Otalgia. 

Aconite and Opium, equal parts of the tinctures, a few drops well down the 
external meatus, will usually subdue the pain. Blistering Fluid, or Croton Oil 
Liniment behind the ear, often relieves earache (R). Glycerin, for dryness of 
meatus (R) ; or Olive Oil for accumulation of wax in external meatus, dropped 
in every night, gentle syringing in the morning with warm water (CI). Opium, 
Morphine in solution, gr. iv to the ^, with gr. j-ij of Atropine, is an excellent 
application (B). Atropine, gr. ■£$ in 3xx of water, a teasp. every three hours 
for a child in the acute otitis media of children from coryza, very successfully 
used to abort the otitis and relieve the earache (Miot) ; a solution locally is 
especially applicable in the earache of children from whatever cause, gr. j to 
the ^, of which gtt. iv dropped into ear to remain for 10 or 15 minutes. Pul- 
satilla, internally and externally, is often used with advantage (P). Cocaine, 
a 4 per cent, solution sprayed over the tympanic membrane through the exter- 
nal meatus, and forced into the Eustachian tubes by inhaling the spray and 
then expanding the tubes by Valsalva's method ; this repeated every three 
minutes is a very sure method of curing otalgia (R). Olive Oil, often used 
warm as a local application, but it is of no service and may do harm by under- 
going decomposition and becoming favorable soil for the growth of aspergillus 
or other vegetable fungi. [Compare Otitis.] 



R- . Chloralis Hydratis, 
Camphorse, 

Acidi Carbolici, . . . aagr. xx. 
Olei Ricini, 3j j. 



Sig. — Pour into the ear (after warming) 
enough to fill it ; cover with cotton wet 
with warm water, and a cloth wrung out 
of hot water. {Brodnax.) 



Otitis. 

Pulsatilla, in inflammation of external auditory canal ; in otitis, as lotion 
warmed and applied by syringe, three or four times a day (P). Aconite, 
quickly relieves the pain (R) ; should be used internally and locally. Carbolic 
Acid, a 20 per cent, solution instilled into ear in moderate otitis, relieves the 
pain at once and checks progress ; a solution in glycerin is best (Rohrer). 
Atropine, in the acute otitis media of children, is very efficient. [See Otalgia, 
above.] Blisters, behind ears, either kept discharging or repeated, are often 
very useful ( Wa). Leeches, behind the ear, afterwards a small blister upon 
the same place, when the leech-bites have healed (H). Warm Douche fre- 
quently to the ear, to secure cleanliness, then dry the part thoroughly (Roosa). 
[Compare Otalgia.] 



Otorrhea. 

Salol and Camphor, equal parts, heated together, have given good results in 
suppuration of the middle ear ; the application causes neither pain nor inflam- 
mation (Pegon). Bismuth Subgallate, on cotton tampon, introduced after 
thorough syringing with a 3 per cent, solution of Boric Acid, and careful dry- 



OVARIAN NEURALGIA OVARITIS. 785 

ing with absorbent cotton, the best means of combating an acute or chronic 
otorrhea, outside surgical measures (Chaniavsky). Boric Acid, finely pulver- 
ized, as astringent and disinfectant application ; may be mixed with pulv. 
Alum, and just enough powdered Lycopodium to keep it dry ; this packed 
carefully through speculum, after washing with a weak and tepid alkaline solu- 
tion. Absorbent Cotton, on holder, may be used every few hours by the patient 
to keep pus removed from the canal. Syringing with warm salt water, once daily, 
as absolute cleanliness is essential in the treatment. Politzer Bag, inflation 
is a useful adjunct in keeping secretions out of tympanum and breaking up ad- 
hesions (Roosa). Mercury, in chronic cases, the Brown Citrine Ointment (B). 
Lead lotions are much employed (B). [See Gonorrhea, for formula.] Potas- 
sium Permanganate, as injection or spray, gr. j to Sjj aq. destil. (B). Silver 
Nitrate, locally, a solution of gr. iv to the £ (B) ; gr. x to the g (Roosa). Cop- 
per Sulphate, gr. j-v to the § (Roosa). Tannin, the Glycerite, locally, is suc- 
cessful (B) ; especially in children (Wa). Zinc Sulphate, locally, in solutions 
of gr. ij-viij to the 3 (B) ; gr. j-v to the g (Roosa). Cadmium, gr. ij to gj 
rose-water (B). Liquor Sodae Chloratse, rrpcv-xxx ad £j aquae when discharge 
fetid ; is highly useful as injection (Wa). Quinine, with Sulphuric Acid, advis- 
able in otorrhea after scarlatina (Wa). [Compare Otitis.] 



Ovarian Neuralgia. 

Codeine, has especial value against ovarian pain (Freund), whether of inflam- 
matory or neuralgic origin, in doses of gr. ^ at least. Opium, often the cause ; 
if use stopped entirely improvement may ensue (E) ; one of the best remedies 
in ovarian pain of non-inflammatory character (Graily Hewitt). Atropine, 
subcutaneously, the best remedy for pain in the pelvic viscera (Wa). Am- 
monium Chloride, gr. xxx with gtt. ij-v Tinct. Aconiti, repeated in ^-hour if 
necessary, to relieve pain (W). Camphor, with Cannabis Indica, of great ser- 
vice in relieving ovarian pain, especially when spasmodic in character (Wa). 
Conium, or, better still, its alkaloid, used as a vaginal pessary, in all cases of 
ovarian pain, whether neuralgic or inflammatory, is quite a specific (Meadows). 
Ether, the compound spirit, in doses of rr^xxx-xl as a palliative (Anstie). 
Gelsemium, deserves a trial ; its power is great but not certain (Wa). Hot 
Water, as vaginal injections night and morning; sunlight baths, fresh air (E). 
Leeches over the groin, or inside the thigh, when ovarian pain persistent, or 
tenderness and aching (Wa). Surgical, Battey's operation as a last resort (E). 
[Compare Dysmenorrhea, Ovaritis.] 



Ovaritis. 

Tartar Emetic, as ointment for counter-irritation over seat of disease, in sub- 
acute ovaritis ; at the same time a pill of Opium, Hemp and Camphor (Hewitt). 
[Formula on next page.] Opium, in suppository or enema, more effectual than 
internally (Tilt). Mercurial Ointment, combined with Camphor and Bella- 
donna, over the seat of the disease by friction (West). Blisters, in subacute 
ovaritis are often of great service, placed over the region or to the cervix uteri 
(Wa). Enemata, of warm water, simple or medicated, in subacute ovaritis, 
are warmly recommended ; they should be retained as long as possible (Wa). 
Salix Nigra, the " pussy willow," in doses of n^xxx of the fluid extract thrice 
daily, of decided benefit in ovarian hyperesthesia, etc., of highly nervous 
women. Ergot, is valuable in chronic ovaritis, with rest and Potassium Bro- 
mide (Tait). Aurum salts, have been found beneficial in dropsy of the ovaries 
(Martini). Ovarian Extract, has been used in ovarian disease [see page 166]. 
Parotid Extract, used as an internal remedy in six cases of enlarged and tender 
ovary with menorrhagia, etc., with signal success (Bell). Turpentine, hot tur- 
pentine epithems applied over the seat of the disease (Wa). Ice, in bag, over 

5o 



y86 



OXALURIA OZENA. 



seat of pain, when intolerable, and patient too much reduced to bear leeches ; 
is often of benefit (Wa). Poultices of Linseed meal, as light as possible, often 
produce great benefit in ovarian inflammation. 



& . Ext. Opii, gr. iij. 

Ext. Cannabis Ind., 

Camphorae, aa gr. vj. 

M. ft. pil. no. vj. Sig. — One pill twice 
daily. ( Gra ily Hewitt. ) 



R. Ung. Hydrargyri, . . . . £vj. 

Camphorae, gr. xl. 

Ext. Belladonnae, . . . . gij. 
M. ft. unguent. Sig. — To be rubbed in 
twice daily. ( West. ) 



Oxaluria. 

Mineral Acids, when eructations of sulphuretted hydrogen (R). Nitro- 
muriatic Acid, renders important service (B) ; especially in the condition show- 
ing general malaise, weakness, and depression of spirits, with oxalate crystals 
in the urine (W) ; also in sciatica and other forms of neuralgic rheumatism 
accompanied with oxaluria, full doses, TtLyj-x, of this acid, with an occasional 
brisk purgative, and cold douche followed by friction (Wa). Zinc Sulphate, 
often very serviceable in irritability of the nervous system, associated with dys- 
pepsia and oxaluria (Bird). Lactic Acid, aids imperfect digestion (B). [Com- 
pare Dyspepsia.] 

Ozena. 

Aurum Salts, are very serviceable in syphilitic ozena (B). Mercury, 
the Ointment of the Nitrate in syphilitic form ; the White or Red Precipitate 
with 58 times its weight of sugar, snuffed after clearing the nose, in non-syph- 
ilitic forms (R). Potassium Permanganate, solution Z] to Oj as an injection or 
spray (B). Hydrastis, the fluid extract locally (B) ; solution Z] to ^viij as 
lotion with Tr\,v of the tincture internally thrice daily (P). Bromine, as inhala- 
tion [see formula below] ; or Iodine with Carbolic Acid, or the latter in one 
per cent, solution, as inhalations (B). Carbolic Acid, a 1 percent, solution in- 
haled from atomizer (B). Silver Nitrate, applied behind veil of palate ; gr. v-xx 
ad 3J (B). Alum, solution, 3) to Oj, for irrigation (R). Glycerite of Tannin, by 
irrigation (R). Salicylic Acid, in very weak solution, 1 to 500, as cleansing, as- 
tringent, and disinfectant wash, used by retro-pharyngeal syringe, and followed 
by applications of Calomel, in powder, to the ulcerated portions of the mucous 
membrane (Massei). Hydrogen Dioxide, the solution as spray, is a most excel- 
lent application. Salol, has done good service, as insufflation. Strontium 
Iodide, has been used in scrofulous ozena, with varied results. Cubeb, the 
Oleo-resin, gtt. xv-xx on sugar after each meal, to restrain the secretion and 
perhaps modify its character (Cohen). Calcium Chloride, gr. xxx-lx with ^j 
Decocti Kramerise ; of which 3ij-iij, diluted with an equal quantity of water, 
should be injected twice daily after cleansing with salt and water (Cohen). 
[Compare Catarrh, chronic nasal.] 



R. Tinct. Iodi, ^iv. 

Acidi Carbolici, .... gj-ij. 
M. Sig. — Use on sponge in a wide- 
mouthed bottle as inhalation. To be va- 
porized by heat of hand. [Potter.) 



R. Bromi, . gss. 

Alcoholis, ^ss. 

M. Sig. — Use by inhalation when va- 
porized by heat of the hand. 



R- . Sodii Carbonatis, 

Sodii Boratis, .... aa gij. 
Liq. Sodae Chloratae, . . ^ss-gij. 

Glycerini, %). 

Aquae, . . . . q. s. ad %v]. 
M. Sig. — Apply by means of a hand- 



spray apparatus. 



Thornton. 



R- . Acidi Carbolici, .... n\xx. 
Aquas Calcis, ..... Oj. 
M. Sig. — Use as wash or spray. 



PAIN. 787 



Pain. 

Opium, is the most efficient of all analgesics and is universally used to relieve 
pain [see page 406] ; the Liniment applied with friction relieves pleurodynia, 
superficial neuralgia, etc., and poultices containing the Tincture are useful ap- 
plications in the pain of inflammation. Opiates soon lose their power in any 
particular dose, and require increasing dosage to sustain their analgesic influ- 
ence, hence in chronic cases all other means should be exhausted before re- 
sorting to them (R). Morphine, is the most analgesic alkaloid of opium ; 
hypodermically in the vicinity of the nerve is curative when not so by the 
stomach (B) ; the Sulphate, gr. y& to }4 with Atropine Sulphate gr. y^ to y^y, 
is very efficient, but the morphine-habit must be kept in mind ; a single injec- 
tion thereof is sometimes curative in sciatica and other neuralgias ; the con- 
joined administration of Morphine and Antipyrin is much more efficient in 
pain than the use of either agent alone. Codeine, has a special influence 
over abdominal pain and that of the ovaries, and is not liable to give rise to a 
drug habit. Antipyrin, is a most efficient analgesic in doses of 10 to 15 grains, 
being especially adapted to neuralgia, migraine and the pains of gouty and 
rheumatic origin, but is of no value in pain due to a local inflammation ; it 
may be used hypodermically. [See under Morphine, above ; also page 172.] 
Acetanilid, is highly efficient in doses of 4 to 7 grains for the pains of locomotor 
ataxia and those of rheumatic origin ; also locally as a dry dressing for painful 
wounds, ulcers, etc. ; it is the active ingredient in a host of recent proprietary 
remedies against pain [see page yy]. Phenacetin, is efficient in 10 to 15 grain 
doses, for neuralgia, hemicrania, etc. Phenocoll Hydrochloride, in dose of 12 
to 15 grains, is a good analgesic in the neuralgic pains of influenza, and in 
gouty and rheumatic pain. Lactophenin, is analgesic and non-toxic; a feeling 
of comfort follows its use (Clevenger). Belladonna, is the best remedy for every 
kind of pain in the pelvic viscera (Anstie). Atropine, hypodermically in local 
pain, neuralgia, sciatica, glaucoma, etc.; when it succeeds, has more lasting effect 
than morphine (R) ; for sciatica, tic douloureux, etc. (B). Iodides, are magical 
in syphilitic nocturnal pains of head (B) ; the Ammonium Iodide, gr. iij ad ,^j 
Ol. Olivae, with friction; causes the disappearance of nocturnal syphilitic pains 
(W). Cimicifuga, relieves many kinds of pain, as neuralgia of 5th, rheumatic 
headache, ovarian neuralgia, dysmenorrhea ; inferior to Ergot in labor-pains 
or after-pains; £>j doses (B). Conium, in cancer, rheumatism, neuralgia, 
ovarian pain, etc. (R); also for the fulgurant pains of locomotor ataxia, chronic 
alcoholism, sciatica, phthisis, etc., doses of tr^x of a fluid extr. of the unripe 
fruit every }4 hour, well watched (Madigan). Iron, with Belladonna, for the 
wandering pains of anemia, in which morphine is dangerous and bromides 
are useless (Waugh). Aconitine, locally over seat of pain ; one of the most 
certain and powerful palliatives in neuralgic, rheumatic, and gouty affections 
(Wa) ; especially serviceable in neuralgia of 5th nerve (B). Carbolic Acid, as 
local anesthetic (R). Cocaine, as a local anesthetic to mucous surfaces, or 
hypodermically for minor operations involving a small area, as circumcision, 
eye operations, etc., has no equal; a 4 per cent, solution is generally employed 
(R) ; has many applications, as in odontalgia, otalgia, neuralgia of superficial 
nerves, etc. Eucaine, is fully as efficient as Cocaine in causing anesthesia of 
the mucous membranes, and is much less poisonous (Schleich) ; is absolutely 
harmless in medicinal doses, and does not affect the heart (Reichert). Theine, 
of very great value for neuralgic pain ; affects the nerve outwardly along its 
course from the site of the injection (Mays). Chloroform, locally, inferior to 
other local anesthetics, two or three drops on cotton into the ear for faceache 
or toothache ; the vapor on raw surface of cancers, for neuralgia of uterus, 
photophobic eye, etc.; by inhalation in renal and biliary colic, and to produce 
general anesthesia [which see] (R). Ether, spray for local anesthesia ; in- 
haled for general anesthesia (R). Guaiacol, locally or by hypodermic injec- 
tion, 1 part in 10 of olive oil, or mixed with equal part of glycerin for painting 



788 PARALYSIS AND PARESIS. 

on the surface, is an efficient local anesthetic, and is used successfully in or- 
chitis, in neuralgic pains of tuberculous subjects, also in sciatica and rheuma- 
tism (Moissy). Chloral, has no direct pain-relieving power, except in dangerous 
doses ; to relieve pain and promote sleep the best agent is a combination of 
Chloral and Morphine ; cautiously, if heart trouble, or in old drunkards ; gr. 
xv-xxx with gr. ^ (B) : sometimes relieves neuralgia, also pain of chronic 
rheumatism, gall-stones, colic, gastralgia, and even of cancer (R). Iodoform, 
as suppository in painful diseases of the rectum or bladder (R). Stramonium, 
is used as ointment (R). Duboisine, used instead of Atropine (B). Rhatany, 
relieves the pain of ulcerative disease of mucous membranes, pain of burns, 
ulcers, and especially of blisters (Tr). Cannabis Indica, formerly used (B). 
Aquapuncture (B). [See under Neuralgia.] Galvanism, of an affected 
nerve gives certain relief; the positive pole on point of emergence, negative 
over superior ganglion of cervical sympathetic (B). Heat, if pain is without 
fever or inflammation (B) ; warm injections soothe the pain of cystitis, prosta- 
titis and abdominal pains generally (B). Hot Water, as bath, relieves pain 
most wonderfully : Napoleon, at St. Helena, suffering from cancer of the 
stomach, appreciated highly the pain-relieving power of the hot bath ; often 
staying half and even whole days therein. Cold, when pain is inflamma- 
tory (B). [Compare the Lists of Analgesics, Anesthetics and Narcotics, on 
pages, 31, 32, 58, ante ; also in this part the articles entitled After-pains, 
Anesthesia, Boils, Chest-pains, Colic, Gastralgia, Headache, Hepa- 
talgia, Inflammation, Lumbago, Myalgia, Neuralgia, Neuritis, Odon- 
talgia, Otalgia, Ovarian Neuralgia, Rheumatism, etc.] 

R- . Antipyrini, gr. xv. 

Cocainae Hydrochlor. , . gr. ss. 

Aquae Destil., .... nl,xv. 
M Sig. — One-half as hypodermic in- 
jection, or the whole when rapid action de- 
sired. {See.) 



U . Liquoris Magendie, . . 5jj. 
Aquae, . . . . q. s. ad ^ ij . 
M. Sig. — A teasp. to a dessertsp. every 
six or eight hours, for pain. Each drachm 
contains % grain of Morphine Sulphate. 

{Potter.) 



Paralysis and Paresis.. 

Nux Vomica, in hysterical paralysis and in that from lead-poisoning ; only 
in chronic cases (P) ; in paraplegia due to softening and wasting of the cord 
(Brown-Sequard). Ignatia, in paralysis of the lower extremities (P). Strych- 
nine, hypodermically into the affected muscles, for hemiplegia, paraplegia, 
local, mercurial, paludal, rheumatismal, facial, infantile aad diphtheritic 
paralyses ; in that of the spinal muscles, of the bladder and all local forms (B) ; 
in hysterical paralyses (P) ; in all forms except cerebral and spinal paralyses 
(Barwell) ; internally in doses of gr. g 1 ^ to ^ (R). Phosphorus, with Cod-liver 
Oil in the paralysis of white softening of the brain (B) ; in hysterical paralysis 
(R) ; in myelitic paraplegia from excessive venery ; the only drug which really 
affects the nerve-centres (W). Belladonna, when depending on chronic in- 
flammation of the cord (R) ; externally as ointment along spine, with Ergot 
internally (Brown-Sequard). Physostigmine, into the eye in ocular paralyses 
(B) ; Physostigma in general paralysis of the insane, also in progressive muscu- 
lar atrophy without much mental disorder, long-standing hemiplegia, para- 
plegia, locomotor ataxia (R). Ergot, in paralysis of bladder from over-distention 
(B) ; paralytic dysuria, sensation of but partial emptying of bladder (P) ; said 
to be useful in paraplegia (R) ; in paraplegia complicated with menstrual irregu- 
larity and forms of paralysis arising from spinal congestion (Wa) ; has cured 
cases of constipation of the paralytic when all the most powerful cathartics 
failed (Curran). Cocculus Indicus, valuable in hemiplegia, paraplegia, and 
paralytic stiffness (P). Picrotoxin has greatly benefited several forms, especially 
paralysis of the sphincters, hemiplegia from cold, and glosso-labio-laryngeal 
paralysis. Cannabis Indica, for retention of urine in spinal paralysis (R). 
Rhus Toxicodendron, is certainly efficacious in paralysis depending on rheu- 
matism (P). Ammonium Iodide and Carbonate, to aid in absorption of thrombi, 



PARALYSIS AGITANS PAROTITIS. 



789 



thus promoting cerebral nutrition in cases of incipient hemiplegia, due to end- 
arteritis deformans reducing the lumen of the vessels in the brain (B). [See 
formula below.] Arnica, in paralysis of the bladder, and many forms (P). 
Orchitic Extract, has been thought to be beneficial in general paralysis [see page 
162]. Capsicum, in ]/ z to 2-grain doses every 4 hours as general stimulant (P). 
Colocynth, in cerebral paralyses, sometimes seems to act favorably upon prin- 
ciples of revulsion or counter-irritation (P). Mustard, as an emetic to stimulate 
failing heart in certain forms of paralysis (P). Senega, in rheumatic paralysis, 
is a powerful help (P). Nutmeg, the Oil as external stimulant (P). Oil of Bay, 
has been given ; is obsolete (P). Cajuput Oil, efficacious in palsy (P). Coun- 
ter-irritation by blistering fluid, in peripheral paralysis of the 7th nerve (R). 
Cod-liver Oil, when low nutrition and faulty assimilation (Anstie). Galvanism, 
in hemiplegia and many forms (B). Electricity, faradization of the muscles 
affected ; localized electricity probably of more importance in confirmed spinal 
paralysis than medicinal treatment. Massage, in infantile paralysis, given 
with Calcium Lactophosphate and Cod-liver Oil, and Strychnine injected into 
the muscles (B). [Compare Hemiplegia, Locomotor Ataxia, Paralysis 
Agitans, Tongue.] 



R. Strychninae Sulph., . .. . gr. iij. 
Aquae Destillatae (fervid.), gx. 
M. Sig. — For hypodermic administra- 
tion : xr\xz=gv. -fa of Strychnine Sulphate. 



R. Ammonii Iodidi, .... ^j. 
Ammonii Carbonatis, . . qij. 
Liq. Ammonii Acetatis, . J vj. 
M. Sig. — A tablesp. thrice daily. (B.) 



Paralysis Agitans. 

Hyoscyamus, full doses of the tincture will palliate the trembling ; or Hyos- 
cyamine, gr. -^ gradually increased to gr. T x g (B). Hyoscine, gr. yi^ or less, 
efficiently but temporarily controls the tremor of paralysis agitans (Weatherly). 
Duboisine, acts very well in most cases. Conium, has benefited some cases 
(Harley). Gelsemium, in full doses, to quiet the nervous irritation (Lavers) ; 
a combination of Conium, Hyoscyamus and Gelsemium [see under Tremor]. 
Potassium Iodide, to promote absorption (Lavers). Cocaine, influences paraly- 
sis agitans more favorably than any other remedy, large doses and frequent 
administration are unnecessary (B). Cannabis Indica, in large doses, lowers 
reflex activity. Picrotoxin, has greatly benefited some cases. Opium, Arsenic 
and Hyoscyamine may be tried, but the disease is incurable, and nothing can 
be done except to attend to the physical comfort of the patient ; there is no 
treatment which can be recommended as satisfactory in any respect (O). 
Sodium Borate, gr. xv-xlv daily, in 3 or 4 doses, produced most striking 
improvement in a case of paralysis agitans which developed after a fall upon 
the shoulder (Sacaze). Phosphorus, in small doses, with Cod-liver Oil, is very 
useful (R). Hypophosphites, the Syrup ought to be of service, if taken 
steadily for a long time. Cod-liver Oil, long continued, is more constantly 
useful than any other medicine (Anstie). Orchitic Extract, has been used 
with benefit [see page 162]. Sulphur Baths, are certainly of great value in 
this disease (Lavers). Electricity, the constant current, anode over the spine, 
cathode drawn along the course of the nerves from where they leave the verte- 
bral column to the periphery (Id). [Compare Chorea, Tremor.] 



Parotitis. 

Aconite, in febrile conditions (R). Mercury, % grain of Gray Powder, 3 or 
4 times a day, is very useful, relieving pain and swelling (R). Poultice of 
Flaxseed meal, is a good local application for the gland. Leeching, often 
gives speedy relief, when pain is great and resists hot fomentations (Wa). 
Care to avoid chilling, important. Incision, when suppuration occurs. Stimu- 
lants and Tonics internally are very necessary in symptomatic parotitis, occur- 
ring as a complication or sequel of other diseases, with adynamic symptoms. 



790 



PEDICULI PEMPHIGUS — PERICARDITIS. 



Pediculi. 

Mercury, as Citrine Ointment or a wash of Corrosive Sublimate solution, for 
lice on all parts of the body; the Oleate destroys lice immediately, and also 
kills the ova (R) ; for crab-lice the ordinary Blue Oint. is very disagreeable, and 
often toxic in its effect on the patient ; a better preparation is Calomel in 5 per 
cent, oint., or the Bichloride, a 1 percent, solution in alcohol, of which ateasp. 
to a pint of water, as a bath to parts twice daily. Cocculus Indicus, destroys 
pediculi (P) ; the tincture undiluted as a wash. Staphisagria, as Oil or an oint- 
ment of the powdered drug (R) ; " lice-bane " (P); the tincture a very efficient 
application, and much more cleanly than an oil or an ointment. Acetum, 
Vinegar will kill the nits, as it softens the adhesive chitin by which the ova are 
glued to the hairs. Benzol, is a very efficient, convenient and cleanly applica- 
tion for destroying pediculi capitis or pubis, if fire or light be carefully avoided : 
a single application is usually sufficient. Ether, washed over the parts, effectu- 
ally destroys crab-lice. Tobacco, a decoction of the leaf is an efficient appli- 
cation, but requires care, especially if the surface is abraded (Wa). Essential 
Oils, will kill pediculi, as Rosemary, Anise (P) ; or powdered Pyrethrum (R). 
Cleanliness, cannot be dispensed with, and in many cases may alone be suffi- 
cient. Boil the underclothing. Isolation of person, and of brushes, towels, 
etc., to prevent infection. In Vienna the following prescriptions are used: — 



R-. Bals. Peruvian., 

Petrolei, aa part. xv. 

Olei Pichuri, part. j. 

To be applied and washed off after 3 
hours. 



R- . Acidi Salicylici, .... part, ij-iij. 

Aceti, ...... . part. xxv. 

Alcoholis (80 per cent.), part. lxxv. 
To be rubbed on with a bit of flannel. 
One application is often enough. 



Pemphigus. 

Antipyrin, internally, for the itching, is efficient. Arsenic, is curative, espe- 
cially when chronic (B) ; largest dose, rr\,v of Liquor Arsenicalis 3 times a day 
on full stomach (R) ; exercises a powerful influence (Wa). Mercury, as Citrine 
Ointment is largely used (Wa). Potassium Iodide, improves the condition in 
pemphigus (Wa) ; with good, simple diet ; Quinine, Cod-liver Oil, etc. Silver 
Nitrate, gr. ij ad ^j aquae locally in pemphigus, after the bullae have burst and 
excoriations remain (Wa). Water Dressings, on lint, covered with oiled silk, 
applied constantly, in pemphigus and rupia ( Wa). Cod-liver Oil, with nutritious 
diet, is a powerful auxiliary to treatment (Wa). Puncturing the blebs and 
evacuation of their contents are necessary as soon as formed; cleanliness, the 
frequent use of a 1 in 1000 corrosive sublimate lotion, a dusting powder of 
equal parts of boric acid, zinc oxide and starch, are speedily effective (Mn) ; or 
buckwheat flour, lotions of Liquor Plumbi Subacetatus Dilutus, or painting 
with a 4 per cent, solution of Silver Nitrate in alcohol, after cutting off the tops 
of the blebs and cleaning the bases. The affection is highly contagious. 



Pericarditis. 

Aconite, when violent throbbing and extreme pain (R) ; of great value, if 
given early (P) ; proves in the highest degree serviceable, when object is to 
diminish vascular excitement or irritability (Wa). Spigelia Anthelmia, useful 
in rheumatic pericarditis (P). Digitalis, when rapid and feeble heart, cyanosis 
and dropsy (P, N) ; in second stage when heart flags, a tablespoonful of the 
infusion every 4 hours is beneficial. Bryonia, exceedingly valuable in second 
stage, that of exudation ; fully equals any remedy in pericarditis (P). Opium, 
regularly in grain doses, every 3, 4, 6, or 8 hours, is very beneficial* (Wa). 
Veratrum Viride, extract made by inspissating the juice of the root, of which 



PERIOSTITIS — PERITONITIS. 79 1 

gr. ij with gr. j of Calomel every 2 hours, valuable (Waring-Curran). Quinine, 
gr. xv-xx may suppress an acute attack, if given at critical moment (B) ; may 
be used as an antipyretic. Counter-irritation, has been much abused ; useful 
at commencement, but not in acute inflammatory stage (B) ; by Iodine painted 
over the cardiac region, or flying blisters in the second stage. Iron, the tinc- 
ture in full doses may be required in the second stage. Poultices, large, hot, 
often renewed (R). Ice may be used instead of poultices in the early stage. 
Paracentesis, by aspiration, may be required in the second stage. [Compare 
Endocarditis.] 

Periostitis. 

Mezereon, in the rheumatic and scrofulous form (P). Mercury and Mor- 
phine, the Oleate externally (R). Potassium Iodide, in syphilitic children, also 
in non-syphilitic periosteal thickening (R) ; holds the first place for syphilitic 
affections of the bones (Wa). Ammonium Iodide, cures periostitis most readily 
when syphilitic (Wa). Staphisagria, when the long bones are affected (P). 
Iodine, the tincture, or blisters locally, of great service in chronic form (R) ; 
under the external use of Iodine periostitis often rapidly improves (Wa). 
Poultices, after an early and free incision, when suppuration takes place (C). 
Incisions, carried deeply, should be made without waiting for fluctuation, when 
great tension exists and there is a tendency to suppuration ; the sides of the 
abscess should then be brought together with compresses and a bandage 
(Gross). Tonics and Stimulants, as milk-punch, Quinine, Iron, and Opium, in 
full and sustained doses, are imperatively demanded in many cases (Gross). 
[Compare Nodes, Onychia.] 

Peritonitis. 

Phenacetin, as an antipyretic ; is efficient and safe. Aconite, of great utility 
when sthenic reaction ; [see Opium below] ; should be given early in all 
inflammations of serous membranes (P). Bryonia, exceedingly valuable in 
second stage, when exudation (P). Mercury, when tendency to fibrinous 
exudation, is employed with good effect (W). Opium, to quiet intestinal move- 
ments (R) ; by far the best agent (P) ; Morphine, gr. ^ hypodermically, will 
often abort, if given early ; Aconite and Opium, the tinctures, gtt. ij of the 
former with gtt. vj of the latter, in water every hour or two ; a larger dose of 
opium if pain is severe (B) ; large doses of opium are easily borne in this affec- 
tion (Wa). Cocculus Indicus, for tympanites ; a few doses will often remove 
the pain and relieve distention (P). Quinine, strongly urged by Trousseau ; is 
naturally indicated in most inflammations (P). Turpentine, for tympanites 
(P) ; turpentine stupes, v-xv drops of Turpentine on flannel wrung out of hot 
water during acute stage, then blisters for a short time (B). Leeches, to abdo- 
men, if patient plethoric and of sthenic reaction, relieve pain (B). Purga- 
tives, are inadmissible when from perityphlitis or inflammation of appendix 
vermiformis (B). Poultices, large, hot, and frequently renewed ; should be 
thin, and covered with cotton-wool (R). Ice, to abdomen (B) ; cold relieves 
(W). Hot Water, as fomentations to relieve pain, sometimes cold compress 
better. Ice, sucked or swallowed, to assuage the vomiting ; sips of cold water. 
Diet, after acuteness of the attack has passed ; should be mild and unstimulat- 
ing. [Compare Puerperal Peritonitis.] 

Peritonitis, Tubercular. 

Quinine, in the acute form to reduce fever, as in acute tuberculosis, together 
with rest, poultices or warm fomentations, liquid diet, Opium, etc. (Whitla). 
Cod-liver Oil, by inunction with friction, also its continuous administration by 
the binder and mackintosh, is of great value in the chronic form of this disease 
(Id). Arsenic, children affected with tuberculosis involving the intestines and 



792 



PERSPIRATION. 



peritoneum have steadily and slowly improved and finally recovered under the 
Arsenic treatment (R). Laparotomy, has been done with uniform success and 
with complete cure of the disease in 80 per cent, of all cases of tubercular 
peritonitis in which the abdomen was opened, cleaned and drained (Tait) : in 
131 cases so treated 84 were cured and 23 greatly improved; only in 3 per 
cent, could death be ascribed to the operation (Konig) ; of 38 cases treated by 
simple laparotomy in 1896-97, 21 cases or 55 per cent, were completely cured 
(Chrobak). Treatment by medicine is useless, tapping is at best only of tem- 
porary service, incision and evacuation of the abdominal contents afford by far 
the best chances of recovery (Id). 



Perspiration. 

Belladonna, as liniment locally, also the tincture internally, especially in 
weakly children who sweat profusely (R). Atropine, gr. ^^ to y^ hypoder- 
mically, or in exceptional cases even gr. ^ in pill, in sweating of phthisis and 
exhausting diseases (R) ; gr. ^ at bedtime for sweats of phthisis (B). Duboi- 
sine, may be used instead of atropine. Pilocarpine, gr. jfo thrice daily, checks 
profuse perspiration (R, Pf ). Naphtol, in a 5 per cent, ointment or alcoholic 
solution, is a very efficient application for local sweating (Kaposi). Potentilla 
Sarmentosa, the Cinquefoil, an infusion of the vine, leaves, and root, may be 
drunk ad libitum, and is a very efficient remedy for night-sweats, having 
stopped them when Atropine failed to relieve (Pope). Salvia, the ordinary 
Sage-tea is very efficient, used internally and locally by sponging the body ; 
the infusion for night-sweats of phthisis (Da C). Quinine, in that of exhaust- 
ing diseases ; in many cases a night-draught of Quinine, Zinc Sulphate and 
Sulphuric Acid is useful (R) Opium, as Dover's powder, may succeed in 
profuse colliquative sweating (R) ; a fact, though it is hard to account for it 
(Wa). Agaricine, is used successfully [see formula below]. Agaricic Acid, 
in dose of gr. ^ to -|, not hypodermically, one of the most efficient agents 
against sweating from various causes, especially that after influenza ; in over 
two years' use, it only failed me in one case (Richards). Camphoric Acid, gr. 
x-xxx, dry on the tongue, not over 2 hours before the expected sweating, is 
remarkably efficient against sweating from various causes, especially that of 
phthisis even when very profuse (Jas. Wood). Aromatic Sulphuric Acid, 
to check sweats of phthisis; bad for digestion (B). Muscarine, has been used 
with great success in the sweats of phthisis and of other morbid states (R). 
Zinc Oleate, rapidly controls excessive and offensive sweating in the axillae 
and groins on slight exertion, also the night-sweats of phthisis (Murrell). 
Zinc Oxide, gr. iij, with gr. ss of Ext. Belladonnas, in a pill at bedtime for the 
sweats of phthisis (R). Gallic Acid, is very useful for the same condition, and 
may be combined with extract of Belladonna (B). Tannic Acid, may be used 
with benefit. Aluminum, the Oleate, checks hyperidrosis and antisepticizes 
the sweat, thus forming a useful application to the axillae and groins of children 
(Wa). Potassium Permanganate, gr. j in ^j of water, for fetid perspirations 
of axillae, feet, etc. (B). Salicin, profuse sweats of hectic fever (Wa). Salicylic 
Acid, in solution with Borax, the most agreeable and efficient deodorant for 
fetid perspirations (B). Carbolic Acid, 2 parts, to 3 of glycerin and water, twice 
daily for fetid sweat (Wa). Oils, rubbed into the whole skin to prevent sweat- 
ing accompanying exhausting diseases, as phthisis ; but sponging with a weak 
acid wash better (R). Ergot, said to arrest sweating (R). Sponging, with 
acidulated water, or very hot sponging in phthisis (R). [Compare Feet.] 



R . Acidi Tannici, gr. xxx. 

Pulv. Digitalis, . . . . gr. xv. 
Ext. Cinchona, . . . . q. s. 
Ft. pil. xx. Sig. — One pill at bedtime. 



R. Agaricinee (Merck), . . . gr. x. 

Atropine Sulphatis, . . . gr. j. 

Acidi Sulph. Aromat. , . . % ijss. 
Solve et filtra. Dose, TT^x in syrup or 
simple elixir, 5 or 6 hours before retiring. 



pertussis. 793 

Pertussis. 

Antipyrin, is successfully employed. Phenacetin, is highly praised. Aconite, 
in all acute congestions (P) ; as a preventive or abortive remedy is very efficient 
when associated with Ipecac and cherry-laurel water (Dervieux). Amyl 
Nitrite, with Carbolic Acid, in steam atomizer, has proved a very efficient in- 
halation (Bayliss). Ipecacuanha, useful in many cases (R) ; TT\j for 5 years of 
age, every hour or two, gives the greatest relief (P) ; when bronchitic or pneu- 
monic complications, combined with Ammonium Bromide (Wa). Bromides, 
relieve spasmodic element (B) ; that of Ammonium will readily cure many 
cases ; gr. ij or iij ter die for infants (Wa). Lobelia, in spasmodic stages ; well 
tolerated by children ; n^x of tinct. every hour for child 2 years old ; also ad- 
ditional dose when cough is imminent (R, P). Alum, when acute stage is over 
and no complication exists, gr. ij— vj every three hours or less every hour, in 
glycerin or honey (R). Bromoform, in daily dosage of 5 to 20 minims, in gly- 
cerin and alcohol, very efficient for relief of paroxysms, and to reduce their 
number, but has little other influence on the course of the disease ; must be pure, 
hence colorless ; increasing doses should not be pushed very far, for fear of 
toxic symptoms (Bedford) ; is almost a specific, acting as a local anesthetic on 
the mucous membrane of the pharynx and larynx, given in doses of 1 to 5 
drops 3 or 4 times daily (Carpenter) ; it may be used by inhalation instead of 
chloroform or ether, to lessen severity of the paroxysms. Hydrogen Dioxide, 
the solution, in drachm doses diluted with 2 or 3 of water, internally, cuts short 
the paroxysms and lessens the duration of the disease. Benzol, is a reliable 
pulmonary antiseptic, and has been used for many years in this affection with 
unvarying success (Robertson) ; the vapor may be diffused throughout the 
room, carefully avoiding a light or fire. Ouabain, in doses of gr. -j^Vo every 
three hours, is highly efficient in all stages of this affection (Gemmell). 
Resorcin in solution, applied to the perilaryngeal mucous membrane, has 
aborted an attack at the outset in 24 hours, has cured well-marked cases in 
from 9 to 14 days, and is a perfect method of prophylaxis for children living 
with those suffering from the affection (Moncorvo). Naphtalin, burned in the 
patient's room, is of high value, both as a palliative and a curative agent 
(Chavernac). Belladonna, obviously of value in febrile stage, is of special use 
when dentition is in progress ; relieves the congestion of air-passages and also 
the determination of blood to the head (P) ; good when profuse bronchial secre- 
tion ; best in spasmodic stage; children bear this drug well, ttlx of tinct. may 
be given hourly to a child 3 years old (R). [Formula on next page.] Sodium 
Benzoate is highly efficient. Conium, or the Hydrobromate of Confine, in 
doses of gr. -^ to gr. ^ according to age, an efficient remedy (W). Drosera, 
small doses are effective (Murrell). Chamomile Oil, a very useful remedy (P). 
Coccus Cacti (Cochineal), in doses of gr. y^ thrice daily for infants, has been 
highly recommended (W) ; proves effective in most cases. Hydrocyanic Acid, 
is serviceable in cough from habit after cessation of whooping-cough proper, 
or in the nervous sympathetic cough of the mother (P). Myrtol, may be ex- 
pected to afford a large measure of relief (B). Formalin, as spray, is quite effi- 
cient. Opium, in the convulsive stage, to produce and maintain slight heaviness 
(R). Cocaine, a 5 per cent, solution, painted on tonsils, fauces, back of tongue, 
and if possible on larynx, is very efficient (Labrie). . Chloral, gr. v-x in spas- 
modic stage, relieves quickly (B) ; gr. iij-viij every 4 hours (Porter). Carbolic 
Acid, as vapor, with steam atomizer ; found to be very beneficial (J. L. Smith). 
Castanea, a decoction of chestnut leaves has been used with much success; 
dose ad libitum (B) ; the fluid extract, in 3-doses, exercises a remarkable in- 
fluence over the cough (W). Valerian, said to control the paroxysms (R). 
Nitric Acid, well diluted in sweetened water, after the subsidence of the catarrhal 
stage (B). Gelsemium, in spasmodic stage (B). Camphor Monobromide, gr. 
v in mucilage and Syrup of Tolu 3 or 4 times a day, has been serviceable (B). 
Zinc Sulphate, gr. %-] with Ext. Belladon., gr. l /e-}2, has varying degree of. 



794 



PHARYNGITIS. 



success (B). [See formula below.] Lactucarium, the syrup as vehicle for 
cough mixtures (B). Quinine, in solution, locally to fauces (Dawson) ; the Tan- 
nate with Sodii Bicarb, of each 5, and Pulv. Acacias 100 parts, used with an 
insufflator (Pollack). Petroleum, on rags around head of the bed, is recom- 
mended highly by Hildebrandt. Silver Nitrate, when acute stage passed (Tr) ; 
probably inferior to Alum (Wa). [Compare Cough.] 



3J- 
3U- 



R. Chloralis Hydratis, 

Potassii Bromidi, . . 

Syr. Pruni Virgin. , 

Aquae, aa f ) \. 

M. Sig. — A teasp. thrice daily for in- 
fants in the convulsive stage. (Dessazt.) 



R 



. Olei Morrhuae, 

Mellis Despumat., 

Succi Limonis, . . . aa partes aeq. 

M. Sig. — A teasp. or two as required. 

(Sir Wm. Gull.) 



R. Amyli Nitritis, ^ss. 

Acidi Carbolici, n\x. 

Glycerini, 

Alcoholis, aa ^ss. 

M. Sig. — Use by inhalation with steam 
atomizer. (Bayliss.) 



R . Bromoformi, ^xvj. 

Glycerini, ^j ss - 

Tinct. Cardamom. Co., 

Alcoholis, aa ^ij. 

M. Sig. — A teaspoonful at commence- 
ment of the paroxysm. (Bedford.') 



R. Bromoformi, " rr^xlviij. 

Alcoholis, 3 iv. 

Tinct. Cardamom. Co., . . ^iij. 
M. Sig. — A teaspoonful in water three 
or four times daily. (Carpenter.) 



R . Zinci Sulphatis, gr. iv. 

Tinct. Belladonnae, . . . TT^xlviij. 

Aq. Anisi, . . . . q. s. ad ^ij. 
M. Sig. — 20 to 60 drops, according to 
age of child, every three hours. 



Pharyngitis. 

Aconite and Belladonna, for acute attacks (B) ; when high temperature (R). 
Belladonna, is very useful, relaxes the pharyngeal muscles (W). Capsicum, 
3j of the tincture to 0)4 of water, as gargle in the very early stage only (R). 
Alum, gargles, in chronic throat inflammations (R). Silver Nitrate, gr. v-xx 
to the %, on sponge probang, successful if systematically applied (B) ; in early 
stage of inflammation ; also on brush, or as spray in the chronic form (R) : the 
solid stick to each diseased follicle, after scraping (A). Ammonium Chloride, 
gr. ij with rr^xv of Tinctura Cubebae, every half hour, often controls acute 
pharyngitis ; when a gouty diathesis exists add \\x of the Ammoniated Tinct- 
ure of Guaiac, and give every hour (Smith). Xanthoxylum, a decoction of the 
bark locally to throat, and rr\,x-xxx of the fluid extract thrice daily, a very 
successful remedy for chronic pharyngitis (B). Tannin, by insufflation to 
affected surface (B). Cubeb, powdered, locally, useful (B). Glycerin, pure, 
locally, with Tannic Acid, very serviceable (B) ; in chronic inflammation of 
the throat (R). Glycozone, frequently applied, is of benefit in follicular pha- 
ryngitis (Edson). Hydrastis, the fluid extract locally, also Tt^v-x internally 
(B). Alcohol, diluted, as gargle in relaxed throat (R). Cimicifuga, when 
pharynx dry and spotted over with inspissated mucus (R). Ipecacuanha, the 
wine as spray in non-inflammatory sore throat, with hoarseness from con- 
gestion of vocal cords (R). Pomegranate Bark, as gargle (P). Resorcin, in 
strong solution, a very efficient application (Tymowski). Potassium Chlorate, 
as lozenge to stimulate the follicular secretions to a healthy condition (A). 
Iron, Quinine, and Strychnine, as tonics, are indicated (A). Zinc Sulphate, as 
gargle, occasionally employed in relaxed throat (R). Inhalation of vapors, or 
of pulverized fluids, by the atomizer, found very beneficial (Wa). Food, of 
piquant kind, spices, pepper, mustard, etc., should be strictly prohibited ; all 
fluids should be used at a moderate temperature (A). Water, by throat com- 
press, relieves ; also in daytime, in obstinate cases. Rest, to voice and cultiva- 



PHIMOSIS — PHLEBITIS PHLEGMASIA. 



795 



tion of beard, are useful aids. [Compare Throat, sore, Tonsillitis, and 
Formulae for Gargles on page 576.] 



R . Tinct. Aconiti, 

Tinct. Belladonnas, . . aa^ss. 

Tinct. Guaiaci Ammon., . 3 v. 

Syr. Limonis, . . . ^ ss - 

Aquae Cinnamomi, q. s. ad^iv. 
M. Sig. — A teasp. every 3 hours for 
acute pharyngitis. 



R. Tinct. Aconiti, ^ss. 

Ac. Hydrocyan. Dil., . . tt\xl. 

Liquor Ammonii Ace tat., ad% iv. 
M. Sig. — Teasp. every 2 or 3 hours 
according to the severity of the case. In 
acute and subacute pharyngitis. 



R. Aluminis, 3 ss— ij . 

Sodii Boratis, 3J SS « 

Glycerini, 

Tinct. Myrrhae, . . . aaspj. 

Aquae, . . q. s. ad 3 iv. 

M. Sig. — Use as an astringent gargle, 
4 or 5 times a day. 



R- . Acidi Tannici, . . . . . gr. Ix. 

Alcoholis, ... . . rt^xxx. 

Aquae Camphorae, q. s. adSy iv. 
M. Sig. — An astringent gargle, to be 
used several times a day. 



Phimosis. 

Belladonna, as ointment, the extract 7 to 20 parts of Lard, has proven effect- 
ual (Wa). Lupulin, 5 to 15 grain doses, of advantage after operation, to keep 
the penis at rest (Wa). Surgical, division of the prepuce by bistoury and 
director ; circumcision (D). Cocaine, a 4 per cent, solution injected at several 
points around the edge of prepuce, as local anesthetic during the operation of 
circumcision. Chloroform, or Ether, as an anesthetic in paraphimosis, before 
attempting reduction (Wa). 

Phlebitis. 

Hamamelis, has as decided an influence on the venous system as Aconite 
has on the arterial (Pf ). Mercury, in frequent and liberal doses, to early and 
decisive constitutional impression ; the best form being Calomel or Blue Mass 
(Gross). Rest, fomentations, poultices, early incision of abscesses, aperients, 
Opium to relieve pain and insure quiet of mind and body (D). Blisters, over 
the course of an inflamed superficial vein (R). Diet, nutritious, also wine, 
especially if great loss of blood (D). Stimulants, as Quinine and Iron, espe- 
cially the tincture of the Chloride, also milk-punch, are needed to combat the 
depression which is sure to arise : the disease is always dangerous and often 
fatal (Gross). Incisions, must be freely made if abscesses form, and the inter- 
nal organs watched for multiple abscess. Ulceration, if it occur, must be 
watched for hemorrhage, which should be arrested by compression and styptics 
(Gross). [Compare Phlegmasia, Varicosis.] 



Phlegmasia Alba Dolens. 

Belladonna, and Mercury, equal parts, as ointment, often of much benefit 
(Wa). Hamamelis, has specific action on the venous system (P) ; extolled by 
Dr. Preston (R). Blisters, in early stage ; are extremely useful if judiciously em- 
ployed (L). Ammonium Carbonate, often valuable where great prostration ; 
full doses (Wa). Hydrochloric Acid, Z] of dilute acid in Oij of Barley-water, 
with ^ss of Potassium Chlorate, to be taken daily (Mackenzie). Opium, large 
doses internally, with leeches and anodyne ointments (Wa) ; Laudanum, 
sprinkled on hot fomentations, if pain severe (L). Leeches, of great service 
during the acute inflammatory stage (Wa). Bandaging, when the more acute 
symptoms subside ; at first with flannel, afterwards with ordinary roller band- 
age (L). Regimen, should be tonic (L). Water, by compresses in active 
stage ; hot and cold douches, in chronic form. 



yg6 PHLEGMON PHOTOPHOBIA PHTHISIS. 



Phlegmon. 

Aconite, or Belladonna are certainly efficacious ; Aconite best (R). Sulph- 
ides, to abort, or when inevitable, to promote; gr. ss-j of Potassa Sulphurata 
every hour or two (B). Silver Nitrate, a strong solution may check if applied 
early in the vicinity (B). Carbolic Acid, injections ; a 2 per cent, solution 
(B) ; used with great success (W). Iodine Injections, after evacuation (B). 
[Compare Erysipelas.] 

Photophobia. 

Atropine, a neutral solution of the Sulphate, gr. j to the ^, for adults, 
dropped into the eye every four hours (C) ; if much lachrymation, so as to di- 
lute the solution, it maybe applied more frequently ; in some cases it irritates 
and has to be abandoned (Wa). Conium, in scrofulous photophobia, gr. ss of 
Coniine in 3j of Ol. Amygdalae, locally twice or thrice daily ; or the. vapor of 
Coniine (Wa). Mercury, Calomel by insufflation (C). Canthoplasty, for the 
spasm of the orbicularis in severe photophobia (C). Glasses, of cobalt blue, 
the best color (R). Arsenic, in the condition described by old writers as stru- 
mous ophthalmia, with its attendant photophobia, is very valuable as an internal 
remedy (C). Chloroform, the eye exposed to the vapor of a few drops, in severe 
photophobia will be speedily relieved (Jones). Croton- Chloral, gr. v-x, in 
young people and those suffering from syphilitic corneo-iritis (Bader). Potas- 
sium Chlorate, internally, is most useful in some cases (Vernon). Cocaine, in 
2 to 4 per cent, solution, a few drops upon the conjunctiva, will be found 
promptly efficient in most cases of severe photophobia. 

Phthisis. 

Creosote, gives excellent results (Bouchard) ; is directly curative, at least in 
the initial stage of the disease (Frantzel) ; promotes the sclerotic change by 
means of which recovery is found to occur (Jaccoud) ; Morson's beechwood 
Creosote should be used, in doses of Try" in whiskey and glycerin, every 3 or 4 
hours ; should be largely diluted to prevent irritation, and continued for many 
months [see page 293] ; relieves cough, diminishes expectoration, stops night- 
sweats, increases weight, decreases fever, promotes appetite, and in many cases 
improves the local condition, as shown by the physical signs (Robinson) : 
the Carbonate (Creosotal), the Valerianate {Eosote), and the Phosphate, have 
each given good results. Guaiacol, the chief ingredient of creosote and 
equally efficient ; the Carbonate {Duotal), in doses of gr. vj to viij, up to 3jss 
daily, is better borne and an efficient substitute [see page 294] ; gr. iv four 
times a day increased to gr. vj six times a day, also inunctions of Europhen in 
Olive Oil, Z] in ^ijss, has given excellent results in many cases. Benzosol, 
contains 54 per cent, of Guaiacol, which it yields up in the intestines : in doses 
of 4 grains, gradually increased to 12 grains, thrice daily, it has given results 
in phthisis, equal if not superior to those from creosote (Walzer). Iodine, 
should be more used than it is; the compound solution, gtt. j-iij thrice daily, 
or when anemia and not much fever use Ferrous Iodide, tt\,xv of the syrup 
pushed to 3j ter die (Da C) ; as inhalation in chronic phthisis ; to lessen 
expectoration and cough; also as liniment painted under clavicles, to allay 
harassing cough, and to check secretion (R) ; extremely useful ; also as intra- 
pulmonary injection, a solution of the compound tincture of Iodine, 1 to 4 of 
distilled water, of which rr^x-xx injected once every 4 or 5 days, through the 
1st, 2d, or 3d intercostal spaces, anteriorly, or in the axillary region, avoiding 
the pericardium and great vessels (Robinson) : Iodine or Iodoform, with 
Creosote, Carbolic Acid, Eucalyptus, Chloroform and Alcohol or Ether, as a 
combination for an antiseptic inhalation (Br) ; a compound solution hypoder- 
mically, each 5-dose containing Iodine gr. ss, Bromine gr. 1 3 j, Phosphorus gr. 



phthisis. 797 

y^j, Thymol and Menthol of each gr. y Zl used in 35 cases with excellent results 
(Ingraham). Europhen by inunction, with Creosote internally, has given cura- 
tive results even in the breaking-down stage, and almost always cures incip- 
ient cases (Flick); [see formula p. 799]. Iodoform internally, has proved 
extremely effective in all forms, as witnessed by numerous observers in various 
countries (S. Smith) ; though not one of the most active germicides, it is 
very destructive to the bacillus tuberculosis (B). Iodol, may be advanta- 
geously substituted for Iodoform (B). Ichthyol, is far superior to creosote 
or cod-liver oil, and is very useful in pulmonary tuberculosis (Cohn) ; a 
mixture of equal parts of Ichthyol and water, of which 4 drops are taken 
thrice daily, the dose being increased by one drop daily until the maximum 
of 40 drops three times daily is reached (Id). Cod-liver Oil, holds first rank 
as a remedy and food in the chronic forms ; a teasp. after meals ter die is 
enough ; when not well borne may be combined with Aqua Calcis, Comp. 
Tinct. of Gentian ; or with Ether when not digested (B, R) ; is of great utility 
by improving nutrition, and by affecting the tubercle ; give ^ss thrice daily one 
hour after meals, with rr^v-xv of Ether, or an equal quantity of malt or whiskey ; 
do not give it in hot weather (Da C). Alcohol, an important remedy ; may be 
given with Cod-liver Oil ; or Spt. Frumenti, ^j-^ij with some bitter, immedi- 
ately after meals; if it disagrees, it harms : curiously.it induces an intractable 
form of phthisis (B). Sulphurous Acid, by inhalation, spray or fumigation, in 
chronic phthisis (R). Formalin gj, Glycerin giv, Distilled Water 3V, as spray 
for 10 or 15 minutes 4 times in 24 hours in the early stage (Green). Aurum, 
the Bromide of Gold and Arsenic internally, with inhalations of Papoid as 
glycerole by the atomizer, gave astonishing improvement in two cases of 
fibroid phthisis with cavities, due to neglected pneumonitis ; also in a case of 
grinders' consumption (E. A. Wood) ; the Chloride has rendered excellent 
service in the hands of Gibbes and Shurly. [See infra, under Chlorine.] 
Arsenic, valuable in chronic forms as no other remedy ; but not in caseous 
phthisis or where much hectic ; may be given by stomach or fumigation (B) ; 
as cigarettes, useful in the diarrhea, probably diminishes temperature, caution 
required ! (R) ; of great value in early stage, in later stages it is of no use ; 
Arsenous Acid, gr. ^, or Fowler's solution nyij thrice daily (Da C). An organic 
compound of Arsenic, named Cacodyle, is attracting much attention in France 
as a cure for phthisis; used hypodermically in doses of 5 to 10 centigrams 
daily, it is free from unpleasant results (Gautier) ; under it certain forms, with 
excavations or with softening of the tubercles, are greatly improved (Letulle). 
Aconite, in small doses for the irritative fever, is a remedy of much value (Da 
C). Antipyrin, in a 2 yi -grain dose hourly for 3 doses daily, for the hectic fever. 
Phenacetin is better borne and is efficiently antipyretic ; extensively employed 
in the hectic of phthisis. Cinchona, for the hectic and sweats, Quinine, gr. xv-xx 
(B) ; if small doses fail, a dose of 6 or 8 grains at once, or in portions repeated 
hourly (R). Ipecacuanha, the wine as spray to throat when bronchial asthma 
and emphysema combined with fibroid phthisis (R). Opium, or Morphine, 
in a viscid vehicle for cough, or as lozenges when cough due to inflamed 
throat (R) ; must in time be given for the cough, which is an irritative one. 
Codeine, gr. y% to % in simple elixir, is useful and does not constipate (Da C). 
Apomorphine, with Morphine, makes a good combination for many symptoms, 
especially for dyspnea, continual cough and thick, tenacious mucus (Br). 
Cannabis Indica, an aqueous solution [see page 243] relieves the cough and 
aids the patient in many ways (Lees). Hydrogen Dioxide, the solution inter- 
nally, in doses of Z] to iij diluted with 3 parts of water, renders good service 
by promoting digestion, palliating cough, and increasing the activity of chaly- 
beate remedies. Terebene, with Thymol and Carbolic Acid, equal parts of 
each, of which £ss to a pint of hot water as an inhalation ; is extremely useful 
for the dyspnea (Camman). Verbascum, the Mullein-plant, has long been a 
popular remedy in phthisis; it facilitates expectoration, improves the general 
condition, and palliates the cough. Calcium Phosphate, in the diarrhea, and in 
chronic forms of phthisis with little or no fever (R). Cimicifuga, useless in 



ygS phthisis. 

tuberculosis, but in phthisis it relieves cough, improves appetite, lessens inter- 
current bronchitis, and so improves the patient's general condition (Wa). 
Cocaine, locally for the throat symptoms, to be applied just before meals are 
eaten (Da C). Sanguinaria, helps expectoration, and revives the enfeebled 
stomach (P). Camphorated Naphtol, undiluted, or rr\jj in olive oil hypoder- 
mically, used with very good results in 15 out of 32 cases so treated (Reboul). 
Chloroform, with glycerin or honey, for the cough in fibroid phthisis (R) ; by 
inhalation in small quantities for the cough and dyspnea, gave extraordinary 
relief to a noble patient of mine during the last 8 months of his life (Spencer 
Wells) ; by continuous inhalation, kept short of full anesthesia, may be effective 
as a germicide in phthisis (Potter, in Pacific Med. Jour., Oct., 1890) : TT\,xv-3j 
or 3ij. by inhalation twice daily, continued for a long period of time, will give 
better results than any other known remedy (Flick) : Creosote, with Chloro- 
form as a vehicle, may be taken into the lungs from a globe nebulizer, pro- 
ducing the most happy results (Id). Chlorine gas, by inhalation, also the 
hypodermic use of Iodine and Chloride of Gold and Sodium, extensively 
employed in pulmonary consumption with good results (Gibbes and Shurly). 
Ferrum, often prescribed; has no especial influence on deposit (B) ; is pre- 
scribed in tuberculosis (Tr) ; the Liquor Ferri Perchloridi, 3j a d ^j aquas, the 
most serviceable local application in laryngeal phthisis, diminishing irritability 
of the mucous membrane, and quieting cough (Mackenzie). Mercury, gr. -j-j^ 
of Corrosive Sublimate every two or three hours, for the diarrhea (R). Benzoin, 
as inhalation, to lessen cough and expectoration (R). Mineral Acids, for the 
indigestion ; especially the dilute Hydrochloric (B). Prunus Virginiana, has a 
domestic reputation, probably due to its influence over cough ; the syrup is 
much used as a vehicle for cough-mixtures (B). Hypophosphites, are very use- 
ful in chonic cases (B) ; have no special effect (Da C). Digitalis, as an anti- 
pyretic ; deranges intestinal canal, therefore injurious in phthisis (B). Copper 
Phosphate, in nascent form soluble in an alkaline body, is held to be specific 
by Prof. Luton of Rheims ; his formula contains Neutral Acetate of Copper 0.15, 
Cryst. Phosphate of Sodium 0.75, Glycerin and Pulv. Liquorice, aa q. s. for one 
pill. Copper Sulphate, gr. T ^, or Silver Nitrate, gr. %, or Bismuth, gr. xx, for 
the diarrhea (Da C). Camphor, in oil, as subcutaneous injections during the 
period of softening [see page 241]. Amick Chemical Cure consists in the use 
of Calomel, Iodoform, Guaiacol, etc., as described by Dr. N. B. Shade in various 
journals (Waugh). [See under Patent Medicines in Appendix.] Aseptolin, 
lately put on the market by Edson, is described on page 89. Tuberculin, 
(Koch's lymph) described on page 511; a deceptive bubble which for a short 
time commanded the attention and admiration of the whole world, but which 
has been ruthlessly pricked by the critical scalpel in the hands of the father of 
modern pathology (Senn). Tuberculocidin, a derivative of Tuberculin (Klebs) ; 
is described on page 514. Antiphthisin, is Dr. Klebs' latest remedy, and is fully 
described on page 514. Antitoxin, advocated by Maragliano and Paquin, is 
described fully on page 180. Nuclein, has been employed with encouraging 
results by Vaughn [see page 161]. Baths, sea-bathing, if chronic, little or no 
fever, without active deposition of tubercle, or scrofulous pneumonia; Turkish 
baths for the cough (R). Grape-cure, is serviceable (B). Aliment, should be 
nutritious and digestible, malt liquors better than wine or spirits : extract of 
malt, cod-liver oil, plenty of meat, and alcohol in moderation (Da C) ; warm 
clothing, bathing and friction of skin, moderate exercise, and a suitable climate. 
Forced Alimentation, when anorexia appears, and superalimentation at all 
times, necessary to successful treatment ; washing out the stomach daily by 
syphon-tube, with warm water alkalinized with Borax, and then feeding through 
the tube (Robinson). Climate, the best by far is that of Egypt or Algeria; 
next coming New Mexico, Southern California, especially in the desert along 
the Colorado River, South Carolina and portions of Georgia and Florida; the 
latter being especially suitable for cases having a co-existing bronchitis ; for 
some cases Colorado is very good, and the Adirondack region for early cases 
in which there is no tendency to hemorrhage (Da C). [Compare Cough, 



PITYRIASIS. 



799 



Hectic Fever, Hemoptysis, Laryngitis tubercular, Meningitis tuber- 
cular, Peritonitis tubercular, Perspiration, Tuberculosis acute, 
•Tuberculous Affections.] 



R-. Quininae Sulphatis, . . gr. xviij. 

Pulv. Digitalis, . . . . gr. vj. 

Pulv. Opii, . . . gr. iij. 
M. ft. pil. no. xij. Sig. — One pill thrice 
daily, for the irritative fever. [Nie??ieyer.) 



&. Iodoformi, 3>j ss - 

Creosoti, ttptv. 

01. Eucalypti, .... TTixxx. 

Chloroformi, 3"j- 

Alcoholis, 

iEtheris, . . aaq. s. ad^i]. 
M. Sig. — io to 20 drops on the sponge 
of a perforated zinc inhaler, to be worn 20 
minutes thrice daily. [Bntnton.) 



Be. . Europhen, '. 3]. 

01. Rosae, try. 

01. Anisi, ^j. 

01. Olivse, ^ij ss - 

M. Sig. — % ss by inunction at bed- 
time ; wash off with bay rum or whiskey 
in the morning. [Flick.) 



R . Iodoformi, 
Creosoti, 
Pulv. Benzoini, 
Bals. Tolu., . . . . aa gr. j. 
In pill, of such 2 to 4 daily. [Hitchard.) 



&. Tinct. Belladonnae, . . 55 ij. 

Syr. Scillae, 3jij. 

Morphinae Sulph., . . . gr. j. 

Syr. Tolutani, . q. s. ad£ iv. 
M. Sig. — Tablespoonful at bedtime, for 
cough and restlessness ; to be repeated if 
necessary. 



B . Codeinae, gr. xv-xx. 

Alcoholis, . . . q. s. ad solv. 

Potassii Cyanidi, . . . gr. xij. 

Syr. Pruni Virgin., . . ,^iv. 

Aquae, . . . . q. s. ad Sjvj. 
M. Sig. — A teasp. 4 to 6 times daily, 
for the cough. [Potter.) 



Be . Arseni Iodidi, 

Strychninae Sulph., 

Hydrarg. Chlor. Corr. , aa gr. j. 

Quininae Sulph., 

Iodoformi, . . aagij. 

M. ft. pil. no. xl. Sig. — One thrice daily 
as a tonic in tubercular cases. [Mann.) 



& 



Creosoti (beech-wood), . TTbyj. 

Glycerini, %]. 

Spt. Frumenti, . . . . ^ij. 
M. Sig. — For one day's use, as directed 
in ^ss doses. [Robinson.) 



[For a Cod-liver Oil Emulsion see formula on page 572.] 



Pityriasis. 

Alkaline and Tonic Remedies generally control mild cases, together with 
baths and emollients ; the more severe ones requiring constant envelopment 
in linseed oil or cod-liver oil (Bulkley). Mercury, in obstinate cases, Donovan's 
solution, is highly successful (Wa) ; the yellow Iodide, gr. x to ,^j of lard, or a 
5 per cent, solution of the Oleate of Mercury in Oleic Acid with one-eighth part 
of Ether, applied by a camel's-hair brush (B) ; Citrine ointment, especially 
when the hairy parts of the face are affected (R) ; an ointment of Ammoniated 
Mercury and Calomel is very useful in ordinary cases of dandruff or pityriasis 
simplex (Bronson). Sulphur, 3»j to ^j of vaselin applied every morning to the 
scalp, with sweet almond oil anointing at night (Jackson). Soap, the liniment 
of soft soap as shampoo every morning for cleanliness, or Borax and water, or 
the yolks of three eggs beaten up in a pint of Limewater with gss of Alcohol, 
all of which make good shampooing mixtures (Jackson). Borax, to cleanse 
the scalp, a saturated solution ; or the Glycerite of Borax (R). Lead, the Liq- 
uor Plumbi, with glycerin, equal parts of each, and two of water, as lotion for 
cases where there are high inflammation and abundant weeping (R). Carbolic 
Acid, 2 parts to 3 of glycerin and water, twice daily, with the daily use of a 
carbolized soap, is often effectual (Wa). Sulphides, ^ss of Potassa Sulphurata 
to Oj of Lime-water, as a lotion, or the Bareges Pomade [see formula on next 
page]. Thyroid Extract, as a stimulant of the cutaneous circulation, has been 



8oo 



PLAGUE PLETHORA PLEURITIS. 



used with satisfactory results [see page 158]. Myrtol, is curative (B). Baths, 
frequently, and hard rubbing after shampooing the scalp ; avoid stimulating 
food in bad cases, as well as the use of a fine-toothed comb on children's 
heads. [Compare Seborrhea, and for Pityriasis versicolor see Tinea 
versicolor.] 



R . Sodae Sulphuratse, 

Sodii Carbonalis, . . . aa %ij. 
Axungiae, .... 3 ijss. 

M. Sig. — Pomade de Bareges. 



& • Hydrarg. Ammoniat., . . gr. xx. 
Hydrarg. Chlor. Mitis, . . gr. x. 

Petrolati, |j. 

M. ft. unguent. Sig. — Local use. 



Plague, Bubonic. 

Strychnine, should be used as a routine treatment and commenced early in 
the disease ; also with or without Ammonium Carbonate in the later stages 
when the pulse begins to fail (Lowson). Morphine, is by far the best hypnotic 
if given with judgment, gr. */%-% hypodermically at the onset to relieve suffer- 
ing and induce sleep, later on gr. l /& suffices (Id). Hyoscine, gr. ^o~rV» or 
Chloral gr. xx with Potassium Bromide gr. xxx, are of service for the same pur- 
pose (Id). Salol, gr. x every 4 hours, as an intestinal antiseptic for the diar- 
rhea, if urgent (Mn). Belladonna with glycerin, applied to the buboes in their 
early stage; if red and inflamed they must be poulticed and when softening 
occurs they should be incised and treated with Iodoform (Mn). Mercuric 
Chloride and Carbolic Acid solutions, were injected into the glands with tem- 
porary benefit, during the Hong-Kong epidemic (Payne) ; good results followed 
the injection of Mercuric Chloride and Potassium Iodide (Cantlie). Iodine, as 
liniment for indolent bubonic swellings (Mn). Calomel in full dose, followed 
by a saline, usually relieves the vomiting (Lowson). Hydrocyanic Acid and 
Morphine, in effervescing mixture, also ice pellets, for the vomiting, if calomel 
does not succeed (Id). Cold, by ice-bags to the head and neck, when head- 
ache and high fever (Mn). Water, sponging the body with warm water every 
hour to reduce hyperpyrexia, is safer than antipyretic drugs (Id). Antitoxin, 
Yersin's serum, from an immunized horse, was used in 26 cases in China with 
24 reported recoveries, but further experience in India has not confirmed its 
value (Id). Vaccination by Haffkine's protective inoculation of healthy per- 
sons, causes severe reaction ; the results, though encouraging, are not conclu- 
sive as to its value (Id). Treatment is very unsatisfactory, no specific or anti- 
dotal drug has ever been discovered. As in other asthenic fevers, give the 
patient an abundant supply of fresh air, avoid over-crowding, use cold affu- 
sions or baths at the height of the fever, also such cooling drinks as may pro- 
mote his comfort. Alcoholic stimulation appears to be of less value than in 
typhus (Payne). Diet, would seem to be of minor importance in a malady of 
such short duration (Payne in Allbutt's System). 



Plethora. 

Aconite, is useful for affections of plethoric subjects, and is decidedly the 
best remedy for apoplexy in the plethoric (P). Arsenic, is used with advantage 
when there is determination of blood to the head (Wa). Sulphur, as a mild 
purgative for plethora from cessation of the menses (Wa). [Compare Abdo- 
minal Plethora.] 

Pleuritis. 

Aconite, no remedy more effective prior to the stage of effusion (R) ; [see 
under Inflammation] ; the tincture in doses of y z drop every 3 hours to a child 
3 years old, for 2 or 3 days (J. Lewis Smith). Veratrum Viride, gtt. viij of tinc- 
ture every 3 hours, with a drop added to each dose until the pulse is reduced or 
nausea occurs (Wa) ; opinions differ as to whether it should be used in sthenic 



PLEURODYNIA. 8<DI 

or asthenic forms (R). Bryonia, exceedingly valuable in second stage ; should 
follow Aconite (P). Tartar Emetic, in early stages and young plethoric sub- 
jects, when much febrile action, small doses, gr. -^ to % , may be useful (Wa) : 
[see under Inflammation.] Digitalis, as antipyretic (R) ; deranges intestinal 
canal (B) ; Aconite preferred (P) ; the tincture in doses of one drop every 3 
hours to a child 2 years old (J. Lewis Smith). Quinine, has abortive power, 
increased by combination with Morphine, gr. xv -f- gr. ss ; also as restorative 
tonic in low-type cases (B). Opium, cannot be too highly extolled (P) ; is 
especially beneficial ; gr. ss of Morphine hypodermically at the beginning will 
often cut short an attack ; during the disease its effects are very beneficial ; a 
slight physiological effect should be maintained (B) ; Morphine for severe pain 
(R). Antipyrin, is found effective in promoting the absorption of pleuritic 
effusions [see page 173]. Diuretin, has caused a large pleuritic effusion to 
disappear [see page 233]. Guaiacol, locally to promote absorption of effusion 
[see page 294]. Potassium Iodide, to promote absorption of effusions, steadily 
for a long time (R) ; also chest painted with tincture of Iodine, one day on each 
wall alternately ; may be washed off with Potassium Iodide, Alcohol or Ether 
(B); as a diuretic to remove effusion (Clark). Iodine, as injections, with great 
benefit and without risk, in empyema and hydrothorax (P). Burgundy Pitch, 
the plaster externally as a mechanical support (P). Asclepias, the popular 
pleurisy-root, is a favorite remedy in the South (W). Pilocarpus, in subacute 
cases to remove fluids (Caro) ; or Pilocarpine Nitrate, gr. \ bis die, for children 
(Vigier) ; is too depressing and therefore unsafe (Smith). Sodium Chloride, 
3ss in ^j of water, flavored with Liquorice, in tablesp. doses every 3 hours, 
often very useful in causing absorption of pleuritic serous exudations ; but is 
contraindicated when exudation is purulent (Br). Bloodletting, by cups or 
leeches, useful by reason of counter-irritation produced, and to relieve pain, 
only in robust sthenic cases (B). Blisters, often greatly abused ; are harmful 
during inflammatory stage (B). Poultices, large, hot, and frequently renewed 
(R). Water, cold wet-pack to chest probably better than a hot one, pinned 
tightly to limit movement of chest-walls (B). Thoracentesis, by aspiration, if 
the quantity of fluid seriously embarrasses the respiration. [For Chronic 
Pleurisy see Empyema, also compare Hydrothorax, Pleuropneumonia.] 

R . Potassii Acetat. , .... gj. R. Morph. Sulphat., . . . gr. j. 

Infusi Digitalis, q. s. ad ^iv. Tinct. Axoniti, .... TT\xxiv. 

M. Sig. — Teasp. every 3 hours to a Liq. Potassii Citratis,. • ^ij. 

child of 4 or 6 years, in the second stage. M. Sig. — A teasp. every 3 hours. 



Pleurodynia. 

Cimicifuga, curative when rheumatic and valuable in sympathetic cases from 
irritability of uterus (P) ; or uterine derangements (R, Wa). Croton Oil, in 
obstinate pleurodynia especially when blackened feces (R). Belladonna, the 
plaster or liniment ; the latter generally best (R). Chloral, made liquid with an 
equal weight of Camphor and rubbed in gently, often affords instant relief in 
severe pleurisy (R). Sodium Salicylate, gr. xv-xx, every 2 or 3 hours, useful 
in most cases (Hughes). Ether, as spray, sometimes immediately and perma- 
nently removes the pain (R). Opium, as liniment rubbed in after warm 
fomentations (Wa) ; or a hypodermic injection of Morphine (R). Iodine, as 
liniment painted on the chest, often relieves where mustard fails (R). Blister- 
ing, often successful when other means fail ; sometimes strong vesication is 
necessary (R). Rest, is important and may be obtained by strapping the 
affected side with strips of adhesive plaster. Poultices, very hot, followed by 
application of lint and oilskin ; Belladonna Liniment generally better (R). 
Mustard, as a poultice, is generally efficient, and can be renewed when the 
pain returns (R). [Compare Myalgia, Neuralgia.] 

5i 



802 PLEUROPNEUMONIA PNEUMONIA. 



Pleuro-pneumonia. 

Bryonia, is often of great service ; limits effusion and assists absorption (P). 
Carbolic Acid, a 2 per cent, solution injected parenchymatously, once or twice 
a day, has had remarkable success (B). Sanguinaria, as a contra-stimulant 
(P). Turpentine, as a fomentation (P). Arnica, the tincture in doses of rr^x 
every 3 or 4 hours, very useful in controlling the heart's action (Wa). Pilo- 
carpine, gr. ss, or £ij of the tincture of Jaborandi, benefits cases of pleuro- 
pneumonia (Wa). [Compare Pneumonia.] 



Pneumonia. 

Aconite, gives good results in catarrhal and fibrinous forms (B); has marked 
effect (R) ; very valuable in first stage (P) ; in several cases it apparently cut 
short the attack (Wa) ; to reduce circulation either Aconite or Veratrum Viride, 
until the pulse is impressed (Da C). Veratrum Viride, valuable (P) ; in the very 
incipiency (B) ; opinions differ as to whether it should be used in sthenic or 
asthenic cases (R). Strychnine, in a full dose hypodermically, repeated if nec- 
essary, for impending cardiac failure ; is more useful in 1 or 2 full doses than 
in smaller doses more frequently (Pye-Smith) ; gr. -^ every 3 or 4 hours with 
free use of alcohol, the uniform treatment in the U. S. Navy, and to it the 
Surgeon-General attributes the unusually low percentage of mortality for 
1896-97 in his service from this disease. Quinine or Salicylic Acid, to reduce 
temperature (R) ; Quinine as a tonic in cases which are asthenic from the first 
(P) ; in conjunction with Aconite and Veratrum, gr. viij-xij daily at start, is 
beneficial (Da C). Antipyrin, to reduce pyrexia ; is decidedly more service- 
able in pneumonia than Quinine (Wa) ; gr. xv several times a day, or 3 hourly 
doses each of gr. xxx, then stopping until temperature rises again (R) ; such 
doses are too high and are dangerous [see page 170]; with Camphor inter- 
nally, successful in all of 22 cases of croupous pneumonia so treated at the 
Lorn Hospital, in 1894, Antipyrin gr. viij, Camphor gr. ij, Morphine Hydro- 
chlorate gr. ^g, in powder every one or two hours (Ivanoff). Camphor, in olive 
oil, in doses of from gr. j to gr. ij three or four times a day, hypodermically, 
in adynamic cases, used simultaneously with the above antipyrin and camphor 
powder (Id) ; in fibrinous pneumonia these injections lower the temperature 
about a degree and ameliorate the general condition. Ammonium Carbonate, 
at crisis for depression ; in infusion of Senega (B) [or the formula on next 
page] ; is useful late in disease when lung tissue breaks down (Da C). 
Ammonia, the Aromatic Spirit as a substitute for the Carbonate, in doses of 
3ss in simple elixir (Da C). Turpentine, as stimulant at crisis (B). Serpenta- 
ria, with Ammonium Carbonate in low types, as a stimulant about the crisis. 
Digitalis, of doubtful value ; may be useful for high temperature, ischemia, and 
low tension of vessels (B) ; as case goes on and circulation is to be further con- 
trolled, Digitalis is indicated (Da C) ; the best agent to slow the heart in 
infantile pneumonia, with Belladonna as an adjuvant (Brown). Bryonia, when 
pleural complications (P). Phosphorus, especially when typhoid symptoms; 
approved by Fleischmann (R). Belladonna is useful in the first stage (P) ; 
Harley esteemed it highly in pneumonia (Wa) ; as an adjuvant to Digitalis in 
infantile pneumonia, to soothe the irritable nervous system and curtail super- 
abundant secretion (Brown). Tartar Emetic, formerly given in large doses ; 
now abandoned ; small doses may be useful, but should be used with care lest 
depression ensue (B) ; at commencement with alcoholic stimulants, if patient 
weak (R) ; may benefit young, robust subjects (Wa). [See under Pleuritis.] 
Sanguinaria, as a contra-stimulant, when fever has abated, and graver symp- 
toms have amended (P). Iodides, no remedy more efficient; Ammonium 
Iodide with Arsenic, to prevent caseation of inflammatory products (R) ; Ethyl 
Iodide, gtt. v-xx ter die by inhalation, very valuable in catarrhal form (B) ; 



POISONING. 



803 



Sodium Iodide is useful in catarrhal pneumonia (Da C). Ipecacuanha, the 
wine in infantile pneumonia, should never be dispensed with, as it promotes 
expectoration, controls hemorrhage and regulates secretion (Brown). Senega, 
in advanced stages as expectorant, when cough is dry, irritating and painiul, 
tightness and oppression of chest (P). Opium, or Morphine by injection, 
sometimes needed for severe pain (R) ; Opium is very desirable in many cases, 
relieves the symptoms and arrests delirium (Wa). Copper Acetate, Kissel re- 
gards it curative ; under it the mortality was only 4 t 3 q per cent. Stimulants, in 
asthenic cases, those of malignant type, and those occurring in aged people 
(Wa). Blisters, useful at very beginning only, or at crisis of disease, harmful 
in inflammatory stage (B) ; to lessen the pain, but should be used in modera- 
tion (R). Wet-pack, hot, tightly pinned to limit motion of chest-walls (B). 
Poultices, encircling the whole chest in children (R). Glycerin, in the form of 
Unna s Paste (see page 329), or in the application called Antifihtogistine, makes 
an excellent poultice and fulfils many indications in pneumonia. Diet, farina- 
ceous, mucilaginous drinks, and rest in warm room (R). [Compare Pleuro- 
pneumonia.] 



R- . Tinct. Veratri Viridis, . TT\xl. 

Spt. ^Etheris Nitrosi, . . gvj. 

Liq. Potassii Citratis, . ^ivss. 

Syr. Zingiberis, q. s. ad^v]. 
M. Sig. — A tablesp. every 3 hours, in 
the early stage. {Da Costa. ) 



R- . Tinct. Aconiti, .... rt\xxiv. 

Tinct. Opii Camphorat., 3 i j . 

Liq. Ammonii Acetatis, 

Syr. Zingiberis, . . . aa ^ ss. 

Aquae, . . . . q. s. ad £vj. 
M. Sig. — A tablesp. every 2 hours, after 
free catharsis by calomel. [Ripley.) 



R. Ammonii Carbonat. , . . gr. xl. 
Infusi Serpentarise, . . . ^iv. 
M. Sig. — A teasp. every 3 hours, as a 
stimulant about the crisis. (£.) 



R . Potassii Iodidi, .... 5jj. 

Ammonii Chloridi, . . . 3Jss. 

Mist. Glycyrrh. Comp., . Jvj. 
M. Sig. — A tablesp. 4 times daily, to 
promote absorption, together with blisters 
to the chest. ( Univ. Penna. Hosp. ) 



R. Sodii Iodidi, . . . . . giij. 
Morphinae Sulph., . . . gr. j. 
Elixir Simplicis, . . . ^ iv. 
M. Sig. — A teasp. ter die, also blisters 
over the apex. In catarrhal pneumonia. 

{Da C.) 



R 



Ammonii Iodidi, . . . . gr. xl. 
Spt. Ammoniae Aromat. ,^ij. 
Elix. Simp, et Aquae, ad ^ viij. 
M. Sig. — Two tablesp. thrice daily. 



In 



syphilitic lobar pneumonia. 



{Da C.) 



Poisoning. 

A Poison, in the medical and toxicological sense, is any substance of inher- 
ent deleterious character and incapable of self-reproduction, which, acting 
chemically or physiologically upon the tissues or fluids of the body, will se- 
riously injure the health or destroy life. 

The most energetic poisons are Hydrocyanic Acid, Potassium Cyanide, 
Nicotine, Strychnine, Carbolic Acid and some reptile venoms. The poisons 
usually selected by poisoners for criminal purposes on others are those which 
produce effects resembling the symptoms of natural disease, as Arsenic, Col- 
chicine, Tartar Emetic, Strychnine, Morphine and Aconite. Those generally 
chosen for suicidal purposes are such as may be most readily obtained by the 
laity, namely — Carbolic Acid, Morphine, Illuminating gas, Charcoal gas and 
Potassium Cyanide ; the first being easily purchased for disinfecting purposes, 
while the last is commonly used in the arts. In 2,097 cases of death from 
poison in England and Wales, from 1863 to 1867, there were 628 due to Opium 
and its preparations, 151 to Hydrocyanic Acid and Potassium Cyanide, 83 to 
Arsenic, jj to Mineral Acids, 66 to Oxalic Acid, 61 to Strychnine, 58 to Mercu- 
rial compounds, 15 to Phosphorus and 11 to Ammonia. 

General Principles of Treatment. The following Rules are laid down by 



804 POISONING. 

high authority : (i) Lose no time. (2) Use the best remedy obtainable at 
once. (3) Get rid of the poison. (4) Stop its action. (5) Remedy the mis- 
chief already done. (6) Fight against the tendency to death (Tanner). In 
the treatment of poisoning, whether by mineral or vegetable substances, if the 
poison is known the first indication is to administer the proper chemical 
Antidote, so as to render it harmless or comparatively so. Next, the stomach 
should be emptied and washed out, lest the newly-formed compound be ab- 
sorbed after a time, also to remove any poison which may have escaped the 
action of the antidote. Next, the appropriate Antagonist should be adminis- 
tered, to counteract the effects of such portion of the poison as may have been 
absorbed. Lastly, such Antagonistic Measures should be employed as may sus- 
tain the action of any organic function showing signs of failure. In most 
cases of alkaloidal poisoning absorption has proceeded so far before profes- 
sional assistance is obtained that antidotes are of no value, hence reliance can 
be placed only upon the physiological antagonist and such supporting meas- 
ures as will tend to maintain vitality until the poison can be eliminated by 
the natural channels. 

Antagonists are agents which oppose each other in their physiological 
action, and may be employed against each other as counterpoisons, to neu- 
tralize their effects upon the organism. They do their work in the blood and 
tissues, after absorption, and are especially available against poisons adminis- 
tered hypodermically, in which cases antidotes are useless. Substances so 
employed are generally the active principles of plants, a few being chemicals, 
as Oxygen and Chloral. Antagonistic Measures include such proceedings as 
tend to neutralize the remote effects of poisons, as artificial respiration, faradism 
of the respiratory muscles, hot and cold applications, douching, constant 
motion or absolute repose, etc. (See page 33.) 

Antidotes affect a poison, either physically or chemically or both, so as to 
remove it from the body or alter its character before absorption, and thereby 
prevent its toxic action upon the organism. They do their work in the ali- 
mentary canal or in the respiratory passages, and are applicable to vegetable 
as well as mineral poisons, but they are not available against poisons adminis- 
tered hypodermically. [See page 36.] Among them are Emetics, Cathartics, 
Washes, Injections, Ligatures, Poultices, the use of the Stomach-pump, of tour- 
niquets, etc., which are termed Mechanical Antidotes ; and the Che?nical or 
True Antidotes, which include Albumin, Milk, Charcoal, Soap, Starch, Oils, 
Tannin, Turpentine, Acids, Alkalies, Potassium Permanganate, Carbonates, 
Hydrates, Sulphates, Sodium Chloride, Iodine, Iron preparations, etc. 

Emetics, when employed, should be used without delay. They are often 
rendered needless by vomiting induced by the poison itself, or by the free use 
of diluent drinks; and are contraindicated when there is severe corrosion of 
the alimentary canal or when abdominal inflammation exists. The best emetics 
are : Zinc Sulphate, for stomachal administration, being non-nauseating, 20 
to 30 grains in water, 5 grains for children. Apomorphine, gr. t$-}4, hypoder- 
mically, when narcosis prevents the use of emetics by the mouth. It should 
be administered hypodermically, as it is very uncertain in action when given 
otherwise. The following may be used: — Copper Sulphate, 1 to 5 grains in 
water ; Ipecac, in powder ; Emetine, gr. T ^ to ^ ; Tartar Emetic, 1 )4 grain s, acts 
slowly and is depressant; Turpeth Mineral; Cadmium Sulphate; Sodium 
Chloride (common salt), 2 teaspoonfuls in a pint of water ; Mustard, 2 tea- 
spoonfuls in a cup of warm water ; also Olive Oil, Soap-suds, Snuff, melted 
Fats, and tickling the fauces with the finger or a feather. Sodium Chloride, as 
an emetic, is contraindicated in poisoning by tartar emetic or corrosive 
sublimate, and so also are Oils and Fats and substances containing them, in 
poisoning by phosphorus, cantharis, carbolic acid or copper salts. 

Cathartics are generally employed after the use of a chemical antidote, to 
remove the compounds formed thereby from the intestinal canal. The best 
are Castor Oil, Croton Oil, Senna, and Magnesium Sulphate (Epsom salt). 



POISONING. 805 

Castor Oil protects the mucous membrane and obstructs absorption, but is 
contraindicated in poisoning by phosphorus, carbolic acid, copper salts, or 
cantharis, the absorption of which is aided by oils and fats. Croton Oil is rapid 
and powerful in the dose of from 1 to 5 minims, in a bread pill. Magnesium 
Sulphate, in the dose of 1 to 4 oz., well diluted, is of special service in chronic 
lead poisoning and to remove antidotal compounds from the intestines. 
Senna, Gamboge, and other drastics are the best cathartics in narcotic poisoning. 

The Stomach Pump and Stomach Siphon are efficient, and do not weaken 
the patient as emetics do, but are not always available, and cannot be used 
when there is corrosion of the stomach or esophagus, for fear of perforation. 
The continuous or occasional washing of the stomach is a measure of great 
importance in the case of soluble poisons, some of which are excreted into the 
stomach [see infra under Opium]. These appliances are almost useless when 
the poison is in solid form and in large pieces (as meat, sausage, fish, cheese, 
etc.). 

Albumin is an ideal chemical antidote, being harmless, easily procured, and 
forming compounds (which are more or less insoluble) with most of the metallic 
salts, corrosive alkalies and mineral acids, as also with Iodine, Bromine, Chlor- 
ine, Creosote, Anilin, and alcoholic solutions of most of the Alkaloids. It is 
especially suitable against inorganic poisons, and was recommended by Orfila 
for invariable use, even on the mere suspicion of poisoning. It should be well 
diluted, the whites of four eggs to a quart of lukewarm water; and should be 
followed by emetics and cathartics, as many of its compounds are soluble in 
an excess of itself. 

Milk is a good substitute for Albumin, its antidotal action being nearly the 
same in range and due to its casein, albumin and free alkali. It is particularly 
valuable against metallic salts, corrosive acids and alkalies (especially Am- 
monia) and the alkaline earths, but it is contraindicated when fatty antidotes 
are to be avoided, by reason of its richness in fat. 

Gelatin is of especial value against Iodine, Bromine and the Alums, but 
requires too much time for its preparation, as it should be broken up, soaked in 
water for half an hour and reduced to the consistence of honey. 

Gluten is of value against Corrosive Sublimate, but is less so than albumin 
and is not easily obtained. 

Tannin (Tannic Acid), precipitates the Alkaloids and their salts, with which 
it forms compounds (tannates), which, though comparatively insoluble are not 
entirely inactive, and should be removed at once from the alimentary canal 
by emetics and drastic purgatives. It acts well against many metallic salts, 
though inferior to albumin for these, except against Tartar Emetic, which 
albumin does not affect, but tannin renders harmless. It is given in doses of 
gr. xv to xlv, in a 2 per cent, solution, every ^ hour; and if combined with 
about 10 per cent, of its weight of Iodine its antidotal effect on vegetable poi- 
sons is greatly increased. If not itself obtainable, decoctions or infusions of 
substances containing it may be used, as tea and coffee, nut-galls, kino, rhatany, 
catechu, and the barks of oak, willow and cinchona. 

Oils and Fats are efficient against the corrosive acids and alkalies, the 
metallic oxides and salts ; but are contraindicated in poisoning by Phosphorus, 
Cantharis, Carbolic Acid, or Copper salts, the absorption of which they pro- 
mote. With the caustic alkalies they unite to form soaps, liberating glycerin ; 
they are inferior to albumin against the metallic salts, and as their action is 
slow they are less efficient than acids against alkalies. Those used are olive, 
cotton-seed, linseed and almond oils, also melted butter and lard. 

Starch, in paste, 1 to 15 of water, is the antidote for Iodine and Bromine, 
with which it forms compounds which are almost harmless. It has some 
value against Corrosive Acids, Corrosive Sublimate, and Zinc and Copper 



806 POISONING. 

Sulphates, but it is not so efficient as Albumin, which is preferred for these 
poisons as well as for Iodine, since it has a greater affinity than starch has 
therefor. 

Soap, as Castile'Soap, dissolved in 4 times its bulk of hot water, to make 
" suds," and given by the cupful, is one of the most efficient antidotes against 
corrosive acids and metallic salts, especially Corrosive Sublimate, Potassium 
Bichromate, and Salts of Tin and Zinc. It is inferior to albumin against 
these, but is preferred to caustic alkalies against acids, as of itself it has no 
corrosive action. It should not be used against alkalies. 

Gum Arabic, in the form of mucilage, is chiefly used as a protective against 
corrosive poisons, and has been recommended in copious draughts against 
poisoning with the Bismuth salts. 

Charcoal has some antidotal value against many alkaloids, the metallic salts, 
and Phosphorus, slowing their toxic action and postponing their effects, prob- 
ably by a protective action upon the gastric walls. It has the valuable prop- 
erty of absorbing gases, but enters into no fixed compound with any mineral 
or vegetable poison. Fresh animal charcoal is the best, though wood charcoal 
is efficient, but in less degree. 

Oil of Turpentine, after long exposure to the air, therefore containing much 
oxygen, is one of the antidotes against Phosphorus. It should be admin- 
istered immediately after the ingestion of that poison, alone or in hot water, 
and in. quantity 100 times that of the phosphorus supposed to be present. 

Organic Acids, such as Acetic (vinegar), Citric (lemon-juice), and Tartaric 
are employed against the Alkalies and alkaline Carbonates. 

Inorganic Acids. — Diluted Sulphuric Acid, in water, is used against the solu- 
ble salts of Barium and Lead, with which it forms insoluble sulphates ; also as 
a prophylactic against the colic of lead poisoning. 

Ammonia, diluted, used by inhalation, is an efficient antidote against the 
vapors of corrosive acids and Nitrobenzol, also against Chlorine, Bromine, 
and Hydrocyanic Acid. 

Magnesium Hydrate and Carbonate are the most efficient antidotes against 
Acids and the acid salts, also against Oxalic Acid and the acid oxalates, 
in the absence of the calcium antidotes therefor. They are also valuable 
against Arsenic, Phosphorus, Mercury, Corrosive Sublimate and other 
metallic salts, forming with arsenic compounds which are almost insoluble, and 
with metallic salts in solution precipitating the corresponding oxides or basic 
salts. 

Magnesia is a compound of the Hydrate and Carbonate of Magnesium with 
water, or a basic Magnesium Carbonate. When heated at a low temperature it 
becomes calcined, losing C0 2 and H 2 ; then mixed with 25 times its weight 
of warm water it becomes gelatinized, in which condition it is best for antidotal 
purposes, in doses of from 1^ to 2 oz., at short intervals for a few doses, then 
at longer intervals. An excess does no harm, but rather benefits the patient by 
its cathartic action. 

Carbonates and Bicarbonates of Sodium and Potassium are employed against 
most of the poisonous metallic salts, especially those of Zinc, which they imme- 
diately decompose, forming insoluble basic compounds ; also against Iodine, 
Bromine, and Potassium Bichromate, forming the neutral chromate with the 
latter and harmless salts with the former. They are useful in dilute solution 
against Acids, but are less easily tolerated than magnesium sulphate. They 
are contraindicated in poisoning by Oxalic Acid, with which they form danger- 
ous compounds. 

Calcium Hydrate and Carbonate, in the form of lime-water, chalk, eggshells 
or powdered oyster-shells, are used against Acids, both mineral and organic, 



POISONING. 807 

and especially against Oxalic Acid and the acid oxalates, which they neutral- 
ize and convert into the insoluble calcium oxalate. 

Sulphates of Magnesium and Sodium (Epsom and Glauber's salts), the solu- 
ble sulphates, are particularly efficient against Carbolic Acid and the salts of 
Barium and Lead. 

Sodium Chloride (Common Salt), in dilute solution, is the best antidote 
against the Silver salts, converting them into the insoluble chloride of silver. 
It may be given with albumin, which is also a very efficient antidote in this 
form of poisoning. 

Potassium Ferrocyanide, given in doses of 30 to 60 grains in water, is of 
special value against the Copper salts, but albumin is equally efficient and 
more easily obtained. 

Potassium Permanganate, is the best antidote against all organic poisons, if 
used promptly, before absorption has taken place, as it rapidly destroys them 
by oxidation. It has been used successfully against Morphine and Strychnine 
salts and Phosphorus in the stomach, and locally for snake-poison. 

Iron. — The Hydrated Sesquioxide is the best antidote to Arsenic in solution 
or in a soluble form, as.it combines with the latter to form a ferrous arsenate, and 
also protects the gastro-intestinal mucous membrane against the local action 
of the poison. In the proportion of 10 parts to one of arsenic the union is very 
complete, but its union with the salts of arsenic is limited even when it is in 
great excess, though much more effectual if there is added to it a small amount 
of ammonia or other caustic alkali, or if the basic ferric acetate is mixed with 
it. For the preparation of the official arsenic antidote see Ferrum Oxidum 
Hydratum cum Magnesia, under the title Ferrum in Part I. Dialyzed Iron, 
Saccharated Iron, and the basic Ferric Acetate have all been used with more 
or less success in arsenic poisoning. 

Copper Carbonate, in dose of 3 to 6 grains, with sugar and water, preceded 
and followed by an emetic, is recommended in Phosphorus poisoning, being 
supposed to coat the particles of phosphorus first with a layer of copper phos- 
phide and then with one of copper itself, thus preventing their solution in the 
fluids of the stomach. 

Sodium Hyposulphite, in doses of 15 grains, in very dilute solution and fre- 
quently repeated, is a valuable antidote against Bleaching Powder (Calcium 
Hypochlorite), Labarraque's solution (Sodium Hypochlorite), and Javelle 
Water (Potassium Hypochlorite), which it reduces to chlorides, itself under- 
going oxidation to the sulphate. 

Chlorine, in the form of Chlorine Water, Labarraque's solution, or Javelle 
Water (see above), is employed externally as an antidotal wash for snake-bites 
and other poisoned wounds ; also, well diluted, internally against alkaloids and 
other vegetable and animal poisons; and as a spray for antidotal inhalation 
against coal gas (Carbonic Oxide), Ammonia, Phosphoretted and Sulphuretted 
Hydrogen, also Hydrocyanic Acid. 

Iodine, in very dilute solution, is used as an antidote against alkaloids and 
their salts, other vegetable poisons and snake-venom. All its compounds are 
more or less soluble and toxic, and must therefore be removed from the system 
as soon as possible. Bouchardai 's Antidote for vegetable poisons consists of 3 
grains of Iodine, 30 grains of Potassium Iodide, and 11 oz. of distilled water. 
The dose, which is from 1 l / z to 3 oz., should be repeated frequently. 

Ammonium Carbonate, in dose of 5 grains, administered hypodermically in 
the vicinity of wounds caused by poisoned arrows, was repeatedly used by Dr. 
Parke, the surgeon of Stanley's last expedition in Africa, with entire success in 
saving life when it was employed immediately after the injury. Persons so 
wounded, if they were at too great a distance to receive this treatment, invari- 
ablv died within a short time. 



808 POISONING. 

Antidote Bag, designed by Martindale, of London, contains the following- 
named articles, labeled with directions for use, viz. — 

Dialyzed Iron. Spt. Ammoniae Aromat. Amyl Nitrite. 

Syrup of Chloral. Oil of Turpentine. Zinc Sulphate. 

Chloroform. Acetic Acid. Ipecacuanha. 

Spt. Chloroformi. Tincture of Digitalis. Potassium Bromide. 

Calcined Magnesia. Tannic Acid. Potassium Permanganate. 

Also a Hypodermic Syringe and Solutions or Pellets therefor of — 

Morphine Sulphate. Apomorphine Hydro- Pilocarpine Nitrate. 

Atropine Sulphate. chlorate. Strychnine Nitrate. 

General Antidotes have been devised for use when the nature of a poison is 
unknown, with the object of a " shot-gun prescription," intended to hit some- 
thing. One of the best is JeauneVs, composed as follows, — Liquor Ferri Sul- 
phatis (sp. gr. 1.45) ^ijss, Magnesia Calcinat. ^ij, Carbo Animalis !§j, Aqua 
3 xx. These ingredients should be kept separate — the solution of the sulphate 
in one vessel, the others together. When needed, the former should be added 
to the latter and violently agitated. Dose, ^jss to ^iij. This is a perfect anti- 
dote for Arsenic, Zinc, Digitalin, etc. It delays the action of the salts of Cop- 
per, Morphine and Strychnine, and slightly influences compounds of Mercury. 
It is valueless for Cyanide of Mercury, Tartar Emetic, Hydrocyanic Acid, 
Phosphorus, or the caustic Alkalies. Bouchardat 's Antidote is described on 
the previous page, under Iodine. Bellini considers the Iodide of Starch 
a valuable antidote to alkaline Sulphides, earthy Sulphides, vegetable and 
caustic Alkalies, and Ammonia. In the first two cases he considers it superior 
to all other antidotes. 

A fresh mixture of the Sulphides of Iron and Sodium with Magnesia, is said 
to be a perfect antidote for Copper salts, Corrosive Sublimate and Mercuric 
Cyanide. If the nature of the poison is entirely unknown, a harmless yet 
effectual antidote in most cases is one composed of equal parts of Magnesia, 
Wood Charcoal, and the Hydrated Ferric Oxide, given freely in plenty of 
water. 

Poisoning by 

Acetanilid. Antagonists. — Belladonna or Atropine, to maintain the blood- 
pressure ; Strychnine, for the respiration ; Oxygen inhalations, to overcome 
cyanosis ; Heat, externally applied. Stimulants and supporting measures. 

Acids. Antidotes, — Alkalies for the least irritant acids, Magnesia, Mag- 
nesium Oxide, slaked Lime, Chalk ; plaster from wall with water, milk, oil, 
white of egg, bland mucilaginous drinks and poultices (R). Antagonists, — 
See under Acids, Mineral, on the next page. 

Acid, Acetic. Antidotes, — Magnesia or Magnesium Carbonate, freely; Soap 
and water, Lime-water, Chalk, White-wash ; also milk, oils and thick gruel 
may be given. Antagonists, — Morphine, gr. % , to ward off shock. 

Acid, Carbolic. Antidotes, — -Any soluble Sulphate to form a sulpho-car- 
bolate, as Magnesium or Sodium Sulphate (Epsom or Glauber's salts). In 
a case where yi oz. of 95 per cent, carbolic acid had been taken, nearly 3 
ozs. of Magnesium Sulphate were used, resulting in full recovery from an 
apparently hopeless condition. Alcohol, is a perfect antidote to the corrosive 
effects of carbolic acid (Phelps). The routine practice in one emergency 
hospital is to wash out the stomach with alcohol and water, equal parts of 
each, and then to leave in the stomach about ^viij or %x of the same mixture. 
This treatment has proved very efficient in a number of cases. Liquor 
Calcis Saccharatus, or the official Syrupus Calcis, given freely. Soap, 
in strong watery mixture (suds), is said to be almost a perfect antidote. 
Cider Vinegar may prove antidotal, as it removes the effects of the strong 



POISONING. 809 

carbolic acid applied locally. Vegetable Demulcents (but no oils or glycerin), 
to protect the mucous surface. Sodium Carbonate, in strong solution locally, 
for the effects of its local use in excess; this also as a wash for the mouth, if 
necessary. Antagonists. — Atropine is a very complete antagonist to the 
systemic symptoms, maintaining the heart and respiration until elimination 
occurs : gr. -^ hypodermically. Amyl Nitrite, by inhalation, Alcoholic 
stimulants freely. Heat to the extremities, also Faradism and friction there- 
of. Venesection in desperate cases (Murrell). 

Acid, Carbonic (Carbon Dioxide). See ante, page 92, also under Illumi- 
nating Gas, below, for the treatment of poisoning by Carbonic Acid and Car- 
bonic Oxide gases. 

Acid, Hydrocyanic (Prussic). Forty minims of the official diluted acid have 
proved a fatal dose. Antidotes, — if time to do anything, Cobaltous Nitrate 
has proved a perfect antidote in over 40 cases (Antal). A?nmonia, diluted, by 
inhalation, or Chlorine Water by spray, for the vapor. Per- and Proto-salts of 
Iron with Magnesia. Calcium or Sodium Chloride, gr. xxx-xl, in water. 
Sodium Thiosulphate. Use emetics or the stomach-pump. Antagonists, — 
Stimulants, as Brandy, Chloric Ether, Ammonia, ad libitum. Alternate hot 
and cold Douche, from a height. Artificial Respiratio7i, the faradic current 
(mild) to chest walls and over cardiac region. Atropine has antagonistic 
action, but is too slowly diffused to be of any value. Ammonia by inhalation, 
by the stomach, and by intra-venous injection, with cold affusion to the spine, 
and artificial respiration, are the measures most likely to avail in cases where 
there is time to do anything. 

Acids, Mineral. Antidotes, — Alkalies, as Sodium Carbonate or Bicar- 
bonate, Magnesia, or Chalk, Soap, Whiting, Wall-plaster, in water. Albumin, 
Flour, Milk, Starch, Olive Oil, to protect the mucous membrane. Avoid water 
in Sulphuric Acid cases. Antagonists, — Opium, Ammonia (intra-venously), 
Alcohol, as stimulants, to combat the depression of the vital powers. 

Acid, Oxalic, also the Acid Oxalates, as Potassium Oxalate, known as " Salts 
of Lemon " or of " Sorrel," used for removing ink-stains. Antidotes, — Cal- 
cium Carbonate or Hydrate (as lime-water, chalk, whiting, wall-plaster, in 
water), or Magnesia. Avoid Potassium and Sodium Carbonates and Bicarbon- 
ates. Bland mucilaginous drinks and poultices to the abdomen. 

Aconite. Antidotes, — Tannic Acid, or Animal Charcoal, powdered, in 
water. Emetics or the stomach-pump. Castor Oil, or other purgatives. Bland 
fluids, and poultices for abdominal irritation. Antagonists, — Atropine ,<Z2,tt€vaz, 
Morphine, Ether, Ammonia, Amyl Nitrite, antagonize its effects on the heart 
and respiration. Digitalis antagonizes its action on the heart and its relax- 
ation of cardiac inhibition (Fothergill). In Aconite-poisoning the stomach 
should be evacuated, warmth applied to the extremities, stimulants adminis- 
tered, artificial respiration if necessary, and the recumbent posture strictly 
maintained. Caffeine may be administered hypodermically, and strong Coffee 
by the mouth. 

Alcohol. Antidotes, — Emetics or the stomach-pump, if much alcohol re- 
cently swallowed. Antagonists, — Ammonia by inhalation cautiously. Cold 
affusion to the head. Warmth to the extremities. Faradism of the muscles of 
respiration. Artificial Respiration. Chloral, gr. xx-xxx every 4 hours to secure 
sleep. Bromides for the same purpose, or Capsicum in doses of gr. xx-xxx. 
Ammonium Chloride, about gss m h a if a pint of water at one draught, has a 
marvelous effect in generally straightening up the victim, antagonizing stupor 
and restoring faculties. Hyoscine or Duboisine, as hypnotic, gr. -^q—^ hypo- 
dermically. [Compare the titles Alcoholism and Delirium Tremens in Part 
III, also pages 137, 138, ante.~] 

Alkalies. Antidotes, — Acids, diluted, especially the vegetable acids, as 
Vinegar, Lemon-juice, etc. Albumin, Milk, Gelatin. Oils to protect the mucous 



8 10 POISONING. 

surfaces. [Compare Ammonia below.] Antagonists, — Opium for the shock 
and vital depression, also Caffeine, Alcohol, and other stimulants. 

Alkaloids. Antidotes, — Tannin holds high rank, forming tannates, which 
are comparatively insoluble. Potassium Permanganate (see ante, page 376). 
Albumin. Iodine. Charcoal. Emetics and cathartics afterwards. Antago- 
nists, — differ for each. [See their several titles in this section.] 

Alum. Antidotes, — Carbonates of Ammonium, Potassium, etc. Other 
treatment as for corrosive salts. [See Metallic Salts, page 814.] 

Ammonia. Sources of Danger, the use of Smelling Salts or Spirit of Harts- 
horn in excess, and the strong solution of Ammonia kept by housekeepers 
for laundry purposes. Antidotes, — Vinegar, Lemon- or Orange-juice, any 
Vegetable Acid, followed by demulcents to protect the mucous surfaces. When 
inhaled, give vapor of Acetic or Hydrochloric Acids or Chlorine-water by in- 
halation, the two latter forming the chloride. Antagonists, — Aconite, Vera- 
trum, Digitalis, as cardiac sedatives. 

Amyl Nitrite. Antagonists, — Ergotin, Atropine, Strychnine, also Brucine, 
Digitalis, Picrotoxin, and all other agents which increase the functional activity 
of the spinal cord and sympathetic, are antagonistic, though not always avail- 
able by reason of their slower rate of diffusion. Stimulants, artificial respira- 
tion, the alternate cold and hot douche, with cold to the head, and Ergotin or 
Atropine hypodermically, are the best measures to be used in cases of poison- 
ing by the Nitrites. 

Anesthetics (Ether, Chloroform, etc., by inhalation). Antagonists, — Atro- 
pine, hypodermically, is of great value in combating the cardiac and respira- 
tory failure of ether (Amidon) ; and is equally efficient in chloroform poison- 
ing, as I have found by experience (Potter). Strychnine, hypodermically, has 
done good service in chloroform narcosis and has many advocates. Amyl 
Nitrite, by inhalation. Oxygen, by inhalation. Venesection, to relieve the 
engorged right heart, supplemented by Galvanism to stimulate the cardiac 
action (Spooner). Artificial Respiration, Fresh Air, Coffee. Faradism of the 
respiratory muscles. Heat applied to the body and limbs. Ice in the rectum, 
Ammonia, 10 minims of the Liquor in 40 of water, intravenously, — unsuccess- 
ful (Bartholow). Invert the patient, draw the tongue well forward with forceps, 
compress and relax the chest, maintain the inverted position until the pulse and 
respiration are good (Nelaton). 

Antimony (as Tartar Emetic, etc.). Antidotes, — Tannin, or any substance 
containing it, is the antidote, forming the insoluble tannate. Albumin or Milk. 
Carbonates of Magnesium and Sodium. Magnesia, in milk, especially for the 
chloride of antimony. Alkalies and Salts of Lead decompose tartar emetic. 
Emesis by tickling the fauces. Demulcent drinks freely, to protect the mucous 
membranes. Water, warm, in large draughts; or lavage of the stomach with 
water first, then with- a solution of Tannin. Antagonists, — Opium, Alcohol, 
Ether, and other antispasmodics. 

Antipyrin. See ante, under Acetanilid, for the treatment of poisoning by 
Antipynn, Phenacetin, Kairin, and similar compounds. 

Arsenic (Arsenous Acid). Two grains have been fatal. Common Sources of 
Danger: arsenical wall-papers, Arsenic mistaken for " salts " or for " magnesia," 
adulterated confectionery, also Paris Green (Cupric Aceto-Arsenite) taken with 
suicidal intent. Antidotes, — Hydrated Ferric Oxide, freshly prepared by 
precipitating a solution of Ferric Chloride with Sodium Carbonate or Ammo- 
nia, — or as the official Ferri Oxidum Hydratum cum Magnesia (see ante, page 
317), in the proportion of gr. viij for each grain of the poison ingested. Dia- 
lyzed Iron, is quite efficient as an antidote, is more easily obtained than the 
hydrated oxide, and has rendered good service in many cases of poisoning 
from inhaling arsenical fumes. Ferri Subcarbonas is equally good, ^ ij followed 



POISONING. 8ll 

by Castor Oil (Leale) ; or Hydrated Magnesia, or Magnesia and Sugar (Carl). 
Magnesimn Bicarbonate or other alkalies (R). Charcoal, £ss or more (R). 
Saccharated Ferric Oxide. Basic Ferric Acetate. Apomorphine, hypoder- 
mically, or Zinc Sulphate, as an emetic (avoid Tartar Emetic). Emesis by 
feather-tickling. Oil and Lime-water mixed, before and after emesis (Taylor). 
Milk or other bland fluids to wash stomach. Castor Oil after emesis. Mag- 
nesia and Linseed tea. Poultices and fomentations over abdomen. Potassium 
Iodide afterwards to promote elimination. Antagonists, — None. 

Barium Salts. Antidotes, — Sulphates of Magnesium and Sodium (Epsom 
and Glauber's salts), of Calcium or Potassium. Diluted Sulphuric Acid. 

Bee and Insect Venom. Antidotes, — Aqua Ammonia \ Sodium Bicarbonate 
or Chloride, or Carbolic Acid, applied to the wound ; or n\,xv of a 2 per cent, 
solution of the first hypodermically, with Liquor Ammonii Acetatis internally. 
[Compare the article on Stings in part III.] 

Belladonna and Atropine. Antidotes, — Tannin, Zinc Sulphate or Apo- 
morphine, as emetics, or the Stomach-pump. Purgation. Magnesium Bicar- 
bonate, and other alkalies (R). Charcoal, ^ss or more is necessary (R). An- 
tagonists, — Morphine is the physiological antagonist to the effects of Atropine 
on the cerebrum, pupils, heart, respiration, arterial tension and kidneys ; 
Aconite, Physostigmine, Pilocarpine and Quinine are each antagonistic to some 
of its effects, Muscarine to most of them. Brandy or strong Coffee. Capsicum. 
Faradism of respiratory muscles. Flagellation. Cold to the head. Ammonia, 
the vapor inhaled into air-passages (R). 

Bromides. Antidotes, — Nitrous Ether is incompatible with Ammonium 
Bromide, Acids and Metallic Salts are so with all the bromides. Poisoning 
thereby is always chronic, never acute, hence no antidotes can be employed. 
Antagonists, — Morphine is the most efficient, especially for the mental symp- 
toms. Digitalis, Ergot, Belladonna, and other vaso-motor stimulants, antag- 
onize many of the effects of the bromides. Cocaine is useful in chronic depres- 
sant poisoning thereby, and Alcohol with Opium as a nervous stimulant. 

Bromine. Antidotes, — Albumin, Starch, Gelatin, Sodium and Potassium 
Carbonates and Bicarbonates. Against the irritant vapor, Ammonia vapor by 
inhalation, or steam inhalations. Antagonists, — Opium and Alcohol as stimu- 
lants, if much depression ensues. 

Calcium Chloride. Antidotes, — Albumin, Mucilaginous drinks, or Oils, 
Milk, Flour and water. Avoid acids. Antagonists, — Opium, Alcohol, for 
vital depression. 

Camphor. Antidotes, — Water to precipitate it from the alcoholic solution. 
Alkalies and earthy salts precipitate even the small quantity which is soluble 
in water. Emetics to remove as much as possible. Antagonists, — Aconite 
and other arterial sedatives. Coffee. Cold. Alcoholic stimulants. Opium 
and Bromides for the convulsions. 

Cannabis Indica. Antidotes, — Emetics to remove as much as possible. 
Antagonists, — Alcohol, as stimulant. Strych7iine as respiratory stimulant. 
Faradism of muscles of respiration. Lemon-juice is said to antagonize its 
effects, which last over 24 hours from a large dose. 

Cantharis. Avoid Oils, also fats and milk, which promote its absorption. 
Antidotes, — Emetics. Demulcents (as linseed tea, gruel, barley-water), 
freely. Water in large quantities, to flush the kidneys. Oleaginous injections 
into the bladder to allay irritation. There is no chemical antidote. Antag- 
onists, — None, but Opium may be given for the gastro-enteritis. 

Carbonic Oxide. See page 813, under Illuminating-gas, for the treatment of 
poisoning by Carbonic Oxide and Carbonic Acid gases. 

Chloral Hydrate. Antidotes, — Liquor Potasscz, in hourly doses of gij well 
diluted, which amount will decompose 20 grains of chloral each time in the. 
blood (Dougall). Emetics, or the stomach-pump, if patient is seen shortly 



8 12 POISONING. 

after ingestion of a toxic dose. Reliance must generally be placed on the 
antagonism of the following. Antagonists, — Strychnine, but only to a limited 
extent ; though Chloral is the most perfect antagonist to strychnine, opposing 
its spinal action (but see page 257). Heat to the body and limbs, by hot 
blankets, hot water bottles, etc., is the most efficient antagonist. Atropine 
antagonizes its cardiac, respiratory and spinal depression, and should be used 
hypodermically, in small doses (gr. ^i_ ), frequently repeated, until its effects 
are apparent. Morphine administered with chloral antagonizes its tendency 
to produce cardiac failure, while synergistic to the hypnotic action of the drug. 
Cocaine is of value for the cardiac and respiratory depression. Alcoholic 
stimulation. Amyl Nitrite by inhalation. Frictions. Coffee, black, a pint 
injected into the rectum, as for narcotic poisoning. Artificial respiration. 

Chlorine. Antidotes, — Albumin for chlorine preparations in the stomach, 
also Aqua Ammoniae in small quantity, well diluted. Ammonia vapor inhaled 
against chlorine inhalations, forming ammonium chloride. Ammonium 
Sulphide has similar reaction, but should be used in great moderation. Fresh 
air. Steam inhalations. Emesis with warm water, then white of egg or milk, 
flour, or lime-water. Antagonists, — Chloroform by inhalation, to ease the 
cough. 

Chloroform (swallowed). Recovery has occurred after the ingestion of one, 
two and even three ounces of chloroform (H. C. Wood). Antidotes, — Sodium 
Carbonate in plenty of water. Emetics. Treatment as for irritant poisoning. 
Antagonists, — Atropine or Strychnine, hypodermically. Amyl Nitrite, by 
inhalation. Coffee, black, a pint into the rectum. Heat to the body and 
especially to the cardiac region. Rouse by slapping with wet towel. Mustard 
to calves of legs and over the heart. Relapse may occur, hence the patient 
should not be left for some time after apparent restoration. 

Cocaine. Antidotes, — See under Alkaloids, above. Antagonists, — 
Chloral is the most direct antagonist, so also are Chloroform and Ether. 
Morphine is directly antagonistic at almost all points of action. Amyl Nitrite 
combats the earliest symptoms of cardiac depression, then Alcohol and Opium 
as cardiac stimulants. Artificial Respiration may be required. 

Colchicum. Antidotes, — Tannic or Gallic Acid, followed by emetics and 
cathartics. Demulcent drinks, warm. Antagonists, — Alcoholic stimulants. 
Morphine, hypodermically for the cardiac depression. Treatment is the same 
as that for Aconite poisoning. 

Conium. Antidotes, — Tannic or Gallic Acid, followed by emetics and 
cathartics. Antagonists, — Nux Vomica and its alkaloids, also Picrotoxin and 
other tetanizers. Alcohol. Muscular Movement. Heat applied externally, as 
soon as the stomach has been evacuated. 

Copper Salts. Antidotes, — Albumin, Soap, Gluten, Milk, Sugar, Mag- 
nesia. Potassium Ferrocyanide, is the most efficient chemical antidote, but 
Magnesia or Albumin may be used. In the absence of eggs, give a thin paste 
of flour and water. Any antidote should be followed by prompt evacuation of 
the stomach, and Potassium Iodide to saturation of the system. Antagonists, 
— Opiuin and Demulcents for the gastro-enteritis. 

Corrosive Sublimate (Corrosive Mercuric Chloride). Antidotes,— Albumin, 
Gluten, Magnesia, Milk, Lime-water. Albumin, in some form, is the most 
efficient; the white of one egg to each 4 grains of the poison, forms the albu- 
minate, which must be at once evacuated by emesis or the stomach-pump, it 
being soluble in an excess of albumin, also in the alkaline contents of the 
intestines. Potassium Iodide for after-treatment, converts the poison into solu- 
ble combinations and promotes their elimination. Charcoal, ^ss or more neces- 
sary (R). Hydrated Protosulphide of Iron, if given within 20 minutes, is said 
to be an efficient antidote. Antagonists, — See under Mercury, page 814. 
Fatal Dose, — gr. iij have proved fatal. 



POISONING. 813 

Creosote. Antidotes, — Mucilage, Oils, are the most easily obtained. An- 
tagonists, — Ammonia, for depression. Treatment is the same as for Acid, 
Carbolic, which see. 

Curare. Antidotes, — Ligate above the wound, if any ; incise the part freely 
and suck it strongly. Evacuation of the bladder repeatedly, to prevent reab- 
sorption. Caustic Alkalies destroy the poison. Antagonists, — Artificial 
Respiration is the most efficient antagonist, maintaining life until elimination 
occurs. Strychnine, though from a member of the same family of plants, is an- 
tagonistic as to its action upon the heart and respiration. So also is Atropine. 

Cyanide of Potassium. Antidote, — Ferrous Sulphate to form Prussian Blue 
(Ferric Ferrocyanide), followed by evacuation of the stomach. Ferrous Sul- 
phate is a theoretical antidote, but is said to be practically worthless. Cobaltous 
Nitrate, is a perfect antidote (Antal). Sodium Thiosulphate. Antagonists, — 
Ammonia, intravenously. Digitalin, Strychnine, Alcohol. Artificial Respira- 
tion, general friction and galvanism. [Compare Acid, Hydrocyanic, page 809.] 

Digitalis. Antidote, — Tannic Acid, to form the tannate, which, however, 
is not inert, so that the stomach should be immediately evacuated. Antag- 
onists, — Aconite for the effects of large doses, Opium for those due to its con- 
tinued use. Saponin and Senegin are its most complete physiological antag- 
onists. Alcohol, Galvanism, Horizontal posture. The treatment is similar to 
that for Aconite. 

Ergot. Antidote, — Tannic Acid, followed by an emetic. Antagonists, — 
Amyl Nitrite, Aconite, Veratrum Viride, Tobacco and Lobelia, antagonize its 
action on the circulation. 

Fish-poison. Antidotes, — Emetics and Cathartics. Antagonists, — Potas- 
sium Chlorate freely, Liquor Ammonii Acetatis, Opium, Capsicum, Chloroform. 

Fungi, Poisonous. Antagonist, — Atropine, is practically specific as an 
antagonist in many cases of fungi poisoning. [Compare Muscarine, page 815.] 

Gamboge. Antidotes, — Potassium or Sodium Carbonates. Magnesia in 
milk. Emetics. Mucilaginous drinks. Antagonists, — Opium for the depres- 
sion. Alcoholic stimulants. 

Gases and Vapors. See Ammonia, Acid Hydrocyanic, Chlorine, Illumin- 
ating-gas, Nitrous Oxide Gas, Sulphur. 

Gelsemium. Antidote, — Tannic Acid, followed by an emetic or the 
stomach-pump, if recent. Antagonists, — Morphine is the most complete. 
Digitalis, Ammonia, Alcohol, Atropine, and to some extent the tincture of 
Xanthoxylum, are also antagonistic. Heat externally, Faradization of the 
respiratory muscles, and Artificial Respiratio7i are measures of prime import- 
ance. Brandy and Capsicum are useful. 

Glass (coarse or powdered). Antidotes, — Bread-crumbs freely to envelop 
it, then emetics. 

Gold Salts. Antidotes, — Ferrous Sulphate. Albumin, as eggs or flour. 
Mucilage. Emetics. Treatment as for Corrosive Sublimate. 

Hyoscyamus. See Belladonna, page 811. 

Hypochlorites, as Javelle Water (Potassium Hypochlorite), Labarraque's 
Solution (Sodium Hypochlorite), and Bleaching Powder (Calcium Hypo- 
chlorite). Antidote, — Sodium Hyposulphite, in dose of gr. xv, well diluted 
and frequently repeated, reducing them to chlorides, itself undergoing oxidation 
to the sulphate. 

Illuminating-gas. Antidotes, — Chlorine-water as spray, inhaled. Antag- 
onists, — Oxygen by inhalation, 4 or 5 quarts. Ammonia vapor inhaled. Gal- 
vanism, by interrupted current to extremities. Artificial Respiration, to be 



814 POISONING. 

maintained steadily for hours. Rhythmic traction of the tongue. Fresh air, 
in plenty ; open all doors and windows. Coffee, black, a pint as enema. Vene- 
section may be of service. Douche, alternately cold and warm, to head and 
chest. Horizontal position, clothing removed. A Icohol moderately by mouth 
or rectum. Catheter may be required in prolonged cases. Subsequently, a 
warm bed, heat applied to the body and limbs, open windows, perfect quiet, 
Condy's fluid about the room, stimulants sparingly, cold acid drinks freely. 

Iodine. Antidotes, — Starch, Albumin, Flour, Gelatin, Sodium and 
Potassium Carbonates and Bicarbonates. Starch is the antidote to free Iodine, 
but the stomach must be evacuated, as the Iodide of Starch is not inactive. 
In chronic poisoning by the Iodides, a free salivary flow induced by chewing 
Pyrethrum-root will hasten elimination of the drug. Antagonists, — Quinine, 
Digitalis, and other restorative agents and vaso-motor tonics. Amyl Nitrite. 
Morphine, for pain. 

Ipecacuanha. Antidotes, — Vegetable Acids and Astringents are incom- 
patible with Ipecac, and may be used as antidotes. Antagonists, — Bismuth, 
Carbolic and Hydrocyanic Acids, also Narcotics, antagonize the emetic action. 

Iron. Antidotes, — Ammonium and Sodium Carbonates, Magnesia, Mucil- 
aginous drinks. 

Lead Salts. Antidotes, — Sodium or Magnesium Sulphate, Sodium Phos- 
phate, Diluted Sulphuric Acid, Magnesium Bicarbonate, Ferrous Sulphate, 
freshly precipitated. Albumin, Milk. Emetics or the stomach-pump. Potas- 
sium Iodide, gr. xv-xxx, 3 or 4 times daily, in cases of chronic poisoning, as 
eliminative (R). The cachexia is much relieved by a combination of Quinine 
Sulphate, Ferrous Sulphate and Diluted Sulphuric Acid (B). Baths of Potassa 
Sulphurata (^j or more in the necessary water), are also very useful in chronic 
poisoning by Lead (R). Antagonists, — Opium, to allay irritation. Belladonna, 
the extract, gr. y%, with Pulv. Rhei, gr. ij, in pill twice daily, for the great pain 
at defecation (Da C). Alum, is the most efficient remedy for the colic ; to a 
pint of boiling milk add 90 grains of powdered Alum, separate the curd and 
sweeten with sugar ; give a wineglassful every hour or two (B). Strychnine, 
for the paralysis, gives good results ; also Atropine, gr. y^, with Potassium 
Iodide, gr. v. Electricity , a slowly interrupted current until it causes reaction, 
for the paralysis of extensors (dropped wrist) ; cure to be completed by the 
faradic current (B). Marked Diagnostic Signs of chronic poisoning by 
Lead are — the dropped wrist, due to paralysis of extensor muscles and a dark, 
blue line around margin of gums. 

Lime. See Alkalies, page 809. 

Lobelia. Antidotes, — Tannic Acid, to form the insoluble tannate. Char- 
coal, powdered in water, [see under Aconite, page 809]. Antagonists, — Alco- 
hol, Digitalis, Belladonna, Ergot, the vaso-motor excitants, antagonize its effects 
on the circulation ; Strychnine, Picrotoxin, and Thebaine, those on the nervous 
system. 

Mercury. [See Corrosive Sublimate, page 812, also Metallic Salts below.] 
Antidotes, — Albumin, Gluten, Flour, Milk. Vegetable astringents. Hy- 
drated Protosulphide of Iron. Charcoal. Alkalies, especially Magnesium Bi- 
carbonate (R). Potassium Iodide, to saturation of the system, as after-treat- 
ment ; converts the metal into soluble combinations (B). Baths, simple or 
sulphurous (R). Antagonists, — Bismuth, Tannin, Sodium Sulphite, Diluted 
Nitric Acid in water, as gargles and mouth- washes for salivation. Belladonna, 
TT^v-x of tincture every 4 to 6 hours, to lessen secretion in ptyalism (B). Hyos- 
cyamine, for the tremor, gr. -£§ gradually increased to gr. y 1 ^ (Oulmont). 

Metallic Salts. Antidotes, — Albmnin, Milk, Magnesia, Starch, Soap. 
Oils and other demulcents. Sodium or Potassium Carbonate or Bicarbonate. 
Lavage of stomach. Emetics and cathartics. Antagonists, — Opiicm, Alcohol, 
Cocaine and other stimulants, for shock and vital depression. 



POISONING. 815 

Mezereum. Antidotes, — Albumin, Milk, Oils and Fats, Mucilaginous 
drinks. Antagonists, — Opium, as stimulant against shock and depression. 
Poultices, cool, to abdomen. 

Morphine. See Opium, on the next page. 

Muscarine. Antidotes, — [see Alkaloids, page 810.] Antagonists, — Atro- 
pine exactly opposes Muscarine, and vice versa. Digitalis is antagonistic to 
some extent, so also is Physostigmine. There is no example of physiological 
antagonism so complete in all particulars as that between Atropine and Mus- 
carine. [See ante, page 119.] 

Mushrooms. Antidotes. — Emetics, if poisoning very recent ; Cathartics, 
especially Castor Oil, if some time has elapsed. Tannic Acid, has been recom- 
mended. Antagonists, — Atropine. Alcoholic Stimulants. Poultices, warm, 
to abdomen. [Compare Muscarine, above.] 

Narcotics. See Alkaloids, page 810, also Opium, Belladonna, Alcohol, Chlo- 
ral Hydrate, Cannabis Indica, Carbolic Acid, Chloroform, Illuminating-gas, 
Hydrocyanic Acid, etc. Vegetable Acids antagonize their after-effects to some 

extent. 

Nitrobenzol. Antidotes, — Ammonia, diluted, by inhalation. Emetics. 
Antagonists, — Alcohol, Liq. Ammonias (3ss in water), or Chloric Ether (£j in 
water), frequently repeated, as stimulants, given internally, by enema or hypo- 
dermically (brandy). Atropine. Artificial Respiration. Galvanic current, in- 
terrupted, to chest-walls, and over cardiac region. Fatal Dose, — Death has 
resulted from merely tasting it. 

Nitroglycerin. See Amyl Nitrite, page 810. 

Nitrous Oxide Gas. Antagonists, — Artificial Respiration, to be commenced 
at once and kept up for two hours if necessary, not faster than 18 per minute. 
Fresh air, open all doors and windows, and fan the patient. Oxygen by in- 
halation, 3 or 4 pints. Douche to chest, alternately hot and cold. The tongue 
should be pulled well forward, and the mouth cleared of any obstruction to 
respiration, as artificial teeth. In apparently hopeless cases, two or three 
violent blows on the chest, delivered in quick succession, may restore the 
cardiac action (Murrell). 

Nux Vomica and Strychnine. Antidotes, — Tannic Acid, forms the very 
insoluble tannate. Iodine in dilute solution, or a soluble salt thereof. Animal 
Charcoal, largely. Potassium Permanganate, has been taken in large dose by 
Dr. Fahr, of Milford, N. J., after having ingested gr. ^ of Strychnine, resulting 
in the entire absence of any symptoms of strychnine poisoning. Lard, is the 
antidote, as shown by numerous experiments on dogs and other animals (Tur- 
ner). Eucalyptus, a decoction as a wash for the stomach ; has a true anti- 
dotal action in frogs (Masmeci). Emetics or the stomach-pump should follow 
the administration of any antidote. The bladder must be frequently evac- 
uated to prevent reabsorption. Antagonists, — Quiet, as perfect as possible, 
is very important. Chloral is the antagonist, gr. xxx as soon as possible, 
repeated in 20-grain doses at hourly intervals, as long as reflex exaltation 
continues. Butyl-chloral Hydrate, is a very energetic antagonist (Grigo- 
rescu). Potassium Bromide, is almost too slow of action to be of much prac- 
tical service. Chloroforfji or Ether inhalation, to procure muscular relaxation. 
Physostigma, is antagonistic (R). Chamomile Oil, remarkably subdues reflex 
excitability in frogs after poisoning by strychnine or brucine(P). Amyl Nitrite, 
by inhalation (R). Veratrum Viride, cured a bad case ; 3j was given at once, 
then gtt. ij every ten minutes (R). Urethan. Methyl and Ethyl compounds 
of Strychnine, Brucine, and Thebaine. Monobromated Camphor. Ice to spine. 
Tobacco, by enema. Valerian mitigates the spasms (P). Curare, gr. }( hypo- 
dermically ; is warmly recommended, but its claims are doubtful (P). Apo- 
morphine, hypodermically, is very effective in dogs (Wills). Nicotine, many 



8l6 POISONING. 

cases prove its curative power (P). Hydrastinine Hydrochlorate, in doses of 
gr. j hypodermically, has been successfully employed. Artificial Respiration, 
if possible. Fatal Dose of Strychnine, — gr. \iox an adult, gr. ^for a child. 

Opium and Morphine. Antidotes, — Tannic Acid, or vegetable astringents, 
followed by evacuation of the stomach, if the poison has been taken by the 
mouth. Charcoal, ^ss or more (R). Apomorphine, as emetic, gr. ^ to -^ hy- 
podermically ; must be administered before narcosis sets in (B). Stomach- 
pump better than emetics, which by the mouth are generally useless in these 
cases. Potassium Permanganate , an efficient antidote if given soon after inges- 
tion of the poison [see pages 376, 404]. Compound Tincture of Iodine. An- 
tagonists, — Atropi?ie, hypodermically, gr. T ^ every 15 minutes for three doses 
(B) ; antagonizes the cerebral action, also that on the respiration, heart, and 
arterial tension ; but, if given too freely, will endanger the case by deepening 
the narcosis [see page 404J ; no one is warranted in omitting it (P). Caffeine, 
is antagonistic, and may be given hypodermically, though generally used in the 
form of strong coffee, frequently administered by mouth or rectum. Cocaine, 
is of especial value against the cardiac and respiratory depression. Strychnine, 
efficiently antagonizes the respiratory paralysis, and may be used in lieu of 
Atropine, or in conjunction therewith. Amy I Nitrite, by inhalation, or Ammonia 
by intravenous injection, when the heart shows signs of failure; the former 
proved eminently successful in a case wherein Atropine proved useless to 
restore the patient. Capsicum, the tincture, ^ss-j by rectal injection, is said to 
antagonize the stupor almost instantaneously. Vegetable Acids, as Vinegar and 
water, Lemon-juice, Cream of Tartar in water, etc., every 10 minutes (R) ; to 
antagonize the narcotism. Douche, alternately cold and hot, or hot water and 
ice alternately to nape of neck, for the narcosis. Artificial Respiration, should 
be kept up for at least two hours (Murrell). Oxygen, by inhalation, is of great 
value (Macalister). Venesection, has proved effective after all other measures 
failed ; is especially beneficial when death is impending from failure of respira- 
tory action due to distention of the right heart with backward pressure (Marshall). 
Potassium Bromide removes some of the cerebral effects of Opium, as the vertigo 
and mental confusion ; others are antagonized by Quinine, and the general 
intracranial effects of the drug are to some extent opposed by Digitalis and 
Tartar Emetic. The Important Measures indicated in Opium or Morphine 
poisoning are — (1) the removal of the poison, (2) the maintenance of respira- 
tion, (3) the keeping up of the circulation. The stomach should be evacuated 
at once, and then washed out repeatedly at short intervals, in order to recover 
the morphine which is constantly excreted into that viscus. Faradization of 
the chest muscles, cold affusion and artificial respiration are of great value, and 
evacuation of the bladder frequently is important, to prevent reabsorption. 
Flagellation is a very dangerous procedure, from the exhaustion which may be 
thereby induced, — strong faradic currents are much more efficient. The anode 
should be placed over the lowest conjoined root of the phrenic nerve, the ca- 
thode three inches below the ensiform cartilage and a little to the left of the 
median line. Common Sources of Danger, — Overdosing with cough mix- 
tures, or Paregoric, or the Soothing Syrups so much used for quieting children, 
all of which contain Opium [see page 399]. The American Journal of Pharm- 
acy estimates the loss of life from the latter cause at 150,000 yearly. Fatal 
Doses, — see page 403. 

Phenacetin. See page 808 under Acetanilid, for the treatment of poisoning 
by Phenacetin, Antipyrin and similar compounds. 

Phosphorus. Antidotes, — Potassium Permanganate , is probably the most 
reliable. Copper Sulphate, as an emetic and a chemical antidote, doses of 3 
grains in dilute solution every 5 minutes, until emesis occurs; is recommended 
by authority, but does more harm than good. Turpentine , old and acid, con- 
taining oxygen, given rapidly in a gum emulsion, is said by some to be the best 
antidote ; it is generally unattainable and has proved useless in many cases. 
Lime-water or Charcoal, to prevent action on the tissues. Hydrated Magnesia, 



POISONING. 817 

as a quickly acting purgative ; may be given in Linseed tea. Copper Carbon- 
ate, with sugar and water. Avoid Oils, Fats and Milk, as they dissolve the 
poison and promote its absorption. Antagonists, — Opium, to counteract the 
cardiac and systemic depression. Transfusion, to repair the blood. 

Physostigma. Antidotes, — Emetics or the stomach-pump. Tannic Acid 
or vegetable astringents. Antagonists, — Atropine, as to the effects on the 
respiration, heart and pupil ; gr. -£$ to ^ hypodermically, repeated until effects 
are evident. The one nine-thousandth of a grain of Atropine, injected 5 minutes 
before giving a minimum fatal dose of Physostigma, prevents its fatal result 
(R). Chloral, is also antagonistic, and over a greater field of action, but to be 
effective must be administered very early in the case (R) ; gr. x by mouth or 
rectum every ^ hour. Strychnine, gr. ■£$ of the sulphate or gr. T ^ of the nitrate, 
hypodermically; or the tincture of Nux Vomica, tt^xx by mouth or rectum, in 
very bad cases (Murrell). Stimulants, freely. Artificial Respiration. Fatal 
Dose, — gr. ij 2 ^ is given as the minimum fatal dose. 

Picrotoxin. Antidotes, — Emetics or the stomach-pump. Acetic Acid gives 
relief in overdosing, and may have some antidotal power. Antagonists, — 
Chloral, is antagonistic to its cerebral and spinal action, but synergistic to its 
depressant power over the heart and respiration. Anesthetics, against its 
spasm-producing action. Potassium Bromide, in addition to Chloral, if tetanus 
(Murrell). 

Pilocarpine (Jaborandi). Antidotes, — Persalts of Iron and salts of the 
metals generally, are chemically incompatible. Antagonists, — Atropine, gr. 
tw f° r S r - \ °f tne poison, is a complete antagonist, the most so known to 
physiological experimentation. Conversely, Pilocarpine is exactly antagonistic 
to Atropine, but Jaborine acts similarly to the latter. Morphine controls the 
nausea and vomiting. 

Potash. See Alkalies, on page 809. 

Potassium Bichromate. Antidotes, — Sodium and Potassium Carbonates 
and Bicarbonates. Soap. Antagonists, — Opium or Alcohol, for the nervous 
and muscular depression. 

Potassium Cyanide. See Cyanide of Potassium. 

Potassium Nitrate (Saltpetre). Antidotes, — No chemical antidote. Emetics 
or stomach-pump. Demulcent drinks and emollient enemata. Milk. An- 
tagonists, — Opium, for the subsequent depression. Aromatics. Brandy. 

Pulsatilla. Antidotes, — Tannic Acid, followed by emetics. Antagonists, — 
Alcohol, Opium, Digitalis. 

Quinine. Antidotes, — Emetics and cathartics, also diuretics and sudorifics 
to promote elimination. Antagonists, — Alcohol, Opium, Coffee. Morphine 
antagonizes its cerebral action, Atropine that on the nervous system and heart, 
also its antipyretic power. 

Rat-pastes, — contain Phosphorus or Arsenic. Ratsbane is Arsenous Acid 
(Arsenic). Rough-on-Rats contains Arsenic (which see). 

Resorcin. Antidotes, — Albumin. Soda or Saccharated Lime, in plenty of 
tepid water, as wash for stomach. Emetics or the stomach-pump. Antago- 
nists, — Stimulants freely. Neat to the extremities. Amyl Nitrite, inhaled. 
Atropine and other cardiac and respiratory stimulants, cerebral excitants, and 
agents which raise the arterial tension, are physiologically antagonistic. Fric- 
tion with warm hand. Galvanism, the interrupted current. Fatal Dose, — 
3ij nearly proved fatal (Murrell). 

Rhus (Poison Oak or Ivy). Antagonists, — Cocaine, a 5 per cent, aqueous 
solution, or a 10 per cent, oleate, locally, is by far the most efficient application, 
promptly relieving the burning and itching. Grindelia Robusta, the fluid ex- 
tract, 1 to 10 of water, or undiluted, is a very serviceable lotion. Other appli- 
cations found useful are : — Carbolic Acid, 5 per cent, solution ; Lobelia, as infu- 
sion, 3J to the pint; solutions of Corrosive Sublimate, Lead Acetate, Chlorin- 
52 



815 POISONING. 

ated Soda, Lime-water with Linseed Oil, Alum-curd. R. Plumbi Acetatis, 3ij ; 
Ammonii Chloridi (crude), gss; Aquae, ^viij ; as lotion on cloths constantly 
wetted therewith, is used with uniform success (Burns). Soap-suds and Hot 
Water, frequent washing therewith the surest, speediest and best treatment 
(Couch). Aristol, freely dusted over the part, gives magical relief (Levick). 
Hydrogen Dioxide, a solution washed over the face and hands, as a preventive 
(Behringer). Sassafras, an infusion of the bark, taken internally and applied 
locally, is almost specific for the rash (Hinton). Sodium Sulphite, granular, 
3j ; Glycerin, ^ss ; Camphor-water, q. s. ad %\v, is preferred as a topical appli- 
cation (Behringer). Opium or Coffee, to relieve the nervous irritability. Rest, 
low diet, and laxatives are appropriate measures. 

Sanguinaria. Antidotes, — Tannin, Alkalies, and most of the metallic salts 
are incompatible. Antagonists, — Opium, Atropine, Amyl Nitrite, etc., to an- 
tagonize the depression of the circulation and the local irritant action. 

Savine. Antidotes, — Epsom salt. Demulcents. Emetics and purgatives, 
especially Castor Oil. Antagonists, — Morphine, gr. )i hypodermically. Poul- 
tices of linseed meal to abdomen. 

Serpent-venom. Antidotes, — Potassium Permanganate, hypodermically 
into the vicinity of the wound, after ligating the part above it (Weir Mitchell). 
Chloride of Lime (Chlorinated Lime) in solution, I in 60, injected in doses of 
20 minims, produced recovery (Hodgson) ; after ligature applied above the 
wound, a solution, 1 in 12, was injected in doses of 30 minims, 25 injections in 
all in different parts of the body, brought about recovery after severe symptoms 
from the bite of a tiger snake (Mackenzie). Hypochlorites of Lime or Sodium, 
Chloride of Lime, and Gold Chloride, are absolute antidotes against serpent- 
venom (Calmette). Antivenene [seepage 183]. Carbolic Acid, strong, or a 
Mineral Acid, as caustic, after forcible sucking of wound by a person with 
perfect mucous surface of lips and mouth, and thorough cleansing. Ammonia, 
Tt^xij of Liq. Ammonias, diluted with 3 volumes of water, hypodermically into 
the radial vein, for snake-poison (Halford) ; is shown to be unavailing by 
Brunton and Fayrer (B). Antagonists, — Strychnine, hypodermically, has 
proved eminently efficient in numerous cases (Baron von Miiller). Alcohol, 
as brandy or whiskey freely. Arsenic, for the rapid prostration (R). Potassium 
Iodide, R. Potassii Iodidi, gr. iv ; Hydrarg. Chlor. Corr., gr. ij ; Bromi, £v\ 
Aquae, 3j ; of which gtt. x in 3ij of Brandy, repeated if necessary (Hammond). 
Viola Cucullata, the common Violet, is used in Pennsylvania against rattlesnake 
venom. [See page 525.] Agave Virginica, is known in South Carolina by 
the name of " rattlesnake's master." 

Silver Salts. Antidotes, — Sodium Chloride (common salt), dissolved in 
water, largely diluted and freely used ; precipitates the silver as the insoluble 
and harmless chloride, and acts as an emetic (R) ; vomiting should be induced 
at once, as silver chloride is soluble in a solution of sodium chloride and in 
the digestive fluids.' Large draughts of salt and water should be taken and 
vomited, this being repeated until no silver remains. The stomach should 
then be filled with milk and the bowels moved by castor oil. Alkalies, espe- 
cially Magnesium Bicarbonate (R). Albumin. Antagonists, — Milk, to allay 
the resulting irritation ; it may serve as food until the stomach is restored. 
Opium, against results of irritation. [See Metallic Salts, page 814.] For the 
treatment of chronic poisoning, and regulation of a course of silver medica- 
tion, see page 192. 

Soda and Sodium Salts. See Alkalies and Potassium Nitrate, also Metallic 
Salts. 

Stramonium. See Belladonna. 
Strychnine. See Nux Vomica. 

Sulphonal. Antidote, Alkalies, freely administered. Antagonists, — 
Stimulants. Diuretics. 



POLYPUS. 819 

Sulphur and Sulphides. Antidotes, — Chlorine-water. Sodium Chloride 
(common salt). Potassium Chloride. Ferrous Sulphate. Chlorine Gas or Cal- 
cium Hypochlorite, for Sulphuretted Hydrogen ; the former should be well 
diluted with common air. Antagonists, — Artificial Respiration is the best 
treatment for poisoning by Sulphuretted Hydrogen. 

Tartar Emetic. See Antimony. 

Tin. Antidotes, — Albumin, Ammonium and Sodium Carbonates, Milk. 
[See also Metallic Salts.] 

Tobacco. Antidotes, — Tannin, followed by emetics, or the stomach-pump. 
Iodides. Antagonists, — Strychnine is the true physiological antagonist to 
Nicotine (or Tobacco) and vice versa. Alcohol, Ammonia, Ergot, Digitalis, 
Belladonna, antagonize its action on the circulation ; Brandy is efficient, also 
strong Coffee. Warmth applied to the surface, also friction. Artificial Respi- 
ration. Recumbent position should be strictly maintained. 

Turpentine. Antidotes, — Magnesium Sulphate (Epsom salt), %j in water. 
Emetics or the stomach-pump. Demulcent drinks, as milk, barley-water, etc. 
Antagonists, — Opium or Morphine, if much pain, and for shock. 

Tyrotoxicon (in milk, cheese, ice-cream, etc.). Antidotes, — Einetics, if 
vomiting is not free ; also the stomach-pump or siphon to rinse out the stomach 
with water. Thymol, Salol, Naphtalin, or other antiseptics. Antagonists, — 
Opium, or other sedatives, to allay irritation. Stimulants, when prostration. 

Veratrum and Veratrine. Antidotes, — Emetics or the stomach-pump. An- 
tagonists, — Alcohol, Opium, Ammonia, Digitalis, and Belladonna counteract 
the cardiac depression. Morphine with Atropine hypodermically, or Lauda- 
num internally, with alcoholic stimulants. Heat, dry, applied to the body. 
Recumbent posture strictly maintained. Coffee, strong, as enema. [See also 
Aconite.] 

Wounds, Poisoned. Antidotes, — Ammonium Carbonate, gr. v hypodermi- 
cally in the vicinity of wounds caused by poisoned arrows, was repeatedly used 
with entire success by Parke, the surgeon to Stanley's last African expedition. 
[See page 147 ; also Serpent-venom on page 818, and the article on Wounds, in 
Part in.] 

Zinc Salts. Antidotes, — Sodiian or Potassium Carbonate dissolved in warm 
water, largely diluted, used freely. Albumin, as eggs and milk, with tepid 
water, freely. Tannic Acid, or vegetable astringents, or strong tea. Lime- 
water. Soap-suds, freely. Mucilaginous drinks. Antagonists, — Opium, or 
Morphine hypodermically. Linseed-meal as poultices to abdomen. Enemata 
of gruel or starch-and-water, if much abdominal pain. 



Polypus. 

Sanguinaria, has been employed as snuff for nasal polypi (P) ; with doubtful 
benefit (W). Tannin, finely powdered, as snuff blown daily into nostrils 
through a quill, is especially adapted to the soft and gelatinous varieties ; while 
it has apparently no effect on the healthy mucous membrane it causes the 
complete withering of the polypus (Wa). Zinc Chloride, has been injected 
interstitially with success in a case of naso-pharyngeal polypus (Barthelemy). 
Iron, a solution of the Chloride is advised as an interstitial application (Auger). 
Acetic Acid, glacial, injection into the body of the tumor, will cause it to shrink 
up and to drop off in a few days. Alum, in powder, applied to point of origin 
to prevent recurrence (D). Surgical, — a nasal polypus should be seized with 
polypus forceps and twisted off at the neck ; it may be removed through the 
mouth or the nostril ; in a few cases the nostril must be dilated with a specu- 
lum, or the ala slit to give access to the root of the tumor (D). 



82b POULTICES PREGNANCY. 



Poultices. 

Poultices and Fomentations are simply local baths utilizing warmth and 
moisture, relaxing the tissues and relieving pain. If applied early they will 
check inflammation, or assist the evacuation of pus when suppuration has set 
in. Poultices should be applied thick (thin in peritonitis), as hot as possible, 
covered with cotton-wool, and frequently changed ; large at onset, very small 
after maturation. Belladonna and Glycerin, equal parts, smeared over tissues 
under a poultice, aid the latter greatly, also Tinctura Opii, especially when the 
skin is broken. Linseed-meal or Oatmeal, Starch, Bread, Bran, are best in the 
order mentioned ; add the meal to boiling water, stir and spread quickly on 
warm linen. Charcoal under the poultice, when foul sores are being treated. 

An excellent method of preparing poultices is to make several bags of 
various sizes, of either of the fabrics known as Swiss and Cheese-cloth, filling 
each bag half full with the linseed meal or other agent used, then sewing up 
the open end. When wanted for use one of these bags is submerged in boiling 
water for a few minutes, and on taking it out the meal is found to have swelled 
so as to fill the bag, which should then be squeezed to rid it of the superfluous 
water, laid on the part and covered with oiled silk and a bandage. If too hot 
it will scald the skin. (Potter.) The ordinary filthy poultice of flaxseed, slip- 
pery elm, bread and milk, has no place among the resources of the aseptic 
surgeon. The common poultice is a hot- bed for bacteria, and as such, it should 
be discarded. In the treatment of an ordinary furuncle with poultices, almost 
every surgeon must have seen occasionally the development of innumerable 
minute daughter-furuncles in the surface covered by the poultice. In phleg- 
monous inflammation of the fingers or hand, the prolonged use of the poultice 
is followed by maceration of the skin, extensive edema of the superficial struc- 
tures, a flabby condition of the granulation — in fact all the evidences which 
point to the poultice as a means of favoring the extension of the infectious pro- 
cess (Senn). 

Fomentations, — Flannel may be wrung very dry out of boiling water, applied 
and covered with oiled silk. Spongio-piline \ a fabric composed of sponge and 
wool, coated with india-rubber, is an excellent vehicle for the application of 
warmth and moisture. The inner surface is moistened with hot water; and its 
utility may be increased by sprinkling the moistened surface with charcoal or 
yeast, or by saturating it with any desired lotion or liniment. 



Pregnancy, Disorders of. 

Mercury, a few grains of blue pill to correct clay-colored stools (L). Iodine, 
the tincture internally for cardialgia (Wa). Aloes, has cured piles in preg- 
nancy, by removing constipation ; cautiously ! (P). Alum, Tannin or Catechu, 
in medicated pessaries for vaginal leucorrhea (L). Castor Oil, an excellent 
laxative (P); to clear out the bowels in diarrhea (L). Cocculus Indicus, when 
intestines much distended with flatus, and frequent desire to urinate from 
flatulent pressure on bladder (P). Bismuth, Calumba and Antispasmodics, 
with minute doses of Opium, for gastrodynia and pyrosis (L). Potassium Bro- 
mide, with Chloroform, as an antispasmodic in dyspnea (L). Sumbul, is invalu- 
able in the restlessness; rr^xxx-xl of the tincture with a little Chloric Ether, 
giving quiet nights for a long time (P). Galla, Unguentum Gallae cum Opio, 
the best local application to hemorrhoids, also fomentations with sponges 
wrung out in very hot water, to relieve pain (L). Digitalis, in infusion, very 
beneficial in the albuminuria (L). Potassium Acetate, with Basham's mixture 
(Liq. Ferri et Ammonii Acetatis), when albuminuria with anemia. Calcium 
Phosphate, believed to exert an influence on the fetus if administered during 
pregnancy, so that mothers who have borne only rachitic or scrofulous children 
will bear healthy ones (Wa). Berberine, found very useful in the periodical 



PROLAPSUS ANI PROSTATITIS. 821 

neuralgias of pregnancy, even in cases in which Quinine had previously failed 
(Maclagan). Camphor Liniment, for lumbar pains (Wa). Senna, the confec- 
tion proves a mild and efficient purgative in the constipation of pregnancy 
(Wa). Milk-diet, the best remedy for albuminuria of pregnancy, if strictly 
carried out (Parvin). Injections, must be used carefully, even tepid water often 
induces uterine contractions (L). [Compare Albuminuria, Nephritis, Ner- 
vousness, Ptyalism, Vomiting of Pregnancy.] 

Prolapsus Ani. 

Nux Vomica, or Strychnine, especially when in children, with constipation ; 
in the latter event add Nux Vomica to a purgative, as tincture of Rhubarb 
(R, P); Strychnine hypodermically, gr. -^ for an adult every 48 hours, }( inch 
from anus and parallel to rectum, into the cellular tissue ; generally requires 
4 to 8 injections (Weber). Piper, the Confectio Piperis in doses of gr. lx to 
cxx, persevered in for 3 or 4 months, in chronic, weak subjects (Wa). Sulphur, 
has a beneficial effect in addition to its laxative value (R). Alum, in solution, 
gr. vj to the § (R). Ice, locally, when parts inflamed (R). Ergot, the fluid 
extract injected into the perineum, is followed by immediate relief (Vidal). 
Ferrous Sulphate, 3j to £viij aquas, of which one-third by enema twice daily. 
Podophyllin, in small doses for rectal prolapse in children (P). Tannin, by 
injection to restrain the prolapsus (R). Hydrastis, by enema, or as a lotion (P). 



Prolapsus Uteri. 

Cimicifuga, to prevent miscarriage in prolapsus uteri (R) ; has a remarkable 
effect upon the uterus (P). Astringents, as Decoctum Quercus, Decoctum 
Gallae (Wa) ; or Pomegranate bark (P). Tannin, as Catechu, Kino, Rhatany. 
Alum, a solution, gr. vj to the 3 (R) ; lb. j ad C j aquae, as hip-bath ; should also 
be passed well up vagina (Wa). Ice, locally when parts inflamed (R) ; ap- 
plied to the spine (Wa). Pessaries, in any form, are of but temporary benefit, 
and in the end positively detrimental (E) ; but many cases cannot be treated 
without mechanical support of some kind. 



Prostate, Hypertrophied. 

Alkalies, for the cystic irritation with acid urine ; great benefit from Liquor 
Potassae, or the Citrate and Acetate of Potassium (B). Triticum Repens, bene- 
fit follows its use in the prostatic enlargement of old men (Sir H. Thompson). 
Ammonium Benzoate, for the cystitis, urine alkaline (B). Ammonium Chloride, 
is occasionally useful, gr. xv-xxx, 3 or 4 times daily (Wa). Iodine Injections, 
through rectal walls (B) ; a weak ointment applied by rectum (Wa). Iodine, 
has been tried in all forms, but is of no value (Thompson). Iodoform, as sup- 
pository in the rectum, has proven of great value (B). Colchicum, in persons 
of a gouty diathesis (Wa). Medicine is not likely to have any control over this 
condition, which is a simple hypertrophy ; castration was suggested by J. Wm. 
White, and has been performed with successful results in three cases by 
Haynes, also by other operators. [Compare Cystitis.] 



Prostatitis. 

Cantharides, a drop of the tincture, 5 may be required, 3 or 4 times a day 
(R). Triticum Repens, is found to be of benefit (Sir H. Thompson). Urino- 
Genitals, especially Turpentine, Cubeb, Juniper, Cantharis(B) ; Cubeb, in doses 
of gr. xx daily, is found of much benefit (Wa) ; Buchu relieves (P). Silver 
Nitrate, a solution, gr. v-x to the ^, applied to the prostatic urethra in chronic 



822 PROSTATORRHEA PRURIGO — PRURITUS. 

prostatitis, may be useful (Wa). Blisters, in chronic prostatitis, a small blister 
on each side of the raphe of the perineum, kept open 4 to 6 weeks, has given 
the best results (Wa). Tonic medicines and regimen should be prescribed 
(Wa). Hot Injections, to relieve pain (R). [Compare Prostatorrhea.] 



Prostatorrhea. 

Iron, the Tincture of the Chloride, when there is much debility (B) ; chaly- 
beate tonics with Quinine and Strychnine (Gross). Atropine, indicated in all 
cases, with Potassium Bromide (Gross). Potassium Bromide, when irritability 
and excitement (B) ; indicated in all cases (Gross). Lead, injections of Gou- 
lard's Extract, 3j t0 <5 X of water, night and morning, for 10 minutes at a time 
(Gross). Ergot, when relaxation exists (B). Bougie, methodically intro- 
duced, is one of the best local measures (Gross). Hydrastis, locally applied, 
a useful medicine (B). [Compare Prostatitis.] 



Prurigo. 

Antipyrin, as a symptomatic remedy, is efficient in true prurigo. Alkaline 
Baths, followed by a carbolized ointment, and Carbolic Acid internally, are of 
value in the papular eruption known as prurigo (Bulkley). Sulphides, Potassa 
Sulphurata, with Tar and Benzoinated Lard, as ointment in genuine prurigo 
(R). Arsenic, in doses of rr\,v of Liquor Arsenicalis thrice daily and gradually 
increased, has exercised a more or less powerful influence (Wa) ; has only a 
moderate effect (Bulkley). Belladonna, controls cases which have resisted 
ordinary treatment (B). Carbolic Acid, locally and internally, is especially 
serviceable in prurigo senilis (B). Mercury, the Bichloride gr. xx with Ammo- 
nium Chloride gr. xxx, in Oj of pure water, as lotion in prurigo contagiosa, the 
so-called army-itch ; nothing equal to it (White). Borax, a saturated solution 
in rose-water locally (R) ; gr. v-x to %} of hot water for pruriginous eruptions on 
mucous membrane of vulva and vagina (R). Galvanism, when prurigo is 
referable to alterations in the cutaneous nerves (B). Tonics, are required, 
nerve-tonics as well as general ones, Cod-liver Oil, Quinine, Strychnine and 
Phosphorus (E. Wilson). Quinine, in large doses, gr. v-x, will control violent 
exacerbations (Wilson). Baths, the Turkish, frequently repeated, with inunc- 
tion of the skin, may be regarded as curative in most cases (Wilson). [Com- 
pare Pruritus.] 

Pruritus. 

Cocaine, in 5 per cent, solution or oleate, is by far the most efficient of all 
antipruritics; relieves the itching of scrotal eczema, pruritus ani et pudendi, 
and especially in lesions of the epidermis where the oleate or solution can 
penetrate at once to the true skin. Resorcin, in solution locally, gives marked 
relief, lasting for several hours, in the majority of cases. Carbolic Acid, is the 
opium of the skin (Unna), and the most useful antipruritic agent ; in combina- 
tion with glycerin, as lotion to the itching surface, gives great relief (Bulkley); 
internally and locally in pruritus senilis (B) ; a one per cent, solution as lotion 
in pruritus ani (R). Chloral, with Carbolic Acid, locally [see page 258]. 
Camphor and Chloral, rubbed together, make a liquid which, added to vaselin, 
gives an ointment which is powerfully antipruritic (Bulkley) ; added to dusting 
powders, allays heat and itching of eczema and intertrigo (R). Tumenol, as 
tincture, is used locally with almost universal success (Neisser). Menthol, seems 
to be of marked value in almost all cases of pruritus, from whatever cause 
(Squibb). Antipyrin, internally as a symptomatic remedy against itching, is 
promptly efficient in nervous pruritus, true prurigo, urticaria, erythema, pern- 



PRURITUS. 



823 



phigus vulgaris and lichen ruber. Alkaline Baths, locally, followed by the 
application of carbolized ointment, give great comfort in all forms of pruritus 
(Bulkley) ; Sodium or Potassium Carbonate preferred (Tr) ; in solution locally, 
3iij ad %iv (B). Brucine, in 20 per cent, solution, has been employed with 
satisfaction in chronic pruritus, as a local application (Mays). Mercury, strong 
solutions of the Bichloride, Black or Yellow Wash or Mercurial Ointment, in 
the itching of skin affections (R) ; Yellow Wash is one of the most efficient 
applications for pruritus ani : solutions of the Bichloride are very useful 
applications in pruritus vulvas et ani (Tr) ; for pruritus vulvae a lotion of the 
Bichloride 1 to 2500 parts of water, with Alum and Starch, is recommended 
(B): Calomel 3j to ^j of Lard, as ointment, is the best application, except in 
the pruritus of urticaria ; very useful in pruritus ani, less so in pruritus pudendi 
(R) : the Oleate, a 5 per cent, solution in Oleic Acid with one-eighth part of 
Ether, applied by a camel's-hair brush, in pruritus ani et pudendi (Marshall). 
Alum, a strong solution is very useful for pruritus vulvae (Tr). Hydrocyanic 
Acid, diluted as lotion, often very serviceable ; may be prescribed in solution 
with Borax (B) ; or Laurel-water as lotion, especially in pruritus senilis (P). 
Potassium Cyanide, Z) to Oj of water, as lotion, for pruritus of various kinds 
when the skin is unbroken (R) ; as ointment or solution, if strong enough, 
relieves greatly, but must be used with caution (B) ; or rr\,xxx of the dilute Hey 
Acid of the Br. Ph. in ,^j of water or glycerin, may be used instead (R). Silver 
Nitrate, a solution, gr. xx to the %, painted over the affected parts in pruritus 
vulvae, is very effective (B). Tobacco, is an effective but dangerous applica- 
tion (B). Iodoform, as ointment, £j a d %'} Adipis (R). Iodine, for itching of 
the nose or inner canthus, sneezing, etc., its inhalation has a marked effect (R). 
Arsenic, for itching of the nose accompanying asthmatic symptoms (R). 
Benzoin, the compound tincture painted on the skin, for the itching of 
eczema, urticaria, etc. (R). Boracic Acid makes an excellent lotion in pruritus 
pudendi, a teasp. to the pint of hot water (R). Borax, gr. v-x to the 5j of hot 
water (R). [See PRURIGO.] Balsam of Peru, is a very good application in 
pruritus ani, scabies, and many other forms of itching (Auerbach). Zinc 
Sulphate and Alum, equal parts of each, are almost a specific in pruritus ani 
(Agnew). Chloroform, as ointment to allay itching of skin diseases. Gelsemium, 
TTLxv of the tincture every half hour, up to 3j m all. for itching which is out of 
proportion to the cutaneous lesion (Pelcher). Lead Lotions, to ease the itching 
of urticaria, pruritus pudendi, etc., especially when the mucous membrane is 
red and excoriated (R), Piperazin, gives immediate relief in the pruritus of 
the uric acid diathesis. Salicylic Acid, as ointment, in pruritus ani et vulvae 
(R). Sodium Salicylate, in 15-grain doses by mouth every four hours, will 
greatly relieve pruritus vulvae, when due to diabetes (G). Tar, as ointment, is 
strongly recommended (Tr) ; for general pruritus, if no cause can be found, the 
two best remedies are Tar and Sulphur, as lotion or bath (Sparks); ointments 
containing Tar give relief in many instances (Bulkley). Sulphur, may be em- 
ployed as a bath, Potassa Sulphurata, ^ij ad C xv of hot water (Sparks) ; or the 
alkaline sulphites locally (Wa) ; the Iodide of Sulphur externally and inter- 
nally, in pruritus senilis (Wa). Chlorine, the Liquor Sodae Chloratae, diluted, a 
useful application in pruritus ani (Wa). [Compare Eczema, Erythema, 
Lice, Pediculi, Prurigo, Scabies, Urticaria.] 



ft 



. Hydrarg. Chlor. Corr., . gr. j. 
Pulv. Aluminis, . . . gr. xx. 

Amyli, 3J SS « 

Aquae, ^vj. 

M. Sig.— Apply locally. {Goodell.) 



R 



Acidi Hydrocyanici Dil. 
Infusi Althaeae, . . . . 
M. Sig. — Lotion. 



3SS-J. 

3 v ~ vii J- 

{Fox.) 



ft. Acidi Hydrocyan. Dil. , pjij. 
Sodii Boratis, .... gj. 

Aquae Rosae, ^ viij. 

M, Sig.— Lotion. (Fox.) 



ft. 



Potassii Cyanidi, 
Pulv. Cocci, . . 
Ung. Aquae Rosae, 
M. Sig. — Ointment. 



gr. vj. 

gr. j. 

(Anderson.) 



824 



PSORIASIS PTERYGIUM PTOSIS. 



:. Potassii Cyanidi, , 
Aquae Laurocerasi, 
M. Sig. — Lotion. 



R. 



Acidi Benzoici, . . 

Olei Caryophylli, . 

Alcoholis, .... 
Solve et adde — 

Cerati Simplicis, . 

Balsami Peruviani, 
M. ft. unguentum. Especially good for 
cabies, but may be used for any pruritus. 



gr. xv. 


rjt . Gummi Camphorae, 




E vi[ h 
[Anderson.) 


Chloralis Hydratis, . . 
Rub together until liquefied 
then add slowly, -with friction, 


aa^j-ij. 


gr. ex. 


Unguenti Aquae Rosae, . 
Sig. — Ointment for itching. 


• IJ- 


gtt. xl. 




{Bulkky 



; vnj. 
I)- 



& . Acidi Carbolici, . . . . 3 i j . 

Glycerini, §j. 

Aquas Rosae, . . q. s. ad ^viij. 
M. Sig. — Lotion for pruritus. 



Psoriasis. 

Chrysarobin, has the most decided effect on psoriasis, 3ss-ij ad ^j of ung. 
aqu<e rosae ; often irritates, and should be employed at first with caution 
(Bulkley) ; gr. x-xxx to the 3 of Petrolatum, applied to each spot twice daily, 
invariably successful (Hughes). Thyroid Extract, several cases of psoriasis 
treated with this remedy alone recovered completely in the course of a few 
weeks (Bramwell). [See page 158.] Aurum, is useful in the squamous skin 
diseases. Ichthyol, is a very efficient application. Thiol, is probably a better 
remedy than Ichthyol ; the dry form, used as a dusting powder, is remarkably 
efficient (Squibb). Aristol, is an excellent application. Arsenic, at first appar- 
ently aggravates, but soon cures the disease (R) ; must be persistently used 
for a long time (B) ; exercises a powerful influence (Wa) ; maximum dose of 
Liquor Arsenicalis tt^v ter die, never on empty stomach (R). Mercury, in patches 
of obstinate psoriasis, especially of hands, even when not syphilitic ; Calomel 
and Mercuric Nitrate ointment may be mixed and Tar ointment added (R). 
Lappa Major, a tincture of the seeds in whiskey, used by tablespoonful doses, 
cured several cases of long standing (Reiter). Carbolic Acid, 1 to 4 of lard, as 
ointment (Wa). Mezereon, a useful adjunct (Wa). Sulphur, internally (R) ; 
a solution of Potassa Sulphurata in water, is excellent in chronic psoriasis (B) ; 
not in acute (R). Sulphur Iodide, externally and internally, in doses of gr. j-vj 
used with great advantage (Wa). Silver Nitrate, occasionally in psoriasis 
of tongue and buccal mucous membrane; if syphilitic, mercurials best (R). 
Nitric and Nitro-Hydrochloric Acids, when symptomatic of imperfect digestion 
and assimilation (B). Phosphorus, as substitute for Arsenic (B). Coptis, has 
reputation in New England (B). Copper Sulphate, applied solid to spots (R). 
Lead, the ointment of the Iodide (B). Tar, painted on, in obstinate cases (R). 
Oils, Cod-liver Oil internally and locally, is the sheet-anchor, especially when 
of strumous origin (B) ; oils and fats to lubricate skin, also warm baths (R). 
Diet and Hygiene, nourishing diet, frequent small quantities of raw vegetables, 
Cod-liver Oil for growing persons, especially when stale fish the cause. Rest 
and change for overworked subjects. Open-air exercise is most useful. Warm 
or tepid soft-water baths at night, with use of pure soap ; daily baths or cold 
sponge-baths. 

Pterygium. 

Silver Nitrate, locally, especially when pterygium with catarrhal conjunc- 
tivitis (Wa). Treatment is unavailing, and benefit is seldom derived from any 
operation (C). Arlt's Operation, the most satisfactory ; cut away as little tissue 
as possible, dissect cleanly, close with suture (Green). 



Ptosis. 

Veratrine, gr. x in 3ij of Sulphuric Ether and ^j of Alcohol, brushed over 
the eyelids, brows and temples every morning, till a slight burning sensation 



. PTYALISM — PUERPERAL CONVULSIONS. 825 

is produced; conjointly with the use of electricity (W). Ergot, aqueous infu- 
sion as collyrium (Wa). Electricity, the constant current may often relieve 
recent cases (C). Operation for shortening the lid, by removing an elliptical 
piece of skin and subjacent muscle (C) ; is not advisable unless the ptosis is 
nearly or quite complete, and of great inconvenience. 



Ptyalism. 

Acids, as astringents, small medicinal doses (R). Sulphuric Acid, internally 
and with Decoctum Cinchonas as a gargle, of great benefit in mercurial ptyal- 
ism (Wa). Potassium Chlorate, in simple or mercurial ptyalism (R) ; in the 
latter form 3j a d £vj aquae as mouth-wash, and internally in teasp. doses, 4 or 
5 times daily (St). Belladonna, very effective in mercurial ptyalism, and that of 
pregnancy ; gtt. v-x, or Atropine gr. -^q- to y^ every 4 to 6 hours (B) : is good 
treatment when ptyalism is the result of some reflex action, but not so when it 
is an effort of nature to eliminate some drug-poison, as mercury, iodine, etc., from 
the system (Whitla). Pellitory, to stimulate the salivary flow in the latter case, 
unless the gums are swollen and ulcerated (Id). Hyoscine or Opium, may 
be used instead of Atropine (Id). Astringents, in ptyalism from excessive 
mercurialism when the gums are swollen and ulcerated ; Alum 1 in 40, Zinc 
Chloride 2 grains to the %, Tannic Acid 1 in 40, or other vegetable astringents 
(Id). Tannic Acid, in mercurial ptyalism is an excellent gargle, Z) of Tannin 
to ^ij of Mel Rosas, and %vj of water (B). Alcohol, diluted, as a gargle (R). 
Potassium Iodide, is sometimes beneficial in mercurial ptyalism, but often 
aggravates it (R). Iodine, the tincture 3ij in ^ v "j of water, as a gargle (R) ; 
is worthy of trial (Wa). Borax, the glycerite is an efficient local application, 
but must be used almost continuously (Whitla). Potassium Bromide, has 
proved useful in the salivation of pregnancy ; it may be combined with small 
doses of Belladonna or Hyoscyamus (Id). Chlorinated Lime or Soda, in weak 
solution, for the fetor (Id). Stimulants, may be needed in severe cases. Diet, 
liquid food when swallowing is difficult. [Compare the Lists of Sialogogues and 
Antisialics on page 62.] 

Ii . Acidi Sulphurici, . . . gss. r£ • Sodii Boratis, . . . . £ij. 

Tinct. Myrrhae, .... gj. Pulv. Myrrhse, .... 5jj. 

Aquas, . . . . q. s. ad 3;vj. Aquae, % v \- 

M. Sig. — Mouth-wash. M. Sig. — Mouth-wash or gargle. 



Puerperal Convulsions. 

Chloroform, by inhalation to narcosis (R) ; its utility unquestionable when 
convulsions are not due to cerebral hemorrhage (B) ; the combined chloroform 
and chloral treatment results in a death-rate of only y.6 per cent. (Winckel). 
Chloral, after the chloroform, given with Bromides by the rectum to keep up the 
effect ; full doses, 20 to 30 grains every 2 hours (B); a remedy of the greatest 
value, in full dose before proceeding to one of the bromides (Playfair, Barnes). 
Bromides, in large doses by enema, are distinctly indicated (P) ; Potassium 
Bromide, 3j-ij by the rectum, after venesection if convulsions return (Whitla). 
Veratrum Viride, in ^ss doses of fluid extract every 15 minutes, to nausea, 
invaluable (R) ; the fl. ext., in doses of nvviij-x hypodermically, may be re- 
peated in half-hour with Morphine, or rt^x by enema, promptly efficient in the 
worst cases (Elmer) ; a very bad case cured by 20-minim doses every hour for 
5 days (Dunn) ; the worst case seen in my 30 years' experience, after 14 seiz- 
ures was promptly cured by a hypodermic injection of n\iv of Norwood's 
tincture in a little water (Etheridge). Pilocarpine Nitrate, gr. £ hypodermically 
every 2 hours, very successfully used in several cases (Finniss); is dangerous, 
being liable to cause edema of the lungs (P). Aconite, one of the best agents 
(P); gtt.j-ij of tinct. every 10 or 15 minutes for the first hour, then at longer 



826 PUERPERAL DISORDERS FEVER. 

intervals (B). Belladonna, the tinct. internally with Atropine hypodermically, 
of verified utility (F). Potassium Bitartrate, administered for a month prior to 
confinement, in quantity sufficient to bring about free action of kidneys and 
bowels, will certainly prevent puerperal convulsions (Anderson). Opium is 
apt to induce eclampsia, unless its use be preceded by free purgation or vene- 
section (Id) ; as Morphine hypodermically, the most important agent for 
cure of uremic convulsions (B) ; with the lancet, sometimes required (P) ; 
Morphine is combined with the chloral treatment by many authorities. Amyl 
Nitrite, by inhalation (B) ; may cause alarming hemorrhage (W). Ice, to 
the head (R) ; and mustard poultices at same time to the feet (Wa). Vene- 
section, by far the most efficient measure (Wallace) ; when great cerebral 
congestion and vascular tension, shown by a livid face, a full and bounding 
pulse, and strong pulsation in the carotids (Play fair) ; remove 15-20 ounces of 
blood, and follow by enemata of Potassium Bromide, o\j-ij» if convulsions re- 
turn ; Chloroform should be very cautiously used, if at all, after blood-letting 
(Whitla). Compression of the Carotids, Trousseau's method, often stops or 
materially modifies the attack, and may be used in most cases to gain time 
until chloroform narcosis is established (Id). Saline Purgatives, the best 
being Magnesium Sulphate, or the compound Jalap powder, with free use of 
the wet pack to act upon the skin, for the rapid elimination of the retained 
excrementitious products, urea, leucin, tyrosin, etc. (Id). 

Puerperal Disorders. 

Cimicifuga, in puerperal hypochondriasis, and depression (Wa, P). Opium, 
either alone or with alteratives, highly serviceable in puerperal intestinal irrita- 
tion ; a few drops of the tincture effectually arrests the diarrhea (Wa) ; when 
shock and marked exhaustion, a moderate dose is of benefit (L). Castor Oil, 
undoubtedly the best laxative (L) ; purgatives generally are not required, 
castor oil the very worst (Fordyce Barker); action uncertain (Parry). Rhu- 
barb, or enemata, best means of stimulating bowels after fourth day (L) ; gr. 
xx-xxx in some aromatic water a good aperient (Wa). Aliment, in puerperal 
state should be easy of digestion and sustaining (L). Catheter, necessary often 
for several days when bladder paralyzed, if warm water lavements fail (L). 
Water, tepid sponging of external parts, vaginal washings daily with warm 
water, with yi^ part Carbolic Acid (L). [See After-pains, Hemorrhage, 
Labor, Lactation, Mastitis, Nipples, Phlegmasia Alba Dolens, etc.] 



Puerperal Fever. 

Aconite, drop doses every one or two hours steadily, with an occasional dose 
of Castor Oil, and repeated hot poultices or Laudanum fomentations, the most 
successful treatment, even in the worst cases, but useless if not promptly effi- 
cient (P). Veratrum Viride, is used with great benefit in most cases (Barker). 
Opium, for wakefulness and delirium (B) ; a very valuable remedy, tending to 
allay pain, and reduce excitement of the nervous and vascular systems (Wa). 
Alkaline Sulphites, especially valuable in early stages, internally and locally ; 
gr. xv-xxx of Magnesium or Calcium Sulphite every 2 or 3 hours, with injec- 
tions every day (Wa). Stramonium, when cerebral excitement (P). Potassium 
Permanganate, gr. %-) ter die, has been given with benefit (B). Alcohol, 
freely used, until all evidence of sepsis subsided, caused recovery in one of the 
most desperate cases of puerperal septicemia of three weeks' standing, with 
temp, falling to 95 and rising to 107 (Hills). Calumba, preferable to Cinchona 
(P). Quinine, only large doses are useful : gr. v-xx every 4 hours (B) ; reduces 
the temperature (P). Warburg's Tincture, is more efficient than the largest 
doses of Quinine in cases of puerperal malarial fever, gss every four hours 
until fever abates, then in diminishing doses to 3j-iji until convalescence is 
established (Fordyce Barker). Turpentine, when depression of vaso-motor 



PUERPERAL MANIA PULSE — PURPURA. 827 

nervous system, cardiac weakness and tympanitic distention of abdomen (P). 
Resorcin, is much used in Vienna by Braun ; gr. xl repeated p. r. n. Strepto- 
coccus Antitoxin, has been used with success by several authorities [see page 
182]. Rest and quiet but attentive nursing, frequent liquid food. Water, hot 
fomentations frequently to the parts, valuable as preventive. Antiseptic Injec- 
tions into the uterus are used, but are strenuously opposed by many of the most 
prominent and experienced clinicians. [Compare Puerperal Peritonitis, 
Septicemia.] 

Puerperal Mania and Melancholia. 

Stramonium, will allay cerebral excitement, and soothe the nervous system ; 
when delirium mild and furious, but intermittent ; tendency to suicide or to 
destroy the child ; rr\,x-xx of tinct. every 3-4 hours (P). Hyoscyamus, in the 
milder cases ; when nervous system is greatly excited (P). Duboisine, as 
calmative and hypnotic, acts efficiently for a time in puerperal mania. Aconite, 
in puerperal mania with high fever and restlessness ; speedy and marked suc- 
cess follows if given soon after the chill (P). Cimicifuga, has cured (B) ; its 
effects are truly remarkable in the mania and hypochondriasis of the puer- 
peral state (P). Chloral, often alleviates symptoms (B) ; to produce sleep 
(Wa). Potassium Bromide, in sthenic cases (R) ; its effects are very variable 
(Wa). Anesthetics, Chloroform or Ether inhaled in violent paroxysms of 
mania (B). Tartar Emetic, in frequently repeated doses (Wa). Quinine, when 
much weakness ; skin cold and sweating (B). Chalybeates, Tinct. Ferri 
Chloridi, nrv-xx, in the anemic form (B). Opium, cautiously (B) ; gives the 
best results in such doses as may be necessary to allay irritation and procure 
sleep (Wa). Poultices, hot fomentations, enemata, or gentle laxatives ; nutri- 
tious and stimulating diet. Lochia, should be watched (P). Weaning, 
imperative in melancholia ; not so in acute mania. 

Puerperal Peritonitis. 

Aconite, has cured cases of the usual type (P). [See under Puerperal 
Fever.] Cimicifuga, especially in rheumatic form, has remarkable effects (P). 
Opium, its curative power in this, one of the best established facts in therapeu- 
tics (B) ; is good, but Aconite often better (P) ; especially valuable in adynamic 
cases (Wa) ; the drug of all others to be relied on (Godson). Turpentine, as 
stimulant, rr^x frequently repeated, better than Alcohol (B) ; by enema, also 
hot turpentine epithems may be used with advantage (Wa). Quinine, in con- 
siderable doses, with or without Opium (B) ; gr. x-xx twice daily as an antipy- 
retic (Wa). Antimony, as Tartar Emetic, gr. j 1 ^ to |- every hour to shorten 
attack and render it more mild (R). Cathartics, advised by many, prohibited 
by as many; evidence is in favor of mild aperients combined with Dover's 
powder or Hyoscyamus (Wa). Poultices, hot, of very great value (B). Water, 
Ice in mouth or swallowed, hot fomentations to abdomen ; in some cases cold 
compresses best. [Compare Puerperal Fever.] 

Pulse. 

Aconite, for a quick, resisting pulse (P) ; a moderate dose, while it makes the 
pulse less frequent, renders it fuller, stronger and less compressible (R). 
Veratrum Viride, reduces febrile heat with abnormal rapidity of pulse (P). 
Veratrine, pulse at first quick and strong, then slowed ; afterward quick, weak 
and irregular (R). Digitalis, for weak, quick pulse. [Compare Heart Dis- 
eases, Fever, etc., also the Lists of Vascular Contractors and Dilators, on 
pages 65, 66.] 

Purpura. 

Sulphuric Acid, often acts happily (B). Ergot, has been strongly urged 
(R) ; is most useful in removing purpura (P) ; many cases are recorded as . 



828 PYROSIS RACHITIS RECTUM. 

cured by hypodermic injections of Ergotin (Wa). Turpentine, has been used 
(R) ; with invariable benefit (Wa). [See Hematemesis.] Nux Vomica, no 
prescription more generally useful than the Syrup of Iron, Quinine, and Strych- 
nine (B). Iron, when due to anemia; the tincture of the Chloride (B) ; is 
preeminently the curative remedy for purpura hemorrhagica, arresting the 
hemorrhagic tendency in 24 to 48 hours (Pize). ' Vinegar, and water, is an 
excellent application by sponging over the body (E. Wilson). Quinine, or Hux- 
ham's Tincture of Bark, are much used (H). Potassium Nitrate, gr. x thrice 
daily in purpura simplex, used successfully (Wa). Styptics, as the Ammonio- 
ferric Alum, tincture of Ferric Chloride (Tr) ; Tannic and Gallic Acids, used 
in some cases (H). Alum, and brandy or whiskey and water at such tem- 
perature as is not chilling, applied by sponging the body, is the best local 
measure (H). Wines are generally indicated (B). [Compare Hemorrhage, 
Scurvy.] 

Pyrosis and Cardialgia. 

Capsicum, in atonic dyspepsia, with heartburn and diarrhea (P). Nux 
Vomica, of the highest possible value in atonic dyspepsia with heartburn, hic- 
cough, regurgitation, etc. ; an excellent combination is tt\,v-x of the tincture 
with rr^xv of dilute Nitric Acid for one dose (P). Pulsatilla, a good medicine in 
the heartburn of dyspepsia in phlegmatic subjects (P). Podophyllin, gr. -^ 
night and morning in obstinate heartburn, with liver derangement (P). Almonds, 
blanched, six or eight are said to relieve heartburn (P). Rhubarb, and other pur- 
gatives are often useful ; also Magnesia, Bismuth, and Ginger (Beale). Opium 
in small doses has been advocated for water-brash (Id). Catechu and Kino, 
also other astringents, sometimes do good, and bitter infusions, especially that 
of Calumba, have been given with advantage in water-brash (Id). Diet, lemon- 
juice, aerated bread, plain biscuit, etc.; but avoid new bread, much vegetable 
food, and pastry. [Compare Acidity, Dyspepsia.] 



Rachitis. 

Lime, as Lime-water, or the Carbonate, or the Syrupus Calcii Lacto-phos- 
phatis (B) ; in small doses (R) ; the Phosphate may be advantageously com- 
bined with Cod-liver Oil (Wa). Iron, the Syrup of the Iodide preferred ; 
Calcium and Ferric Phosphates excellent in combination (B) ; must be con- 
tinued a long time (R). Nitro-hydrochloric Acid, as baths, gives excellent 
results (Wa). Quinine, often very valuable (P). Thymus Extract, is suggested 
as probably useful [see page 160]. Aliment, food rich in Calcium Phosphate 
and other phosphatic salts; oatmeal, Graham bread, etc. (B) : Cod-liver Oil, 
the best constructive agent (B) ; a full animal diet (Wa) : cold sponging (R). 



Rectum, Diseases of. 

• Podophyllum, in doses of gr. ^ to ^ night and morning, for a child, may 
relieve prolapsus of the rectum (P). Belladonna, the extract locally in fissure 
(R) ; and irritable ulcers (P) ; internally and locally to remove ulcers, also ex- 
cellent for burning pain following defecation ; or with mercurial ointment, equal 
parts of each, for fissures and ulcers (P). Acetanilid, in fine powder, is an 
excellent application to ulcers of the rectum. Phosphorus, in chronic inflam- 
mation of the rectum, has been highly recommended (R). Cocaine, gr. xl to 
gj of glycerite of starch, applied by Seeley's Pile-pipe, very efficient in control- 
ling spasm of the rectum. Potassium Bromide, in 5 parts of glycerin, locally, 
for fissures and painful growths (R). Iodoform, as suppository in painful 
diseases, relieves greatly (R). Pepper, the confection, as gentle stimulant in 
fistula, ulcers, hemorrhoids (P). Castor Oil, in fissure and hemorrhoids, is 
commonly used as purgative (R, P). Sulphur, with Confectio Sennae, in irrit- 



RECTUM REMITTENT FEVER. 



829 



able rectum, is very soothing (Wa). Stramonium, an ointment of the fresh 
leaves to alleviate pain (P). Conium, the extract in doses of gr. x to allay 
pain and irritability in rectal cancer (Wa). Spigelia Anthelmia, an enema of 
the juice also a decoction internally, are used by the Venezuelan natives with 
success in the epidemic gangrenous proctitis of that country (Ackers). Lemon, 
roasted, and one of the quarters introduced into the rectum once or twice 
daily, is used with very satisfactory results in the same affection (Id). Purga- 
tives, are best for proctalgia (D). Surgical, an incision through mucous mem- 
brane, and in severe cases to divide part of the sphincter, in ulcer or fissure ; 
a flake of cotton should be laid in the wound, so that it may heal by granula- 
tion (D). [Compare Anus, Diarrhea, Dysentery, Hemorrhage intes- 
tinal, Hemorrhoids, Prolapsus, Rectum ulceration of, Sprue. J 



Rectum, Ulceration of. 

Mercury, the Red Oxide, 3j to the ^j of Unguentum, as ointment in flat 
ulcers of rectum existing just within the anus (Coulson). Belladonna, the 
extract locally for rectal ulcers, is very efficient (P). Carbonic Acid, per anum, 
is strongly advised (Wa). Chloroform, as ointment, in irritable ulcer of rectum 
(Curling). Iodoform, in suppository, extremely useful in painful ulceration 
(R) ; used in many cases with very satisfactory results, but in some instances 
poisoning occurs; hence it should be used with caution (Wa). Phosphorus, 
as an internal remedy, is highly recommended in chronic inflammation of the 
rectum (R). Copper Sulphate, with Opium, may often be used internally with 
advantage, and a weak solution of the same, or of Silver Nitrate, locally (Curl- 
ing) ; the writer had a case resisting treatment for three years, in which a cure 
was effected by the persevering use of a pill of Cuprum Sulphate, Extract of 
Opium, and Quinine Sulphate [see below]. Silver Nitrate, gr. }(-] combined 
in pill with Opium, gr. ss ; and a solution, gr. x-xx to the pint, by enema (B). 
Glycozone, %} in ^xij of lukewarm water, mixed immediately before using, and 
given by enema once daily, in ulceration and chronic inflammation of the 
rectum and lower gut (Edson). [Compare Dysentery.] 



R. Cupri Sulphat., 

Morphinae Sulphat. 
Quininsc Sulphat., 
M. ft. pil. no. xxiv. 

thrice daily. 



. aagr. ij. 
. . gr. xxiv. 
Sig. — One pill 
{Potter.) 



R. Chloroformi, ;?j — ij« 

Zinci Oxidi, 3 SS - 

Olei Olivse, gj. 

Cerati Cetacei, . . . . 3 iv. 
M. ft. unguentum. [Curling. 



Relapsing Fever. 

Cathartic, a mild one at beginning (H) ; if jaundice or other hepatic derange- 
ment, a Calomel purgative, cautiously lest irritation (Wa). Potassium Citrate, 
as cooling diaphoretic. Quinine, in moderate doses after the crisis, at least 
until the relapse, which will not be prevented by any amount of Quinine (Wa). 
Leeches or Cupping, best for headache (A). Alcohol, required by some pa- 
tients. Diet, supporting, especially in third week, beef-tea, etc. Urine, should 
be watched carefully (A). [Compare Typhus Fever.] 



Remittent Fever. 

Antipyrin or Phenacetin, in full dose during pyrexia, to lower the temp., is 
very efficient treatment, especially if conjoined with Quinine during the remis- 
sion ; the latter drug being too slow of action to be of immediate service in the 
pyrexia. Aconite, in the hot stage, if any febrifuge is required, frequently re- 
peated doses (B) ; is next in value to Quinine for high fever and headache, gtt. 
j of a good tincture every hour (Da C). Quinine, 20 to 30 grains in single dose 



83O RETINA RHEUMATISM. 

once or twice daily until the temperature is reduced, with other appropriate 
remedies (B) ; 15 to 20 grains at most (Maclean) ; 30 to 50 or 60 grains in severe 
cases of pernicious remittents several times a day without regard to exacerba- 
tion (P, B); 10 or 15 grains should be administered at once in bilious remittent 
and other severe forms of malarial fever, without waiting for the remission or 
sweating; an aperient may be given at the same time, 5 or 10 grains of Calo- 
mel is the best (Mn) ; when vomiting is severe the rectum should be cleared 
out with an injection of warm water and then an enema of Quinine gr. xxx in 
Water ^iij, with a few drops of acid to aid solution, and 5 or 10 grains of Cal- 
omel may be given at the same time by the mouth (Id). Warburg's Tincture, 
has achieved a very high reputation, but must be used in less dosage than 
directed, and supporting treatment given when its sudorific action commences 
(Wa). Gelsemium, exercises a really beneficial influence ; depresses the tem- 
perature (B) ; valuable in bilious remittents of the South (Pf ). Morphine, gr. 
^ hypodermically to abort pernicious remittent fever (B). Purgation, by Cal- 
omel with Jalap or salines afterwards, is very necessary during the course of the 
disease (Da C). Quassia, an excellent tonic in the convalescence, combined 
with mineral acids (Wa). Packing, by the wet sheet, is resorted to with advan- 
tage, except when hepatic or splenic congestion exists (Wa). [Compare 
Fevers tropical, Hemoglobinuric Fever, Intermittent Fever, Mala- 
ria.] 

Retina, Affections of. 

Mercury, in syphilitic retinitis, is of great value ; Calomel gr. j-ij with Opium 
gr. %-Yz every 4 or 6 hours ; also mercurial inunction till the gums are affected 
or the disease yields (Wa). Potassium Iodide and Bromide, in combination, 
in retinal hemorrhage, to promote absorption of the effused blood and to benefit 
the congestion (C). Physostigmine, locally, to contract the pupil, and diminish 
the amount of light admitted to the eye (Wa). Iron, in full doses, generally the 
tincture of the Chloride, in pigmentary retinitis ; seems to have a tendency to 
arrest the malady (C). Leeches, to the temple better than general bloodletting 
(Wa) ; when much local congestion present, depletion by artificial leech is 
almost always indicated (C). Pilocarpus, in detached retina and optic neuritis ; 
has been found a very useful remedy in retinal affections generally. [Com- 
pare Amaurosis.] 

Rheumatism, Acute. 

Plans of Treatment, may be resolved into three, viz., — (1) that by Salicylic 
Acid, (2) that by Alkalies, (3) that by Iron. Salicylic Acid or the Salicylates, in 
20-grain doses, to not less than 3'j in 24 hours, in solution with excess ot 
alkali, is especially suited to vigorous, sthenic subjects, whose stomachs will 
bear it, in whom it often effects a cure in 3 or 4 days. Salicin, gr. x-xxx every 
2, 3, or 4 hours; gr. xv every 3 hours in powder mixed with water (Maclagan), 
or same dose of Salicylic Acid, is of great benefit ; good effect generally ex- 
perienced within 48 hours (R) ; the Acid is better than the Salicylates, but 
must be abandoned if not effective after 3 or 4 days (Da C). Oil of Gaultheria, 
as a substitute for Salicylic Acid, used very successfully in form of emulsion 
(B). Alkalies, for flabby, fat subjects; alkaline carbonates, as Potassium Car- 
bonate ^jss every 24 hours, alone or with a vegetable acid, until the urine 
becomes neutral or alkaline, when it may be reduced one-half, and so main- 
tained for some days, when Quinine or Iron may be used ; if successful, this 
treatment brings about a cure in two weeks : the alkaline treatment is now 
seriously questioned ; an injurious dyscrasia results from their use (B) ; Potas- 
sium Bicarbonate, gr. xxx every 4 hours, in a dilute solution, until joint-symp- 
toms and fever disappear (Wa) : cardiac complications require Ammonium 
Carbonate, in 5-grain doses frequently, also Infusion of Digitalis with hypo- 
dermics of Morphine, and a blister over the precordium, followed by Iron 



RHEUMATISM, ACUTE. 83 I 

and Quinine after the acute symptoms have subsided (B). Tincture of the 
Chloride of Iron, for feeble, anemic and nervous subjects, rr\xxx every 4 
hours, with an occasional saline laxative, blisters around joints, and Atropine, 
as an anodyne rather than Opium, used hypodermically in the vicinity ot the 
affected joint (B) ; very serviceable in pale, delicate subjects, ir^xx-ocxx every 4 
hours ; also as prophylactic where tendency ( Anstie) ; harmful to the plethoric 
and overfed (B). Iron and Salicylic Acid in combination, should be most 
valuable, but as heretofore prescribed has always made an insoluble pre- 
cipitate ; this is overcome by Dr. Peabody in the formula given on the next 
page, which makes a ruby-red mixture, and has advantage of preventing the 
anemia which results from the Acid given alone. 

Aconite, very serviceable when much heat and dry skin (B) ; subdues pain 
in inflamed joints and perhaps shortens the fever (R) ; in small doses fre- 
quently repeated is of the greatest value, and if used from the start prevents 
organic cardiac disease (P) ; not reliable as a curative agent, but is a valuable 
adjunct to other remedies (Wa). Veratrum Viride, said to be useful (R) ; small 
doses as antipyretic, may be combined with Opium (P). Salipyrin, has been 
employed with excellent results, in 15-grain doses every l / 2 hour or hour, until 
about Z'\) have been taken, continuing with smaller doses for a long time after 
convalescence, to prevent relapses. Salol, the great remedy, none superior 
(B) ; given in doses of 15 to 30 grains, up to 3ij in 24 hours, and continued for 
some time after acute symptoms have subsided ; may prove toxic in large doses, 
with symptoms of carbolic acid poisoning. Salophen, is said to be equally 
efficient and non-toxic, 3j~3jss daily. Antipyrin, has held a high place for 
several years [see page 172]. Phenacetin, is an efficient and safe antipyretic. 
Phenocoll, for the pyrexia, is used with marked success. Rhus Toxicodendron, 
positively invaluable in after-stage, also in subacute forms, muscular or ten- 
dinous, worse at night (P, Pf ). Hydriodic Acid, the Syrup, in dessertsp. doses 
every 2 or 3 hours, the best remedy for acute and subacute rheumatism, reliev- 
ing pain and swelling in 18 to 24 hours (Craig). Cimicifuga, has excellent re- 
ports (B) ; much used, and is said to quell the pain speedily (R); found very 
serviceable (P). Dulcamara, recommended especially for persons who are 
subject to catarrhal affections in cold and damp weather (P). Ammonium 
Bromide, an excellent treatment, followed by Quinine ; gives a very low pro- 
portion of cardiac complications ; gr. xv-xx every 4 hours (Da C) ; is dis- 
agreeable but strongly recommended (B). Arnica, lowers pulse and tempera- 
ture, relieves articular pain and swelling, diminishes urea (P). Trimethyl- 
amine, rr\,iv-viij in Peppermint-water, often has remarkable power in acute 
rheumatism and gout (B). Bryonia, after the swollen joints have been reduced 
by other means, is extremely efficient for the pain and stiffness (P). Spigelia 
Anthelmia, for rheumatic pericarditis and endocarditis ; rheumatic fever with 
pain shifting from joint to joint (P) ; seems to fix the disease in certain joints, 
and prevent its shifting around (P). Sulphurous Acid, by fumigation, the 
patient covered with blankets and exposed to strong fumes, produces perspira- 
tion, sleep and relief (R). Colchicum, alleviates the symptoms, and shortens 
their duration (Wa). Laville's Mixture, is said to be a tincture of Quinine and 
Colocynthine, but it is more than probable that Colchicine is the active agent 
therein. Quinine, as antipyretic ; not so useful as wet pack or cold bath ; gr. 
ij-v after the more acute symptoms have subsided (B) ; is best for the head 
symptoms (Da C). Opium, strongly recommended as anti-rheumatic ; gr. j 
every 2 or 3 hours, increased to gr. xij in 24 hours ; tolerance remarkable in 
this disease ; in rheumatic carditis indispensable (Wa) ; a very good remedy 
in moderate doses (Da C). Lithium Bromide, equally good in all forms, 
especially for insomnia, delirium (B). Digitalis, in powder, gr. ij every 4 
hours, usually effective after 2 to 7 days ; especially useful in cardiac complica- 
tions with cyanosis and edema. Lime-juice, ^viij daily, Lemon-juice inferior 
(R). Blisters, are a very effective method ; a number of small blisters applied 
to vesication around a joint (B) ; large flying blisters around a joint (R). 
Water, cold baths for the hyperpyrexia (Da C) ; the wet pack efficacious in 



8 3 2 



RHEUMATISM, CHRONIC. 



rheumatism, also a vinegar vapor bath (B) ; the wet pack, 20 or 30 minutes, 
and tepid (70 ) shallow bath 1 or 2 minutes. Cold applications only when skin 
hot and dry, and temperature high. Warm baths, or hot compresses very use- 
ful. Spongiopiline an excellent substance for applications. Diet, low during 
the fever, water, barley-water, milk-and-water, gruel ; use liquid food through- 
out, avoid malt liquors, port wine and sugar. Lemon-juice may be used freely. 
Blankets, instead of sheets to sleep in, and flannel underclothing, are useful 
adjuncts. Pack the joints with cotton covered with rubber cloth or oiled silk. 
Dry Heat, applied by the Tallerman apparatus is of great value in tendinous 
inflammations, also in subacute rheumatism through its sweating and local in- 
fluence (W). 



R 



Olei Gaultherise, . 
Acidi Salicylici, 
Sodii Boratis, . . 
Syr. Picis Liquidae, 
Aquse Anisi, 



• 5J- 

. gr. lxxx. 
aagij. 



M. Sig. — A dessertsp. every two hours. 



Potassii Iodidi, . . . . gij. 
Vini Colchici Sem. , 
Syr. Simplicis, . . . aa^iv. 
Aquae Menthae Pip. , . . ^v. 
M. Sig. — Tablesp. every 4 hours. 

(New Orleans Charity Hosp.) 



R. Propy laminae Chi orid., gr. xxiv. 
Aquae Menthae Pip., . ^yj. 
M. Sig. — A tablesp. every two or three 
hours. (Tyson.) 



R 



M 



Acidi Salicylici, . . . . 3 i j . 
Ferri Pyrophosphat. , . . gj. 
Sodii Phosphatis, . . . gr. xij. 

Aquae, gvj. 

Sig. — A tablesp. every two hours. 
(Pea body.) 



R 



Ammonii Phosphatis, . £jss. 

Tinct. Colchici Seminis, ^j. 

Tinct. Aconiti, . . . . Zij. 

Syr. Simplicis, .... giij. 
M. Sig. — A teasp. every three or four 

hours. (Corson.) 

R 



M 



Sodii Salicylatis, . . . ^ ss. 
Tinct. Lavand. Co., . . ^iij. 

Glycerini, g v. 

Aquae, . . . . q. s. ad %\']. 

Sig. — A tablesp. every three hours, 



well diluted. 



Rheumatism, Chronic. 

Arsenic, is very good in most cases, given in small doses steadily (Da C) ; is 
more efficient than Sulphur and should be used instead of the latter in the Chel- 
sea Pensioner [see page 568], an old remedy for chronic rheumatism (Fother- 
gill). Sulphur waters are undoubtedly efficient (Da C) ; Sulphur locally, also the 
Sulphides as baths (R) ; is certainly of benefit (B). Guaiac is another ingredient 
of the Chelsea Pensioner; is used with varying success (B) ; the ammoniated 
tincture in milk often gives excellent results (Da C) ; is vile to the taste. 
Potassium Iodide, especially when pains are worse at night, or of syphilitic 
origin (R) ; should always be fairly tried in chronic rheumatism (Da C) ; was 
Sir Astley Cooper's remedy ; Iodides often prove very satisfactory, especially in 
strumous or syphilitic subjects (B). Rhus Toxicodendron, a very powerful 
agent in subacute muscular or tendinous rheumatism worse at night (Pf) ; the 
tendons, ligaments, and fasciae are most benefited ; externally, as lotion on 
compresses ; also internally, small doses every two hours (P). Aconite, the 
extract as plaster to joints is unquestionably very useful (P) ; is more useful in 
chronic than acute rheumatism (Wa) ; the liniment of the B. P. locally over the 
sciatic nerve when affected (Fothergill). Ichthyol, is invaluable given inter- 
nally in pill, gr. x-xxx thrice daily ; also as ointment with Lanolin 50 per cent. 
(Illinsky); or as a liniment with Turpentine or an equal weight of a mixture of 
Lanolin and Olive Oil, with 30 per cent, of Chloroform. Cimicifuga, some- 
times has wonderful success, yet often fails ; no indications (B) ; in rheumatic 
neuralgias and headaches, and rheumatism of uterus (P) ; signally beneficial 
in many forms (R). Lithium Bromide, gives excellent results, when smaller 
joints are swollen and tender (B). Lithium Salicylate, in 15- to 20-grain doses 
every four hours, gives good results in lingering, subacute cases after acute 



RHEUMATISM, GONORRHEAL. 833 

attacks (Da C). Colchicum, is of decided advantage in the neuralgia of 
chronic rheumatism (B). Colchicine Salicylate, is used with satisfaction [see 
page 285]. Bryonia, is a useful remedy, especially for painful and stiff joints 
(P). Mercury, the oleate of Mercury and Morphine locally (R). Mezereon is 
strongly recommended (P). Phytolacca, has proved useful (B). Dulcamara, 
has been used with benefit (P). Iodine, locally, for pain around joints (R). 
Quinine, in rheumatism with debility, shown by night sweats or sweats during 
sleep and only then (Wa). Arnica, the tincture and infusion are useful (P). 
Cajuput Oil, internally and externally in muscular rheumatism (P). Turpentine, 
benefits and relieves the pains ; internally and externally as liniment (P). 
Aletris, is extensively advertised as an efficient remedy. Nuclein, has been 
used with decided advantage (Vaughn). Eucalyptus, the leaves wrapped 
around, the affected part, renewing them daily for a week or more, often very 
efficient as a local stimulant, but will produce vesication if too long continued 
(Gibbons). Xanthoxylum, has long had deserved reputation, TT\,xv-3ij of fluid 
extract (B). Thuja Occidentalis, is useful for rheumatic pains (P). Manganese 
Sulphate, is one of the remedies (B). Belladonna, the extract locally very 
valuable for pains (P). Cod-liver Oil, internally and externally, exercises 
some influence (B). Chimaphila, may prove useful, especially when lithiasis 
(P). Lupulin, as an anodyne (P). Burgundy Pitch, as plaster locally (P). 
Aliment, avoid spirits and malt liquors, coffee, also starchy, animal and sac- 
charine food ; the farinaceous vegetables and acid fruits suitable (B) : Alkaline 
mineral waters have deserved reputation (B). Turkish Baths, in chronic mus- 
cular rheumatism (B) ; steam bath daily of great benefit, may be obtained at 
home by pouring water on hot bricks in a tub, the patient sitting on a board or 
chair above, enveloped in a blanket (Brick). Carbonic Acid Baths are some- 
times beneficial [see page 93]. Red Flannel next skin, very popular, but white 
better, as the red often gives rise to eruptions (Da C). [Compare Arthritis, 
Lumbago, Myalgia, Pleurodynia, Sciatica.] 

R . Pulv. Resin. Guaiaci, 

Potassii Iodidi, . . aa %]. 

Tinct. Colchici Seminis, ^iij. 

Aquae Cinnamomi, 

Syrupi, . . aaq. s ad ^vj. 
M. Sig. — A dessertsp. to a tablesp. j 
thrice daily. {Pepper.) | 

R. Tinct. Guaiaci ^Ether., . ^j. 
Tinct. Colchici y£ther., . ^vj. 
Tinct. Cann. Ind. yFther., 3 ij. 
M. Sig. — 25 to 30 drops on sugar, every 
4 hours, for rheumatic and neuralgic symp- 
toms. {Atlee.) i 



Acidi Arsenosi, . . . 


• g r - »j 


Pulv. Guaiaci, . . . 


• 3 51 J- 


Pulv. Capsici, . . 


• 3 SS - 


Pil. Aloes et Myrrhae, 


• 3 "J- 



R. 


Linim. Aconiti (B. P 


), 




Linim. Belladon., 


aa gij. 




Glycerini, 


• ii'h 


M 


Sig. — Apply locally 


over the seat of 


pain 




{Fothergill.) 


R. 


OleiSinapis, . . . 


. 3.SS. 




Olei Terebinth., . . 


• 3»J- 




Camphorse, . . . 


3 iv - 




Liq. Amnion. Fort., 


3iij. 




Tinct. Capsici, . . 


• 3 iv - 




Alcoholis, . . q. s. 


ad Svj. 


M 


Sig. — Russian Spirit, a liniment for 


rheumatism. 




R. 


Potassii Iodidi, . . 


• 3J- 




Potassii Nitratis, . 


• 3 SS - 



R. 

Pulv. Guaiaci, .... ^iii. 

Ext. Cimicif. Fl. , 

Glycerini, aa ^ss. 

Ft. pil. no. cxx. Sig.— One thrice daily. Vini Colchici Sem.,q.s.^ J ij. 

The modified Chelsea Pensioner. M. Sig.— A teasp. after each meal. 

{Fot her^ill.) {Potter.) 



Rheumatism, Gonorrheal. 

Opium, as Dover's powder, full doses in the acute stage (Wa). Potassium 
Iodide, with tonics and stimulants, after the acute stage has passed, followed by 
friction, shampooing, and passive movements of the joints (Wa). Ammonium 
Chloride, in free doses, especially when the muscles are affected (Fuller). 
Potassium Chlorate, internally, and as urethral injection, until urethral dis- * 
53 



834 RHEUMATISM, MUSCULAR — SCABIES. 

charge is entirely stopped, then Tt^xx of Tinct. Ferri Chlor. 4 times daily, with 
gr. x of Quinine daily, and good food (Da C). Aspirate, when pus is discov- 
ered around the joints; the case will be one of pyemic rheumatism, and may 
involve more joints than one (Da C). 

Rheumatism, Muscular. 

Diaphoretics, as Dover's powder, with Potassium Nitrate, or Ammonium 
salts, also dry heat to the part involved and rest in bed (Da C). Morphine 
gr. )i and Atropine, gr. ^ F , together hypodermically, are of great service in 
most forms (R). Lithium Bromide, is almost specific (B) ; Lithium and its 
salts where there is a uric acid diathesis. Colchicine, a -^ solution in 5-minim 
doses hypodermically thrice daily into the affected muscles, very effective in 
cases resisting other treatment. Colchicine Salicylate, is used with benefit [see 
page 285] . Aurum, the Bromide of Gold and Arsenic is employed successfully 
(Barclay). Jaborandi, or Pilocarpine hypodermically, to get the skin acting 
freely, a great desideratum (Da C). Potassium Iodide and Colchicum, or Qui- 
nine, gr. xij-xvj in 24 hours, if the case lingers over a week (Da C). Capsicum, 
powdered, with Lard, 3'\j to the ^, rubbed over the part, night and morning, 
with a gloved hand, is very efficient (Macdonald). Cimicifuga, is often very 
efficient in lumbago, myalgia, pleurodynia, and similar conditions (Wa). Xan- 
thoxylum, gives relief in some cases of muscular rheumatism (B). Liniments 
are of little use except to amuse the patient, but Chloral J;j in ^vj of Linim. 
Saponis, makes a good one (Da C). Electricity, the constant current daily 
renders good service. [Compare Lumbago, Myalgia, Neuritis, Pleuro- 
dynia, Rheumatism chronic, Torticollis.] 

Roseola. 

Scarcely any treatment called for; no local application needed, as the rash 
is but slightly irritating. Aconite or Belladonna, according to the symptoms, 
or Ammonium Carbonate, answers all the indications. [Compare Measles.] 

Sarcinae. 

Sulphites and Hyposulphites, have been employed to destroy sarcinae and 
torulae in the stomach (R) ; or Sulphurous Acid, diluted, before each meal 
(Wa). The treatment of these microscopic fungi is that of the primary gastric 
affection. [Compare Cancer, Dyspepsia, Gastric Dilatation.] 

Scabies. 

Sulphur, a solution of Potassa Sulphurata £ss m ^j f as local application ; an 
extemporaneous Sulphide may be made by boiling one part of quicklime and 
two of sulphur in ten of water (B) ; Sulphurous Acid, as gaseous bath, the 
quickest method ; Hebra's mixture of Sulphur, Chalk, Tar, Soap and Lard, less 
irritating and equally sure (R). Calcium Sulphide, as a bath (W). Sulphuric 
Acid, internally, has cured when other remedies failed (Wa). Storax, equally 
serviceable and not irritating as is Sulphur, one part to two of Olive Oil, 
with a warm bath (R). Mercury, the Bichloride is very efficient, if used 
strong enough, but caution is required in its employment (B). [Formula on 
next page.] Staphisagria, a certain remedy ; 3 to 5 of Lard, boiled for 24 
hours, when cooled, after straining add a little essence ; friction with this 
4 times daily (Wa). Balsam of Peru, the best of all applications, killing the 
acarus, relieving the itching and dermatitis, and disinfecting the parts; rub in 
Z) over the body after a warm bath (Bruce) ; is fatal to the itch-mite (Oldberg). 
Manganese, the Oxide, 3U to 3jj Adipis as ointment (B). Copper Sulphate, as 
lotion, ^j to Oj, has been used with great success, after crusts are thoroughly 



SCARLET FEVER. 



835 



removed with soap-and-water (B). Alkalies, as soaps or ointments to remove 
cuticle and break up burrows (R). Carbolic Acid, locally (B). [See under Tinea 
for formula.] Cocculus Indicus, as ointment, useful (P). Tar Ointment, re- 
lieves itching quickly and cures disease in 10 to 12 days (P). Anise or Ka- 
mala, as ointments, efficient (P). Benzoic Acid, gr. x-xx ad 0)4 aquae, as 
lotion, effectual for the pruritus (R). [See formula under Pruritus.] Beta- 
Naphtol, in 3 to 5 per cent, alcoholic solution or as a 10 per cent, ointment, is 
by far the best application (Shoemaker) ; a 2 per cent, ointment applied by 
friction has caused acute nephritis in two brothers aged 6 and 8 years, one of 
whom died therefrom (Baatz). Linen, should be immersed in boiling water, 
other garments should be baked in an oven or well fumigated with Sulphur 
vapor, to destroy the acari and their ova (R). 



& . Styracis Liquidis, . . . . 3 ij. 

Ung. Sulphuris, £iv. 

Ung. Petrolei, . q. s. ad £]. 
M. Sig. — Apply after washing. 



I R- . Sulph. Sublimat., .... gj. 
Balsam. Peruv., . . . . 3 ss. 

Adipis, ^j. 

M. Sig. — For children. {Duhring.) 



M 



Hydrarg. Chlor. Corr., . . gr. iv. 

Alcoholis, ^vj. 

Ammonii Chloridi, . . . 3 ss. 
Aquae Rosse, . . q. s. ad ^vj. 
Sig. — Lotion for scabies, phthiriasis, 



and tinea versicolor. 



{Fox.) 



Sulph. Sublimat. 
Olei Cadini, 
Cretae Preparatae, 
Saponis Viridis, 
Adipis, . . . 
M. ft. unguentum. 



aa^ij. 
. 31JSS. 

aa^j. 

(Bulkley.) 



Scarlet Fever. 

Aconite, of the highest value for all marked increase of temperature (R) ; 
helps development of the eruption when due (P) ; in the early stage, when 
patient is not decidedly adynamic, is very useful (W). Belladonna, during the 
eruptive stage, when depression exists, and rash is imperfectly evolved (B) ; as 
prophylactic has been recommended (R) ; is often efficacious as prophylactic 
(P) ; the preponderance of evidence is certainly in favor of such use of the drug 
(Pf); this virtue is claimed by imposing authorities ; when so given its dose is 
gr. \ several times a day (Tr). Mercury, gr. \ of Gray Powder every hour has 
marked effect on inflamed tonsils (R). Ammonium Carbonate, feeble circula- 
tion, cyanosis, delirium (B) ; in all forms, especially if given early (R); one of 
the most reliable remedies ; gr. iij-vij, according to age, in milk or Cinnamon- 
water, every hour or two (Wa). Potassium Iodide, in full doses, a very satis- 
factory remedy (Mitchell). Mineral Acids, Muriatic internally and as gargle ; 
Nitric locally to sloughs in the throat (R). Salicylic Acid, given in 125 malig- 
nant cases, with mortality of only 3^ per cent. (Shakowaki). Salol, in doses 
of 7 to 30 grains daily, according to age, internally, with gargles of a solution 
of Carbolic Acid, used in several cases with recovery in all and without albu- 
minuria or other complications (Quioc). Carbolic Acid, internally and as gargle, 
successfully used [see Measles, for formula] ; seems to exercise some influence 
as prophylactic (Wa) ; is good for the vomiting and for its general effect on the 
disease ; n\,ss, every 2 or 3 hours (Da C). Sodium Sulpho-carbolate, as a 
means of introducing Carbolic Acid into the system ; has been successfully 
employed (Wa). Chloral with Paregoric, is highly efficient for calming the 
patient [see page 258]. Potassium Chlorate, in grain-doses every ]/ 2 hour, will 
not injure the kidneys, and will give results equal to those of larger doses on 
the throat inflammation (Smith). Asclepias, to promote the eruption (W). 
Zinc Sulphate, gr. -^ every 3 hours, believed to have specific influence on the 
disease (Hoyt). Sodium Benzoate, is highly efficient, having slower but more 
permanent effects on the fever than Quinine or the Salicylates (Klebs). Boric 
Acid, makes an excellent gargle (Da C). Juniper, as diuretic when dropsy 
(R). Magnesium Sulphate, as purgative, to prevent sore throat and other* 



8 3 6 



SCIATICA. 



sequelae (R). Veratrum Viride, in convulsions (R). Rhus Toxicodendron, of 
great service, if typhoid or rheumatic symptoms (P). Digitalis, very useful ; 
lowers temperature and maintains kidney action (B) ; the best antipyretic and 
diuretic, the infusion with dry cups for the renal dropsy in its inception ; later 
on a milk diet and Basham's Mixture (Da C). Potassium Permanganate, 
locally to throat, and internally, gr. ^-j ter die, has undoubted benefit (B). 
Sulphurous Acid, by inhalation, spray, or fumigation, in malignant sore throat 
(R). Chlorine Water, in sloughing of throat (R) ; seemingly prophylactic 
(Wa). Quinine, small doses in adynamic states, large in hyperpyrexia (B) ; 
very successful when used systematically from the start (Wa). Ferric Chloride, 
the tincture in doses of tt\,x-xv, according to age, in advanced stage; when 
.dbuminuria and hematuria, is very valuable (Wa). Mustard Bath, on reces- 
sion of rash, to bring it back (R). Oil Inunctions, very grateful, especially use- 
ful in desquamative stage ; Cacao-butter the most elegant (B). Ice, sucked, for 
the sore throat (R). Water, cold baths with oil inunctions are all that are 
needed in mild cases ; when temperature above 104 , urine scanty and rash 
retroceding, the cold-wet pack renders signal service (R) ; cold wet compress 
to neck, through the whole course, renewed every 3 hours (R). Diet, fruit, if 
ripe, in season, toast, gruel, etc., in simple cases ; in malignant, extract of beef, 
stimulants as per pulse. Milk the most suitable aliment, both as nutrient and 
as diuretic ; a strict milk diet was enforced during the illness in all the cases 
mentioned above under Salol (Quioc). [Compare Albuminuria, Bright's 
Disease, Uremia.] « 



ft . Acidi Borici, 3 ss. 

Potassii Chloratis, 

Tinct. Ferri Chloridi, aagij. 

Syrupi, 

Aquae, aa ^ ij . 

M. Sig. — Tablesp. every 2 hours, to a 
child of five years. [Smith.) 



ft. Acidi Carbolici, . . . gss-j. 

Vaselini, £iv. 

M. Sig. — By inunction to the entire 
surface. 



ft. Acidi Salicylici, . . . 

Tinct. Aconiti, .... 

Infusi Digitalis, .... 

Spt. Amnion. Aromat., . 

Syr. Aurantii Cort., . . 

Aquae, . 

M. Sig. — Teasp. every 3 
child of five vears. 




ft. Acidi Borici, 
Glycerini, . 
M. Sig.— For i 
used as a gargle. 



hours, for a 
(Brown.) 

. . . . ziij. 
. . . . ^ iv. 
pint of water, to be 
{Da Costa.) 



Sciatica. 

Opium, internally and externally (Wa). Morphine, hypodermically, is espe- 
cially curative in sciatica (B) ; 3 or 4 injections of gr. l /e each may almost be 
regarded as a specific (Wa) ; a single injection sometimes cures long standing 
cases permanently ; if not it may be repeated every second day or so (R) ; 
should be injected deeply into the adjacent muscular structure (Pepper). Apo- 
morphine, gr. ^ hypodermically, given by accident instead of morphine, caused 
immediate disappearance of the pain in a very severe and intractable case, 
not returning again for 12 months, and then only a slight attack which pro- 
gressed favorably under Potassium Iodide and Gelsemium (Owen). Antipyrin 
or Acetanilid, efficiently analgesic. Salipyrin, has been employed with excel- 
lent results in rheumatic sciatica. Salicylic Acid, as paste locally, 3j with 3iv 
of Lanolin and 01. Olivae, q. s., also Rhus Tox., gtt. j of a 1 per cent, solution 
of the fluid extract internally every 4 hours, cured one very obstinate case 
(Aulde). Salol, gr. vij in evening and gr. xv more at midnight, completely 
cured me after 3 weeks suffering in bed, unrelieved by other remedies (Aschen- 
berg). Ether, as spray, is generally of temporary value (R). Guaiacol, 
painted over the nerve as a local anesthetic. Aurum, the Bromide of Gold 
and Arsenic has rendered good service in chronic cases. Chloroform, applied 
on flannel along the course of the nerve, and covered with oiled silk (Wa); 
Ti^xv of the official spirit, or Tr^v-xv of pure chloroform, by deep hypodermic 



SCLERODERMA — SCLEROSIS. 837 

injection into the vicinity of the affected nerve, gives the best results in old 
cases (B). Cocaine, a 4 per cent, solution, hypodermically along the course 
of the nerve, affords instant relief ( Wa). Gelsemium, has been used with vary- 
ing success. Nux Vomica, is often successful in chronic sciatica (Wa). 
Belladonna, has afforded relief (R) ; Atropine, hypodermically, is curative, gr. 
3*0 to ^r m tne vicinity of the nerve (B). Stramonium, gr. % to % every 3 or 
4 hours for 4 or 5 doses, often affords decided relief, but should be stopped 
when the slightest symptoms of narcotism appear (P). Duboisine, is a good 
substitute for Atropine, and equally effective. Veratrine, in strong ointment 
or oleate locally ; the tincture of Veratrum Viride internally is also recom- 
mended (R). Aconite, locally (P) ; as ointment controls sciatica in some cases 
(R) ; valuable in many obstinate cases (Wa). Ammonium Chloride, in 
mild forms (R); in cases occurring in the young (Anstie). Iodides, in syph- 
ilitic or metal poisoned subjects (B) ; often fails (R) ; Potassium Iodide in daily 
doses of 3j dissolved in Decoction of Sarsaparilla, most efficacious in sub- 
acute or chronic (Wa). Turpentine, causes an exquisite sensibility along the 
track of the great nerves (Tr) ; occasionally of great value in sciatica, yet not 
a specific, nor have we scientific indications for its use (P) ; ^ss doses for 4 to 
8 successive nights (R). Sulphur, locally, believed to relieve the pain ; effect 
probably due to the flannel surrounding it (R) ; is worthy of trial after active 
symptoms are subdued (Wa). Phosphorus, in neuralgic form; less satisfac- 
tory in sciatica than in other neuralgias (R). Rhus Toxicodendron, a very 
powerful therapeutic agent in various rheumatic affections of the fibrous tissues 
(P). Cimicifuga, is highly extolled (R). Nitroglycerin, in doses of try thrice 
daily, gradually increased to u\,v, of a one percent, solution, promptly curative 
in a long-standing and severe case (Lawrence) ; its powerful anti-neuralgic 
properties were well exhibited in 3 cases which would not respond to other 
agents, two being cured and one remarkably improved thereby (Mikhalkine). 
[See formula below.] Cold of intense degree, produced by refrigeration of 
limb by Methyl Chloride, extremely efficient (Jacoby) ; has been found effectual 
when applied to the sound limb. Cantharides, as counter-irritant, to free vesi- 
cation (R). Aquapuncture, has had extraordinary success (B). [See under 
Neuralgia.] Acupuncture, occasionally affords instant relief (B) ; often 
cures cases of long standing (R). Nerve- stretching, by forcibly flexing the 
thigh on the abdomen (Lange). Poultices, applied very hot (R). Turkish- 
Baths, are often very useful (R). Electricity, produces excellent results (B) ; 
does great good, but often aggravates ; the continuous current best, when stage 
of acute inflammation past (W) ; galvanism often quickly relieves the pain 
(Pepper). Cod-liver Oil, should always be tried in obstinate cases (W). [Com- 
pare Neuralgia, Rheumatism chronic] 

R. Tinct. Colchici Seminis, ' R . Tinct. Trinitrini (1 p. c), 3Jss. 

Tinct. Belladonnas, Tinct. Capsici, . . . . . Jjjij. 

Tinct. Aconiti, . . . . aagj. Aquas Menthae Piper., . . ^iv. 

M. Sig. — rt\vj every 6 hours. Remark- \ M. Sig. — 5 to 10 drops to be taken 

ably efficient. (Metcalf.) j three times a day. {Mikhalkine.) 



Scleroderma. 

Cod-liver Oil, our sheet-anchor, used internally and locally (B). Electricity, 
is used successfully (B) ; with stimulating inunctions offers the best prospect of 
improvement (Bulkley). Strontium Iodide, has been used, with varied results. 



Sclerosis. 

Aurum, the preparations of Gold are among the remedies which are believed, 
by some writers to retard the progress ; others being Arsenic in full doses, 
Silver Nitrate in l /- grain doses, Physostigma and Ergot (Osier) : Gold is a 



838 SCROFULOSIS SCURVY. 

specially curative agent in all forms of sclerosis, including cirrhosis of the 
liver, interstitial nephritis, cirrhosis of the lungs, etc. ; and Dr. Barclay's 
Liquor Auri et Arseni Bromidi is very efficient in these affections, and much 
superior to the Chloride of Gold and Sodium (E. A. Wood). [Compare the 
titles mentioned in this article, also Atheroma, Locomotor Ataxia, 
Paralysis Agitans.] 

Scrofulosis. 

Ammonium Iodide, when glandular enlargement (Wa) ; Ferrous Iodide, 
when debility and emaciation, a powerful and efficacious remedy ; also in 
anemia of scrofula, the syrup rr^xx-Sj ter die (Wa); useful in simple gland- 
ular hypertrophy, but disappointing in scrofulous (B). Strontium Iodide has 
been used with varied results in scrofulous otorrhea. Iodine, tinct. or oint. 
applied over scrofulous glands — take care not to increase inflammation (R) : 
Iodine and Iron the best remedies, but all medicines utterly useless without 
strict hygiene (A). Aurum, the Bromide of Gold and Arsenic has rendered 
good service in a case of adenitis with enormous enlargement of the neck (E. 
A. Wood). Calcium Salts, the Chloride in doses of gr. x-xx in milk after food, 
when glandular enlargement of neck and chronic diarrhea ; the Phosphate of 
great use for sores (R) ; is of eminent service as a palliative (Wa). [See Sul- 
phides below.] Spongia Usta, formerly held in high repute ; has fallen into 
perhaps unmerited neglect; contains Sodium Iodide, Magnesium Bromide, 
Calcium Phosphate and Ferric Protoxide, all in small quantities (Wa). Iron, 
Ferrum and Calcium Phosphates combined give good results, also chalybeate 
waters (B) ; must be long continued (R). Sulphides, for sores, abscesses, sup- 
purating glands ; gr. fa or ^ of Calcium Sulphide every hour or two (R). 
Coniine, gr. % to Z) of Almond Oil applied two or three times a day to con- 
junctivae in scrofulous photophobia; has proved very successful (P). Cod- 
liver Oil, the best remedy to promote assimilation (B); of great service in the 
various manifestations of this disease (R). Stillingia, a domestic remedy, used 
with much success (B). Capsicum, in scrofulous and fistulous ulcerations, a 
weak infusion becomes a useful stimulant (P). Mezereum, strongly recom- 
mended (P). Sarsaparilla, useful by reason of its tonic and alterative proper- 
ties (P). Hyoscyamus, the bruised leaves as cataplasm for scrofulous ulcers 
(P). Prunus Virginiana, is found very useful in the hectic (P). Chimaphila, 
holds a certain amount of reputation as a useful remedy (P). Tussilago, was 
employed by Cullen (P). Gentian, is valued ; the infusion a useful vehicle for 
chalybeates, etc. (P). Blisters, for scrofulous glands (R). Grape-cure, renders 
much service (B). Alcohol, no doubt as to its great value ; with Cod-liver Oil, 
or in small amounts at meals (Wa). Phosphorus, eminently serviceable in 
scrofuloderma, gr. x in Ol. Olivae ^j, doses of rriv-x, thrice daily after meals 
(Broadbent). Phosphates, see above, under Calcium and Iron. Aliment, 
raw or broiled meat, the latter for children. Abundance of fresh air and sun- 
shine. Sea-air, sunlight, moderate exercise, and light digestible food are nec- 
essary. [Compare Cachexia, Coxalgia, Glands, Ophthalmia.] 

Scurvy. 

Citric Acid, used with great advantage, though inferior to Lemon-juice (Wa). 
Lemon- or Lime-juice, of the utmost value, both as preventive and a curative 
agent ; its efficacy believed to be due to its Potassium salts ; Oranges are highly 
useful (Wa). Acids, especially Vinegar, to prevent scurvy, in the absence* of 
lime-juice or fresh vegetables (R) ; dilute Muriatic Acid, gtt. v, thrice daily 
with juice of three lemons daily, vegetables and fresh meat (Da C). Potas- 
sium Chlorate, is probably a remedy of some value (Wa) ; is not (W). 
Cinchona, a decoction, or the dilute tincture with Myrrh or the Chlorates, a very 
useful gargle. Quinine, internally when much prostration, combined with 
mineral acids (Wa). Alcohol, diluted, as gargle (R). Atropine, hypodermic- 



SEA-SICKNESS SEBORRHEA SEPTICEMIA. 839 

ally for salivation (R). Alum, a solution in water with Tinct. Myrrhse ^ss, 
several times daily as lotion for ulceration of the gums (W). Liquor Sodae 
Chloratae, gvj ad ^xij aquae, as a mild application to gums (Wa). Dietetic 
Treatment, alone required; Lemon-juice plays no essential part in the treat- 
ment ; the full diet of an hospital, comprising fresh meat, vegetables, and milk, 
is generally sufficient. [Compare Cancrum Oris, Purpura.] 

Sea-sickness. 

Antipyrin, is successfully employed. Chloral, the most effective remedy ; 
gr. xv-xxx every four hours (R). Staphisagria, has given relief (P). Creo- 
sote, checks the vomiting (R). Chloroform, drop doses pure (R) ; rtljj-v on 
sugar (B). Atropine, hypodermically, gr. T \^ in epigastrium, will relieve (B) ; 
o r - shs t0 this g lv en with Strychnine, gr. y 1 - to -^ hypodermically, is really 
specific in most cases, and in some if given before sailing, will prevent for the 
whole voyage, though but one dose be administered. Bromides, in full doses 
(Beard) ; the Sodium Bromide preferred, in doses of 30 grains thrice daily for 
3 days before sailing and continued for the first 3 or 4 days of the voyage, is 
by far the most effective treatment and never produces evil effects (Rockwell). 
Cocaine, is quite efficient : the Hydrochlorate 1 in water 100, of which ff\jv-v 
on a bit of ice thrice daily (Otto); a 2 per cent, solution, as spray high up into 
nasal passages, is specific against nausea. [See under Nausea.] Morphine, 
gr. T2-to ^ hypodermically, will often relieve severe cases (B) ; often fails (Wa). 
Amyl Nitrite, by inhalation (B) ; is strongly recommended, but must be cau- 
tiously used. Champagne, iced ; tablespoonful doses every quarter-hour (B). 
Calumba, a few drops of the tincture will sometimes relieve (B). Spinal Ice- 
bag, often successful (R). [Compare Nausea, Vomiting.] 

Seborrhea. 

Glycerin, especially useful ; with Lead Acetate, Borax or Zinc, diminishing 
secretion ; also acts efficiently when there is a want of sebaceous secretion 
(Wa). Zinc Oxide, 3j. Plumbi Carbonat. £j. Cetacei Jj, 01. Olivse q. s. Ft. 
unguent. (B). Oleate of Arsenic, is of benefit (Wa). Mercury, an ointment 
of the White Precipitate is serviceable on the scalp, with an occasional sham- 
poo with tar soap or soft soap in solution, followed later by mildly stimulating 
lotions (Bulkley). [Compare Acne, Pityriasis.] 

Septicemia and Pyemia. 

Quinine, only large doses, gr. xv-xx, are useful (B) ; supposed to diminish 
the temperature (R) ; to cinchonism, in childhood the best remedy (Wa) ; is 
probably the most useful medicine, given in full and frequently repeated doses 
(Haward). Salicin, to reduce the temperature in septicemia and to relieve the 
cerebral symptoms (R). Salicylic Acid, has decided value (B). Potassium 
Permanganate, is given with advantage, gr. }(-gr. j thrice daily in distilled water 
(B). Boracic Acid, a saturated solution to wounds, ulcers, etc. ; also Chlorine 
as disinfectant (B). Oleum Caryophylli, locally, also Oleum Gaultheriae, Thymi, 
etc. (B) ; as antiseptics. Sulphites, may do some good in chronic cases, but 
the use of Sulphurous Acid has not given the results in man which Polli ob- 
tained from its use on animals (Haward). Streptococcus Antitoxin, has been 
used successfully [see page 182]. Antistreptococcic serum, 20 cc. in puerperal 
septicemia (Mapleton) ; also in acute hemorrhagic septicemia 3^ cc. every 4 
hours, increased to 7 cc. after eight injections (Balance). Saline Injections of 
a quart of normal salt solution, -^ per cent., into the subcutaneous cellular 
tissue, has given excellent results in acute septicemia (Lanphear) ; hypodermic 
injection fully as effectual as intravenous, used in 12 cases of which 10 recov- 
ered (Duret). Water, hot water as dressing for wounds to avert pyemia, 



I 



84O SHOCK SICK-ROOM. 

Hamilton's immersion plan (B) ; stumps to be immersed in warm bath (R) ; 
every wound, however slight, should be immersed in Bichloride solution, 1 to 
10,000, as prophylactic, then dried with a sterile cloth and coated with collo- 
dion (Wyeth). Aliment, plentiful, with wine and good ventilation, are not to 
be neglected (Wa) ; concentrated food, milk and alcohol (Currier). Stimu- 
lants are necessary, brandy the best (Wa) ; Turpentine is a better stimulant 
than alcohol (B). Abscesses must be opened early, especially when in joints, 
to prevent pyemia. 

Shock, Surgical. 

Codeine, in large dose, gr. j, hypodermically, immediately after laparotomy, 
quiets pain, prevents intestinal contraction, and relaxes the tonic spasm of the 
vessels which forms the first stage of shock, shown by the small and rapid 
pulse, before the second stage, that of paresis of the vaso-motor system, sets 
in, as shown by the soft, compressible pulse ; Morphine is the ideal relaxer of 
spasm, but has many objectionable qualities which Codeine is free from (Boise). 
Amyl Nitrite and Glonoin, relax arterial spasm, and are indicated in the first 
stage of shock. Strychnine hypodermically, is the best medicinal agent in the 
second or paretic stage of shock, when the vessels are relaxed and the pulse 
is soft and compressible ; a full dose, gr. -3^, is necessary, and may be repeated 
in yi hour (W). Digitalin, hypodermically, may also be of great service in 
the second stage. Alcohol, as Brandy or Whiskey, hypodermically or by 
enema, is commonly used; is harmful, being a vaso-motor paralyzer, encour- 
ages hemorrhage, increases restlessness and in large doses weakens the heart 
— Strychnine is far better (Estes). Ether as a stimulant is open to the same 
objections as alcohol (Id). Heat, is a potent preventive of shock; the room 
should be warmed to at least 72 F., exposed limbs should be wrapped in cotton 
batting, and hot water bottles wrapped in towels should surround the patient's 
body both during and after operation. Hot Water, as clyster, a pint injected 
into colon, and repeated as required, after laparotomy, in which operation the 
handling of the intestines sets up irritation of the sympathetic system, and is a 
potent cause of shock ; this acts as a sedative thereto, and restores fluid to the 
blood, allaying thirst and supporting patient. Normal Salt Solution, consisting 
of Yi of one per cent, of Sodium Chloride in sterilized water, intravenously or 
subcutaneously to raise the volume of the pulse, stimulate the heart and restore 
volume to the blood, renders good service in the second stage of shock. Saline 
intravenous injections are inferior to saline rectal injections, the effects of the 
former being evanescent, but the latter are frequently used with most satisfactory 
results (Estes). The best fluid for injection into the cellular tissue is — Calcium 
Chloride 0.1, Potassium Chloride 0.75, Normal Salt Solution, 0.75 per cent, 
strength, 1 (Edes). Absorption from the cellular tissue is very rapid and the 
injection is not dangerous as is intravenous injection. 

Sick-room. 

Every home of any pretensions should contain a room especially arranged 
and kept ready for the use of sick members of the family. Such a room should 
be on the upper floor, and preferably in the south-east corner, so as to have 
the best sunny exposure ; or still better, should be itself the upper floor of a 
two-story annex, separate from the main building, but joined thereto by a 
light, latticed bridge. It should have no upholstered furniture, a bare but 
painted floor, and rough-plastered and painted walls and ceiling, without pic- 
tures or paper, curtains or hangings. It should contain no sink, wash-basin, 
water-closet or any other convenience which connects with the sewers, but 
should communicate with the kitchen by a dumb-waiter, or have connected 
with it a smaller room, furnished with a gas-stove and the other requirements 
of a diet-kitchen. It should contain everything requisite for nursing a case of 
typhoid fever, scarlatina, diphtheria, measles or small-pox ; and all its arrange- 



SNEEZING SPERMATORRHEA. 84I 

ments should be supervised by the family physician. The possession of such 
an appendage to the home would enable the owner to defy the mandate of a 
Health Officer, in regard to removing an inmate thereof to a public pest-house, 
as it could be shown to the satisfaction of any reasonable court, that a case of 
infectious disease could be better isolated and more humanely treated in such 
a room than in any " pest hospital" yet erected by our political administrators 
of health laws (Potter). 

Sneezing. 

Arsenic, a drop of Liquor Arsenicalis three times a day in paroxysmal sneez- 
ing, allied to asthma (R). Potassium Iodide, gr. x, several times a day (R). 
Iodine inhalations, in paroxysmal sneezing with itching of nose (R). Camphor, 
in incessant sneezing, with profuse running from eyes and nose ; the powder 
should be snuffed, or the alcoholic solution inhaled (R). [Compare Catarrh, 
Hay-fever, Influenza.] 

Somnambulism. 

Potassium Bromide, will give decided relief in the somnambulism of children 
allied to epilepsy, often with squinting, which may become permanent, generally 
the result of deranged digestion ; the nightmare of adults will usually yield to 
the same drug (R). [Compare Nightmare.] 

Spasmodic Affections. 

Aconite, externally and internally for spasms not of a severe type (P). Aconi- 
tine, as ointment in the most severe, as well as in the milder local spasmodic 
affections ; in angina pectoris, spasmodic asthma, cough, etc. (P) ; in spasmodic 
laryngitis has good effect (R). Camphor is said to relieve in many forms, as 
strangury, etc. (R). Hyoscine, is used with advantage in various spasms (Erb). 
Belladonna, of value for spasms of sphincter muscles, especially those of pel- 
vic organs (P) ; Atropine hypodermically in local spasm (R). Strychnine, of 
great value in spasmodic asthma (P) ; also in tetanus, chorea, and epilepsy 
(Pf, S). Veratrine, as solution, brushed over lids once a day in painful spas- 
modic contraction of the orbicularis (Wa). Opium, very useful as an anti- 
spasmodic, especially if given with a stimulant, as Alcohol, Ether, or Chloro- 
form (R). Ipecacuanha, in spasms of respiratory organs, of great value (P). 
Chamomile Oil, in spasms of hysterical persons, in 4 to 6 minim doses a very 
excellent remedy ; also useful in pseudo angina pectoris (P). Lobelia, a valu- 
able antispasmodic in cautious hands (P). Lupulin, in gouty spasms (P). 
Tobacco, in spasmodic asthma, and for relaxation of muscular spasms (P). 
Sumbul, is of use in gastric spasms (P). Cardamom, is usefullv employed in 
gastric spasms (P). Ammonia, useful in children's colic (R). Chloroform, in- 
haled for intestinal spasm (R). Sulpho-carbolates, in flatulent spasm of 
women, usually a neuralgia of the abdominal nerves, the pain being excited 
by flatulence ; act by preventing the formation of wind, — sometimes Phos- 
phorus better (R). Mustard Poultice, an excellent counterirritant in spas- 
modic affections (P). [Compare list of Antispasmodics on page 39, and in 
this section the titles Angina Pectoris, Asthma, Chorea, Colic, Convul- 
sions, Cough, Croup, Dysuria, Epilepsy, Gastrodynia, Hydrophobia, 
Hysteria, Laryngismus, Pertussis, Stammering, Tetanus, Torticollis, 
Trismus.] 

Spermatorrhea. 

Potassium Bromide, when due to plethora, erections normal, but persistent 
and teasing; is harmful in debilitated states, or daily losses (B) ; combined 
with cold sponging and the use of a hard bed (R). Digitalis, 3j or ij of the 
infusion twice or thrice daily ; few remedies are more successful in arresting 
spermatorrhea (R, P) ; when feeble erections, frequent emissions, cold hands 



< 



842 



SPINA BIFIDA SPINAL CONGESTION. 



and feet (B). Cantharis, deficient tone of seminal vesicles, erections feeble, 
sexual feeling torpid ; the tincture, gtt. ij-iij ter die (R) ; with Iron internally in 
emissions (R). Phosphorus, for the induced physical and mental debility; 
also, Hypophosphites of Lime and Soda (R). Gelsemium, as anaphrodisiac, 
may be combined with Belladonna or Cimicifuga (B). Nux Vomica, for relaxa- 
tion and atony (B). Strychnine, in large doses, especially when impotence (R). 
Quinine, has been recommended (R). Belladonna, gr. % °f extract with gr. 
jss of Zinc Sulphate, three or four times a day, often successful in nocturnal 
emissions (R). Atropine, relaxed genitalia, no dream or orgasm (B). Camphor 
Bromide, has been useful (W). Lupulin, is a good anaphrodisiac ; with 
Camphor, when a genital sedative is required (B). Iron, the Iodide, is useful in 
anemic cases (B). Ergot, beneficial in relaxed state (B). Hydrastis, is a use- 
ful injection, gtt. x of the fluid extract through a urethral tube to the prostatic 
portion of the urethra (B). Cimicifuga, useful in weak, relaxed conditions (B) ; 
when hypochondriasis exists it is very beneficial (P). Hyoscine, is a most use- 
ful remedy through its influence on the spinal centres (W). Silver Nitrate, a 
vesicating solution applied to perineum generally useful, and without danger 
(B) ; in solution, gr. xxx to the ^, applied by urethral syringe to the prostatic 
portion of the urethra, is Lallemand's treatment, and still finds favor with many 
surgeons (Whitla). Arsenic, when from weak and relaxed seminal vesicles. 
Kind Advice, frequently the best treatment, as this affection is often due to the 
phantasms of a morbid imagination. Bladder, should be emptied after the 
first sleep. [Compare Emissions, Hypochondriasis, Impotence, also the 
List of Anaphrodisiacs on page 31.] 

R 



Potassii Bromidi, . 
Sodii Bicarbonat. , . 
Infusi Digitalis, . . 
Atropinae Sulphat. , . . gr. -£$. 
M. Sig. — One dose, to be taken at bed- 
time. ( Gross. ) 



gr. xv. 
^ss. 
_1_ 



R. 



M 



Tinct. 

Tinct. 

Sig. 



Gelsemii, . . . £j. 
Belladonnse, . . gij. 
—15 drops thrice daily. 



(B. 



R . Lupulini, .... 


. . gr. x. 


Pulv. Camphorse, . 


• • gr- vj. 


Ext. Belladonnae, 


• g r - ] J- 


M. ft. pil. no. xij. Sig.- 


—One pill thrice 


daily. 


(B.) 



R. Tinct. Cantharidis, . . £ij. 
Tinct. Ferri Chloridi, . 3 vj. 
M. Sig. — 20 drops in water thrice daily. 
In impotence with spermatorrhea, of great 
utility. (H. C. Wood.) 



Spina Bifida. 

Iodine, injected into the sac, £ss of tincture, or gr. ss, with Potassium Iodide 
gr. v, aquae 3j. has cured numerous cases (B) ; Iodi gr. Y%, Pot. Iod. gr. ]/ 2 ad 
aquae 3 J (Wa). Collodion, as a means of compression (B). Bayer's Operation, 
treats the tumor as if it were a hernia ; he dissects out two lateral flaps from 
the skin covering it and removes the sac, leaving only two lateral flaps of the 
dura, which he sews together, afterwards bringing the skin and muscles together 
separately. 

Spinal Concussion. 

Lead-water and Opium, as lotion over the seat of injury (A). Leeches, if 
pain persistent (A). During the early stage the treatment of shock must be 
instituted, stimulants and restoratives being freely administered ; traumatic 
neurosis may be treated with electricity, massage, hydropathy and the rest- 
cure ; inflammatory symptoms require the treatment for acute or chronic 
myelitis (Lyman). [Compare Myelitis.] 



Spinal Congestion. 

Ergot, gives excellent results (Brown-Sequard). Turpentine, as hot epithems, 
useful (Wa). Antiphlogistic measures, with rest and absolute diet; wet cups 



SPINAL IRRITATION SPRUE. 843 

or leeches to the column ; cool affusions or ice-bags to the spine while patient 
is in a warm half-bath (Ros). [Compare Meningitis, Myelitis.] 

Spinal Irritation. 

Aconite, as ointment locally (R). Belladonna preparations, locally, gen- 
erally are better than Aconite (B). Ignatia, in small doses diminishes irrit- 
ability of cerebro-spinal axis (Pf). Strychnine, persistently, will ameliorate 
wandering neuralgic pains due to irritability of nervous system (B). Ergot, 
large doses for congestion (Hammond). Conium, in functional derangement 
of the cord, with excessive irritability of the reflex function (Wa). Firing, 
sometimes very beneficial (B). Electricity, the inverse galvanic current gives 
much relief (Hammond). Blisters, with hot-water bag to spine, large doses 
of Strychnine, Phosphorus, Phosphoric Acid and Opium, are the methods 
based upon the anemic theory of the disease ; out of 156 cases so treated 133 
were thoroughly cured (Hammond). [Compare Meningitis, Myelitis, Neu- 
ritis, Neurasthenia.] 

Spinal Paralysis and Softening. 

Ergot, to starve the inflammation by occluding the spinal arteries (Ham- 
mond). Electricity, best ; galvanic current from spine to nerves and muscles 
(Ros). Mercury and Potassium Iodide, a thorough course, in spastic para- 
plegia when syphilis is suspected (O). Massage, with forcible flexion and ex- 
tension and proper apparatus, to overcome rigidity and contracture in infantile 
spastic paraplegia, have often enabled a patient to get around comfortably (O). 
Baths, warm, of every description, are useful in spastic spinal paralysis (Ly- 
man). Suspension, has been tried with some degree of success (Id). In 
softening the treatment must be palliative and supporting only (H). [Com- 
pare Locomotor Ataxia, Myelitis.] 

Splenic Affections. 

Mercury Biniodide, gr. j to 3j of ointment, rubbed in before a hot fire, has 
given excellent results in chronic malarial enlargement of the spleen (Wa). 
Quinine, in simple malarial enlargement (B) ; gr. xv or xx or more daily, one 
of the most effectual remedies (Wa). Ergot, the most effectual remedy for 
enlarged spleen (Da C). Ammonium Iodide, effective in chronic splenitis, with 
Unguent. Hydrarg. Iod. Rubri externally ; also small doses frequently repeated 
in all splenic derangements from malaria (B). Iodine, locally in chronic forms 
(B). [Compare Leucocythemia.] 

Sprains. 

Arnica, is very useful ; the infusion internally and externally (P) ; the tinc- 
ture diluted as lotion is very effectual (Wa). Aconite, the liniment to painful 
sprains, often affords relief (Wa). Turpentine, as a liniment (P). Ammonium 
Chloride, in solution, as lotion, or with bread as poultice, to remove discolora- 
tion due to sprains (W). Rhus Toxicodendron, the tincture £>ss to Oj of water 
is a good application to sprains. Oil of Bay, as a stimulating liniment (P). 
Cold Douche, salt may be added; the force must be regulated by the condition 
of the tissues (R). Heat, by fomentations alternated with cold affusions (D). 
Rest, is the most essential measure and should be perfect; a roller bandage 
with splints may be required to secure rest of the part. 

Sprue. 

Simaruba, the Ailanthus glandulosa, in large doses of a stronger decoction- 
than usually prepared, has given satisfaction in some cases of dysenteric origin 



i 



844 STAINS STAMMERING STERILITY. 

(Mn). Santonin, the yellow form, gr. v in 3j of olive oil, once or twice daily 
for a week, has given good results (Begg) ; tried without benefit (Mn). Calcium 
Carbonate, as powdered cuttle-fish bone or powdered crabs' eyes, two teaspoons- 
ful at a time, after purgation by castor oil, also an aromatic tincture containing 
probably Simaruba and Opium; the method of a successful but irregular 
" sprue doctor" of Shanghai, who said that the object of his treatment was to 
remove the slime which coats the bowel (Mn). Castor Oil, as an aperient 
before commencing the milk-cure (Id). Rhubarb, the compound powder as an 
aperient occasionally, when relapses of diarrhea, sore mouth and flatulent 
dyspepsia (Id). Silver Nitrate, in solution by enema, for cases of dysenteric 
origin (Id). Cocaine, in solution, gr. v to the ^, brushed over the painful 
mouth before taking food, relieves suffering (Id). Borax, a weak solution as 
mouth-wash after taking milk (Id). Fruit-cure, has given good results in Java ; 
the diet must consist entirely of such fruits as are pulpy and free from coarse 
seeds, fibres, and excessive acidity, except pine-apple, which is interdicted (Van 
der Burg). Milk-cure, is by far the most successful treatment ; at first not more 
than 60 ounces in the 24 hours, sipped through a glass tube in small quantities 
hourly. A Yz pint may be added daily after a few days, until 100 ounces are 
reached, and after 10 days more this may be increased gradually to a daily 
maximum of 6 or 7 pints. For 6 weeks after the stools become solid, and the 
mouth free from irritation, no other food should be permitted (Mn). Kumyss, 
sometimes agrees for a time when milk fails to give satisfaction (Id). Diet, 
after the above-mentioned six weeks, may be varied by a raw egg added to the 
milk ; later, some artificial malted food, arrowroot or other digestible starch ; 
still later, fish or chicken (Mn). Meat-juice, obtained by squeezing a pound 
of good beef-steak, cleared of fat and underdone, every 2 hours for 7 or 8 doses 
daily, in those cases where milk does not agree (Macleod). Hygiene, the 
patient must never feel cold, and hence must dress warmly. He should not 
return to the tropics (Mn). [Compare Dysentery.] 

Stains. 

Silver Nitrate Stains may be removed by washing with Potassium Cyanide 
Sijss, Iodine, gr. xv, Water, ^iij ; or, after moistening the spots, drop on them 
a few drops of Tinct. Iodine, and wash out with a solution of Sodium Hyposul- 
phite, gss to ^j (B). Blood-stains, if on dark-colored materials are best seen 
by an artificial light. After a few hours they become of a rusty, reddish-brown 
color, which they maintain for years. The microscope shows the characteristic 
corpuscles. These stains when on Iron are difficult to distinguish from rust ; 
the latter is not soluble in water, while blood is extremely so. Heat applied to 
the metal will cause the blood to peel off, unless the stain has been exposed 
long enough to have rust mingled with the blood. A solution of blood in water, 
heated, forms a coagulum which is soluble in hot caustic potash, the solution 
thus formed is green by transmitted light, and red by reflected light. Menstrual 
blood cannot be distinguished from that resulting from a wound (Husband). 

Stammering. 

Vocal Training, the rhythmical method, the most successful, the chief end in 
view being to regulate the precipitate, irregular form of respiration ; but long 
continuance necessary, six months, a year, or more, in special institutions 
(Ros). The patient must be taught the use of language anew, treated with 
especial kindness, and never subjected to mockery or punishment. [See Potter 
on Speech audits Defects, Lea Prize Essay, Philadelphia, 1882.] 

Sterility. 

Aurum, cures sterility when dependent on chronic metritis or amenorrhea, 
or coldness, more certainly than any other remedy ; the Chloride, gr. -^ (B). 



STINGS AND BITES STOMATITIS. 845 

Potassium Iodide, when due to syphilis (R). Dilatation of os and cervix care- 
fully when sterility depending on obstruction, with dysmenorrhea (H). Ster- 
ility is frequently associated with uterine displacement (Meadows) ; less often 
with atresia. In persons of good health it may be caused by an acid discharge 
from the uterus, which kills the spermatozoa; for this Vichy water internally 
and per vaginam, also alkaline baths (Charrier). Is due to aspermatism of the 
husband in more cases than generally believed (Gross). Many cases are due 
to blocking of the cervical canal with a morbid discharge from the cervical 
glands, and such may be relieved simply by repeated cleansing of the canal 
with a cotton-wrapped probe or forceps. 

Stings and Bites. 

Quassia, a strong infusion used as a wash in Java on the mat-covered floors 
infested with fleas, the swarms vanishing as by magic (Neale). Ammonia or 
Alkalies, a weak solution, in stings of insects, to neutralize the formic acid (R) ; 
Ammonia, as nervine stimulant in snake-bites, more useful than brandy or any 
other stimulant ; rr\,x-xx of Liquor Ammonias in water or wine, every half hour 
or oftener ; also externally or hypodermically, 1 in 2 of water into a vein 
(Wa). Ammonium Carbonate, gr. v hypodermically, as used for wounds by 
poisoned arrows. [See under Wounds.] Carbolic Acid, a weak solution 
sponged over the body, to keep off mosquitoes (R). Salicylic Acid, 1 to 19 of 
flexible collodion, locally for bites of insects; allays pain at once, and only in 
rare cases is the neighboring tissue swollen. Mercury, the Bichloride, 1 to 1000 
of flexible collodion, is equally effective. Potassium Permanganate, in strong 
solution, 1 to 6 locally, is promptly efficient for all reptile-bites and insect- 
stings; if wound is small, make incision to enlarge it, and insert lint soaked in 
the solution ; if a rattlesnake-bite, inject the solution hypodermically above the 
wound (Dupon). Viola Cucullata, the common violet, is used as an internal 
remedy in Pennsylvania for rattlesnake-bite, and is successful in a remarkable 
degree ; the leaves are eaten, and a poultice of Indigo and salt is at the same 
time applied to the wound. Arsenic, 1 part to 5 of black pepper, is the Tan- 
jore pill, highly esteemed in India for bites of venomous snakes (Wa). Cal- 
cium Chloride, a filtered solution injected into wound from snake-bite, success- 
ful in seventeen cases (Binz). Silver Nitrate, the sharpened stick applied to 
every sinuosity of the wound ; excision safer (Wa). Sugar, applied to stings 
of wasps, said to relieve almost instantly (Wa). Ipecacuanha, as poultice or 
paste, allays pain or irritation ; is regarded by some as almost specific (Wa). 
Antivenene [see page 183], is an effective antitoxin against the venom of 
several serpent species (Fraser). Stimulants, in snake-bites, freely, are most 
important ; Liquor Ammoniae the best (Wa) ; stimulants are indicated in 
snake-bites, but there is no remedy of any value therefor (Gross). Sting, 
should always be removed if left in the wound ; pressing upon it with the bar- 
rel of a small key will expose it. [Compare Wounds.] 

R . 01. Picis Liquidae, 01. Olivae, [ R. Carbonis Vegetab. , . . 

Ol. Hedeomae, .... aa^j. Potassii Nitratis, . . . 

Spt. Camphorae, Acidi Carbolici, .... 

Glycerini, aa^ss. Persian Insect Powder, . 

Acidi Carbolici, ^ij. Mucil. Tragacanth., . . 

M. Sig. — Shake well. Lotion against To make fumigating pastilles for use 

mosquitoes, for fishermen and hunters. 1 against mosquitoes. 

Stomatitis. 

Potassium Chlorate, locally and internally ; large doses necessary, gr. x-xx ; 
in ulcerative stomatitis of nursing women and aphthae, of no value in mercu- 
rial form (R). Hydrastis, the fluid extract locally in mercurial and aphthous 
stomatitis (B). Glycozone, frequently applied, is of benefit in ulcerative 



i 



846 STRABISMUS — SUPPURATION. 

stomatitis (Edson). Carbolic Acid, a concentrated solution in glycerin care- 
fully, as a mild caustic in aphthous stomatitis (Wa). Alcohol, Brandy-and- 
water an excellent lotion (B). Mineral Acids, pure Hydrochloric applied on 
pine wood to ulcers (B). Eucalyptus, a decoction of the leaves, locally (B). 
Glycerite of Tannin, in ulcerative stomatitis (R). Copper Sulphate, solution 
painted over edges of gums in ulcerative stomatitis ; generally dry Alum 
better (R). Alum, in ulcerative form, applied dry with the finger several 
times a day, especially when disease affects one-half the jaw (R). Salicylic 
Acid, to ease the pain of catarrhal stomatitis ; one part, dissolved in sufficient 
Alcohol, to 250 parts of water (R). [Compare Aphtha, Cancrum Oris, 
Sprue.] 

Strabismus. 

Belladonna, for the strabismus of encephalitis (P). Atropine, with strong 
convex glasses, to suspend accommodation for months, or years if necessary ; 
may cure convergent strabismus in its earlier stages, in children of 3 years of 
age and younger (Green in C). Operation, required in most cases, especially 
when of congenital origin. Glasses, properly adjusted to sight, serve to 
strengthen the weak muscles in children, and to pull the axes right (Gould). 

Strophulus. 

Nitric Acid, Ac. Nitrici Dil. 3ss-j, Bismuthi Subnit. 3ss, Tinct. Digitalis 3j, 
Glycenni 3SS, Aquae Rosas ^vij, applied to the affected parts frequently (Wa). 
Zinc Oxide, dusted freely over the part. Magnesia, or some other mild alkali, 
with improved feeding and aperients, to which measures this affection gener- 
ally yields in infants. Lancing the gums, is proper (H). [Compare Lichen.] 

Sunstroke. 

Veratrum Viride, and Gelsemium, as sedatives, instead of stimulants, when 
the pulse is full and strong (Ely). Water, as cold affusion when the patient is 
stricken down unconscious (R) ; absolute rest and quiet, free air, loose clothes. 
Potassium Bromide, in cold water by enema. Stimulants when the pulse is 
frequent and feeble. Chloroform, if convulsions. Leeching, in the stage of 
reaction (Wa). [Compare Heat-stroke] 

Suppuration. 

Sulphides, small doses, gr. ss-j, frequently repeated, are very serviceable 
(B). Calcium Sulphide, when ichor secreted instead of pus; also arrests sup- 
puration, or if that is impossible will hasten maturation (R). Quinine, recom- 
mended in profuse suppuration (R) ; to sustain system when suppuration pro- 
longed (B). Sarsaparilla, is very useful (P). Phosphates, Parrish's syrup to 
repair waste from suppuration (B). Iron and Manganese Iodide, the syrup in 
cachectic states resulting from suppuration (B). Hydrogen Dioxide, is a most 
energetic pus-destroyer ; the solution may be applied in lull strength, or diluted 
with an equal part of water. Glycozone, acts similarly but more slowly ; after 
cleansing by Hydrogen Dioxide solution, the application of Glycozone stimu- 
lates healthy action and hastens the cure ; for which purpose it has no superior 
in the entire range of therapeutics (Edson). Bismuth Subiodide, dusted over 
a suppurating surface after cleansing, is highly efficient as an antiseptic and a 
stimulant of healthy granulation. Acetanilid, is effective for 2 or 3 days, but 
ultimately fails to prevent suppuration (Foote) ; the following combination, 
used as a dressing, absolutely inhibits suppuration where it can reach the 
wound surface, and checks and quickly abolishes suppuration if that be 
already present, — Acetanilid, powdered, 48 ; Boric Acid, powdered, 15 ; Starch, 



SURGICAL FEVER — SYNOVITIS. 847 

powdered and finely sifted, 35 ; Carbolic Acid, liquid, 2. It should be changed 
twice daily as long as there is discharge to moisten it, when the wound becomes 
dry the dressing may be left on for days (Fallas). Nuclein, has been used 
successfully in suppurative disorders (Vaughn). [Compare Abscess, Boils, 
Carbuncle, Septicemia.] 

Surgical Fever. 

Aconite, quickly and repeatedly administered in early stages, during chill or 
soon after, the safest treatment (P). Salicylic Acid, or Sodium Salicylate, espe- 
cially useful as an antipyretic (B). Chloral, gr. xv-xxx every 2 hours ; there 
is no better treatment (Wa). 

Sycosis. 

Nitric Acid, ^j to Oj aquae, as wash, used frequently (R). Boracic Acid, 
3j'ss finely powdered and incorporated with ^j of Vaselin, is found most use- 
ful (Wa). Salol, as an antiseptic powder, has done good service. Mercury, 
Citrine Ointment has been extensively employed, also the Oleate of Mercury, 
both with good results (Wa). Arsenic, the Oleate is found beneficial, and the 
Solution of Arsenic and Mercury, Donovan's solution, internally is highly 
useful. Mercurial Ointments, are extensively employed (Wa). Sodium Sul- 
phite 3), Glycerin Hjj, Water 3iij, locally, when of parasitic origin (Wa). 
[Compare Condylomata, Mentagra.] 

Syncope. 

Nux Vomica, in drop doses of the tincture every 5 minutes, to restore the 
cardiac action in extreme cases of syncope approaching heart- failure, especially 
when of neurotic origin ; is promptly efficient (Macfarlan). Cinnamon, the Oil, 
as a powerful stimulant, is sometimes employed (P). Alcohol, as brandy or 
wine, when heart suddenly enfeebled from fright, etc. (R). Amyl Nitrite, in 
some forms, especially in anemic subjects, its inhalation speedily restores con- 
sciousness (O'Neill). Atropine, gr. T h'u~TQ subcutaneously, the best means of 
resuscitation, there being no medicine which so promptly exalts the force and 
rapidity of the heart's action (Harley). Duboisine, may be used instead of 
Atropine. Ammonia, internally, or breathed into the air-passages (R) ; the 
Carbonate as smelling salts (Wa). Lavandula, the compound tincture (Wa). 
Chloroform, internally, for hysterical people, as cardiac stimulant (R). Posi- 
tion, leaning forward, with head as low as possible (R). Galvanization, of the 
pneumogastric (B). Cold Water over the face, and volatile substances to the 
nose (B) : cold affusion always (Wa). [Compare Heart Affections.] 

Synovitis. 

Potassium Iodide, with Iron and Quinine, in syphilitic patients with consti- 
tution broken down (D). Iodine, in chronic synovitis, painted around joint ; 
the solution injected into white swelling (R). Quinine, and free stimulation in 
all cases of pyemic synovitis, such as occurs in acute rheumatism of gonor- 
rheal causation, occasionally in typhoid fever, and may result from a trifling 
injury in strumous subjects. Mercury, and Morphine, the Oleate locally (R) ; 
an elegant and efficient application (B) ; in syphilitic cases Mercury internally 
when acute symptoms have subsided (D). Aconite, for pains in inflamed 
joints (R). Silver Nitrate, locally to vesication almost, often very beneficial 
(Wa). Carbolic Acid, injected into joint (B). Alcohol, and water, equal parts, 
an excellent evaporating lotion (B). Blisters, a flying blister every night in 
chronic synovitis (R). Cod-liver Oil, in strumous cases (B). Surgical Treat- 
ment, splints to keep the limb motionless in all cases arising from injury ; during 
acute stage splint should be fastened at some distance above and below the 



< 



848 SYPHILIS. 

joint, not touching the joint itself; straight position, leeches to the joint, or 
cupping near it ; ice, evaporating lotions or hot fomentations ; blisters inapplic- 
able until the acute stage subsides (D) : if suppuration occurs the joint must 
be dealt with as any other abscess cavity (MacCormac). Heat, as fomentations 
or poultices in the acute form. The results of dry heat, applied by the Taller- 
man apparatus seem almost marvelous in traumatic synovitis, whether in base- 
ball men or other persons (W). Bandage, or Strapping, to cause absorption of 
fluid ; bandage with cold water after alternate bathing with hot and cold water, 
in chronic synovitis. [Compare Coxalgia, Joint Affections.] 

Syphilis. 

Mercury, the mainstay in the earlier and later stages ; the Protiodide in pills 
of gr. ]/e each, one after each meal increased by one every third day, until teeth 
get sore or bowels disordered, then drop two pills from each dose (Keyes) ; 
the best remedy for primary and secondary forms, not in tertiary ; small doses 
are best, stopping short of ptyalism (B) ; Blackwash, Calomel, or Citrine Oint. 
very useful in mucous sores, tubercles, and elevated indurations ; in syphilitic 
ozena, psoriasis, rashes, condylomata, etc., the Bichloride, gr. ij-v in ^j of Al- 
cohol, painted over syphilitic mouth lesions daily (Keyes); Mercury is believed 
to be a true vital antidote against the virus (R) ; used for at least two years can 
eradicate it (Keyes) ; internal administration best because most practicable ; 
the two great preparations are the Bichloride and Protiodide, of the former the 
curative dose for a man is about x / z grain daily, for a woman % grain, below 
which the drug has no active effect on the disease ; dose of the Protiodide is 
larger, for a man about 2 grains, for a woman gr. iy£ daily (Fournier). Nitric 
Acid, in secondary forms (R) ; holds a high place as an internal remedy (Wa) ; 
when sponginess of gums excessive, £iv to ^ij aquae, teasp. 4 times daily ; 
also use locally (St) ; as cautery for the initial lesion, the fuming a'cid, if used 
at all, should be applied early and thoroughly, followed by Blackwash locally 
on lint (Bulkley). Potassium Iodide, is approached by no remedy in constitu- 
tional syphilis ; also for mercurial cachexia, syphiloma of nervous system, and 
many disorders of syphilitic origin ; will certainly arrest ulceration of nares, 
palate, etc., if given in large doses, gr. xx-£j every 4 hours (R) ; is of little 
value in early stages ; in the later should be combined with Mercury (St). 
Rubidium Iodide, is more pleasant than Potassium Iodide, having a milder 
taste, and is borne far better, especially by the stomach and in regard to the 
production of iodism and cardiac difficulties (Neisser) ; is indicated in patients 
in a low state, with weak cardiac activity (Mering) ; in doses of ^jss to ^iij of 
a 5 per cent, solution daily, gave the best possible results without troublesome 
disturbances (Bunge). Iodine, as gargle for ptyalism ; the tincture applied to 
syphilitic sores of the throat (R) ; or ^ss of tincture to ^iv Syr. Fusci., a tea- 
spoonful well diluted ter die, after meals, when Potassium Iodide can not be 
borne (St). Iodoform, powdered and dusted over ulcers (B). 

Aurum, after Mercury and the Iodides, in old cases of secondary and ter- 
tiary, ulceration of the throat, ozena, phthisis, syphilitic bone-diseases (B) ; its 
beneficial action incontestable (Tr) ; the Bromide of Gold and Arsenic has 
rendered good service in trifacial neuralgia diagnosed as due to syphilis (E. A. 
Wood) ; Gold is unquestionably useful in the later stages, its best effects being 
obtained with very small doses (Pf ) : the Bromide of Gold, Arsenic and Mer- 
cury (Mercauro) is highly praised in the late manifestations of syphilis, espe- 
cially in those affecting the nervous system. Stillingia, with Nitric Acid in 
chronic cases of broken-down constitutions from abuse of Mercury and Iodides 
has been most satisfactory (B). Cascara Amarga, is said to have remarkable 
powers as an alterative in syphilis, but to be useless if alcohol and tobacco are 
used at the same time. Sanguinaria, in secondary and tertiary forms is held 
to be very useful (P). Sarsaparilla, a most important remedy, as adjunct to, 
and in abuse of Mercury (P) ; with Guaiac and Mezereon, as the Compound 
Decoction of Sarsaparilla, in tertiary form (B). [See Guaiac, below.] Bella- 



TABES MESENTERICA. 



849 



donna, with Mercurial Ointment, for secondary ulcerations of rectum (P) ; the 
tincture 3'iv ad %\) aquae, a teaspoonful 4 times a day in water, instead of mer- 
curials (St). Iron, the Iodide in constitutional syphilis, to promote constructive 
metamorphosis (B) ; where anemia exists (R) ; the Potassio-Tartrate.gr. xv-xx, 
every 4 hours, especially in the gangrenous form (Otis). Guaiacum, in tertiary 
syphilis only, or as vehicle for Potassium Iodide and Mercuric Chloride (B). 
Carbolic and Salicylic Acids, locally to syphilitic abscesses, Carbolic best (B). 
Zinc Chloride, Iodide, Nitrate, locally to syphilitic ulcers (R). Syphilis Anti- 
toxin, has been used with encouraging results [see page 183]. Denutrition, the 
Arabic "hunger-cure" efficient, but unpopular (B). Turkish Baths, or wet 
packing, ameliorate and aid the cure of constitutional svphilis (B). Hygiene, 
is of the greatest importance in syphilis (Bulkley). Cod-liver Oil, remarkably 
improves condition resulting from prolonged use of Mercury and Iodides, the 
syphilodermata, and squamae; internally and by inunction (R). [Compare 
Chancre, Condylomata, Ptyalism, Ulcers.] 



R . Hydrarg. Iodidi Rubri, . gr. iij. 

Potassii Iodidi, .... giij-vj. 

Tinct. Aurantii Cort. , 

Syrup. Aurantii Cort., aa %j. 

Aquae, . . . . q. s., ad^viij. 
M. Sig. — A teasp. thrice daily after 
meals. (Otis, for the Mixed Treatment.) 



R . Hydrarg. Bichloridi, . . gr. iv. 
Tinct. Benzoini, . . . ,^ss. 
Aquas Cologniensi, . • %)• 
Aquae Rosae, ... . Jivss. 
M. Sig. — Apply locally with sponge to 
skin for 20 minutes. For squamous syphil- 
ides. (S. W. Gross.) 



R. 



Massae Hydrargyri, . 
Ferri Sulph. Exsiccat. 
Extr. Opii, . . . 

In pill, thrice daily. 



g r - U- 
g r - J- 

g r - " 



(Otis. 



R. Hydrargyri Bichloridi, 

Ammonii Chloridi, . aagr. iij. 
Tinct. Cinchonas Comp., 

Aquae, aa^iij. 

M. Sig. — A teasp. thrice daily. Each 

3 contains gr. T X g of Corrosive Sublimate. 

(Bum stead.) 



R 



M. 
meal. 



Hydrarg. Iodidi Rubri, gr. ij. 
Ammonii Carbonatis, . gr. xx. 
Potassii Iodidi, . . . ^iij. 
Tinct. Gent. Co., q. s., ad J iv. 

Sig. — A teasp. in water after each 
(Fox, for the Mixed Treatment.) 



R. Hydrarg. Chlor. Mitis, 

Lycopodii, ... aa2[ij. 

M. Sig. — Use as snuff thrice daily, in 
lesions of the nostrils. (Diday.) 



The Three Eights. 



Hydrarg. Chlor. Corr., . gr. viij. 
Potassii Iodidi, .... gviij. 
Syr. Sarsaparillse Co., . Jfviij. 
M. Sig. — A teasp. thrice daily. 



R 



Potassii Iodidi, . . . . 
Ammonii Carb., . . 

Tinct. Cinchonas Comp. 

Glycerini, 

Syr. Aurantii Cort., . . 



3U- 
3 SS - 

3 iv. 

3JSS. 



M. Sig. — A teasp. in plenty of water 



after each meal. 



(Keyes.) 



i 



Tabes Mesenterica. 

Calcium, the Chloride and Phosphate (R) ; the former is a powerful remedy 
if kept up (Wa). [See under Scrofulosis.] Iodine, with Cod-liver Oil by in- 
unction (El) ; locally over glands ; carefully, lest inflammation be increased (R). 
Potassium Iodide in small repeated doses, valuable (Wa). Mercury, Corro- 
sive Sublimate with bark ; gr. j ad 3'\) Tinct. Cinchonas, after meals, for chronic 
glandular disease (D). Phosphates, for malnutrition (B); the Hypophosphites 
act slowly but surely (Wa). Iron and Iodine, in various forms are the most 
useful remedies in scrofulosis, but medicine is powerless without strict hygienic 
measures (A) ; the Iodide or Phosphate of Iron and Cod-liver Oil, as for tuber- 
cle elsewhere (El). Fel Bovinum, is worthy of trial, though at best a palliative 
(Wa). Cod-liver Oil, is the best remedy to promote assimilation (B) ; of great 

54 



85O TASTE TEETH TEMPERATURE. 

service (R). Chaulmoogra Oil, is of benefit, used by inunction (Wa). Aliment, 
raw meat, cream, chocolate, and cocoa, are valuable nutriments in these cases 
(El) ; peptonized foods are of inestimable value (Wa). Hygiene, change of air, 
especially to sea-air, is all-important (El). [Compare Scrofulosis.] 



Taste, Disordered. 

Mercury or Podophyllin, as purgative for cankery taste unconnected with 
alcoholism ; or half-glass of pure cold water daily half an hour before break- 
fast (R) ; }/$ gr. of Gray Powder 3 or 4 times a day will generally remove the 
disagreeable taste in the mouth due to dyspepsia, in the course of chronic dis- 
ease or in early convalescence from acute illness (R). Electricity, faradization 
as a stimulant of the nerves in the tongue, may aid the recovery of function 
when loss of taste is due to nerve disease (Gowers). 



Teeth. 

Potassium Iodide, in doses of gr. x, thrice daily, often cures looseness of 
teeth from periostitis of alveolar processes (Wa) ; Iodine, the tincture painted 
over gums close to the teeth when the gums begin to recede ; also to remove 
tartar (R). Cinchona, powdered bark often used in tooth-powders (R). Col- 
lodion, on cotton, as filling for carious teeth (P). Liquor Sodae Chloratse, 
3vj ad sjxij aquae, a highly useful application in fetid discharges from carious 
teeth (Wa). [Compare Dentition, Gums, Odontalgia.] 



Temperature in Disease. 

Average Normal Temperature, of adults, 98. 6° F. ; of children, 99 ; of the 
aged, 98. 8°. Diurnal variation i° to 1.5 F., highest from 9 A M. to 2 p.m. 
Above 108 F. is a fatal sign, which issue may be averted by cold baths, reduced 
by ice from 96 to about 6o° F. (A). The clinical thermometer placed in the 
mouth, axilla or rectum, and retained in situ for five minutes, should go hand 
in hand with Aconite in the treatment of inflammations (R). [For Antipyretics 
see the articles on Fever and Inflammation, also the list of these agents 
on pages 37 and 38.] 

Clinical Thermometry is one of the principal means of positive diagnosis. 
The thermometer should be self-registering, certified, and accurately marked 
according to the Fahrenheit scale. The most reliable temperature is that in 
the rectum or vagina; less so in the axilla and folds of skin, and still less re- 
liable in the mouth. A correct reading of the thermometer cannot be obtained 
in less time than five to seven minutes (Da Costa). 

The Average Normal Temperature of the body is 98. 6°, which, like the pulse, 
will vary somewhat in individual cases ; as a general practical result it is agreed 
that in temperate regions the normal temperature at completely sheltered parts 
of the surface of the human body amounts to 98.4 Fahr.,or a few tenths more 
or less ; and a rising above 99. 5 , or a depression below 97. 3 F., is a sure indi- 
cation of some kind of disease, if the increase or depression is persistent. 
The temperature is increased at the prime of life, is raised and depressed 
temporarily by the influence of diet, stimulants, exercise, etc. The minimum 
diurnal temperature is observed at 2 a.m., the maximum at 4 to 6 p.m. The 
greatest recorded range of temperature in disease is 50.4 ; the minimum is 
71. 6° in a case of sclerema neonatorum (Ouain's Diet.), the maximum 122 . 
In severe and fatal cases it rarely exceeds 107 , and rarely falls below 92 , even 
in fatal collapse. It may rise 3 to 4 after death, as observed in a case of typhoid 
fever in which death occurred with a temperature of 107 , which increased 
shortly afterwards to 1 10. 5 . A temperature of 107 indicates malignancy, and 



TEMPERATURE. 85 I 

when met with for two consecutive days in typhus, scarlatina, measles, pneu- 
monia, pyemia, meningitis or rheumatism, death may be expected shortly. 
In relapsing, remittent and intermittent fevers, and in the initial chill of an 
abortion, the temperature may reach 107 without indicating great danger. 
During the last hours of life in many diseases, the temperature rises to 109 - 
ni° ; for example, in tetanus, sunstroke, typhus, etc. With a temperature of 
96 collapse is imminent. 

Abnormally High Temperatures reported in the British Medical Journal, by 
Dr. Donkin, include those of eight cases, all but one in females, and none 
proved fatal. Pain was a prominent symptom in all. (1) 111.6 ; convalescing 
from enteric fever. (2) 108 ; no organic lesions; ovarian pain. (3) 115.8 ; 
great abdominal pain and excitement. (4) m°; convalescing from enteric 
fever. (5) 113 ; enteric fever. and double pneumonia. (6) 112 ; synovitis; 
this was the only male. (7) 112 ; painful stump, with necrosis. (8) 117 ; 
pyonephrosis. Dr. Jacobi of New York reported a case of injury in which the 
temperature taken in the mouth, axillae, rectum and urethra, before many wit- 
nesses and with many thermometers, was 148 F. and yet the patient did not 
die. Dr. Welch mentioned as a well-known case, one Galbraith of Omaha, in 
whom the temperature went to 171 F.for some hours. 

High Average Temperature (above 104 ), is found in severe pneumonia, 
scarlatina, remittent, typhus, typhoid and relapsing fevers, pyemia, etc. Mod- 
erate High Temperature (102 and above), is seen in peritonitis, acute rheu- 
matism, pericarditis, pleurisy, dysentery, cerebro-spinal meningitis, catarrhs, 
etc. A temperature of ioo° and above is found in chronic affections, incipient 
inflammations and mild fevers. When, in effervescence, the heat increases 
rapidly, it will in defervescence decline proportionately fast and vice versa. 
Look for a grave affection when high temperature is of continuous type. A 
distinct interval between the morning and evening temperature is a favorable 
sign. A slow and gradual increase indicates typhoid fever; in rheumatism 
and anomalous fevers the increase is more rapid, and still more so in acute 
inflammatory disease, as pneumonia, pleurisy, typhus, scarlatina, rubeola, 
etc. The rise is usually rapid in intermittent fever, febricula, and ephemeral 
fevers. A rapid effervescence and slow defervescence indicates some com- 
plication of disease ; the reverse order indicates great danger. When the 
temperature begins to fall from the evening to the morning, it is an indication 
of improvement; while a rise of temperature from the evening to the morn- 
ing is a sure indication that the patient is worse. Stability of temperature 
from morning to evening is a good sign, but from evening to the morning is 
unfavorable. 

Decrease of Temperature below the normal point is rare. It occurs some- 
times transitorily, announcing a favorable crisis, by preceding the return to 
the normal temperature. It is also met with occasionally during the morning 
remission of remittent fever ; also during the apyrexia of intermittents ; in acute 
collapse, preceded or not by fever ; in chronic wasting diseases, and some- 
times also on the approach of death, especially in typhus fever. 

In Phthisis, the temperature is higher in the evening than in the morning; 
later, higher at early bedtime than at noon, and high again at dusk. This is a 
valuable and delicate test of the progress of tuberculization. 

In Typhoid Fever, the accession is by a rise of one degree each day, with the 
diurnal variation. If the evening temperature does not exceed 103. 5 , the dis- 
ease will probably be mild ; but a temperature of io5°in the evening indicates 
a severe type and much danger. A sudden reduction to 95 in the third week 
denotes intestinal hemorrhage ; a lingering temperature of ioi°-io2° in the 
fourth and fifth weeks indicates non-cicatrization of the intestinal ulceration. 

In Scarlatina, the rise of temperature is rapid, 104. 7 may be reached in a few 
hours and 105 by the second day. It seldom rises above 105 and almost 
never above 106 ; is continuous until the eruption begins to fade, when remis-. 
sions take place unless complications arise. 



( 



852 TESTICLES TETANUS. 

In Measles, 103 is the usual temperature, with daily variations, increasing 
with the eruption and catarrhal symptoms. A high temperature lasting beyond 
the tenth day denotes complications. 

In Diphtheria, the temperature by the end of the third day will, in uncom- 
plicated cases, not exceed io3°-io4°. It falls temporarily when the exudation 
appears. Defervescence occurs in the severe but favorable cases, from the 
twelfth to the fourteenth day ; in the milder cases not before the sixth. In 
some fatal cases it occurs early, from the third to the fourth day. In asthenic 
cases the temperature of the surface falls, while that of the interior remains 
high, ioo° in the axilla and 103 in the rectum. During convalescence, the 
temperature is low and readily depressed, but -may be raised by intercurrent 
maladies. Any increase after the first five days, or a continuous high tem- 
perature after the first ten days, is unfavorable. A sudden rise may indicate 
complications. 

Co-Relation of Pulse and Temperature. — As a general rule the co-relation 
of pulse and temperature may be stated as follows, namely : — an increase of 
temperature of one degree above 98 F. corresponds with an increase of ten 
beats of the pulse per minute. 

Testicles. 

Mercury, the ointment, locally in indurations and enlargements of testes 
( Wa) ; Corrosive Sublimate, with Cinchona or Sarsaparilla in sarcocele (D). 
Camphorated Naphtol, used hypodermically in tuberculosis of the testis with 
very gratifying results (Reboul). Aurum, is highly recommended in hypochon- 
driasis accompanying testicular disease, and as a tonic for low-spirited, pining 
boys with undeveloped testes. Water, cold applications in neuralgia of testes 
with tonics and neuralgic treatment generally (D). Suspensory Bandage, with 
rest, in many affections of the testes (D). [Compare Hydrocele, Orchitis, 
Varicocele.] 

Tetanus. 

Potassium Bromide, not less than ^ss during the day, with Chloral at night 
as a hypnotic ; out of 21 cases so treated but 3 died ; its physiological action 
indicates it to be the best remedy known (W) ; in very large doses, 3j every 3 
or 4 hours, has given better results than any other remedy (B). Chloral, in 
full doses, gr. xx, no remedy more effectual (B) ; has sometimes cured (R); 
best used in combination with Potassium Bromide (W). Chloroform, in small 
and frequently repeated inhalations, also by friction, has been useful in many 
instances ( Wa) ; anesthetics give temporary relief (B) ; four cases of acute tet- 
anus treated successfully by chloroform inhalations, the daily dose varying from 
gij to iv (Preobrajensky). Paraldehyde, promises well, in full doses, 3ij-ijss ; 
does not depress the heart, as chloral and the bromides do (B). Strych- 
nine, of decided service (P) ; cured 8 cases of traumatic form in doses of gr. 
tV to i (S) ; the evidence as to its curative power is of doubtful credence, but 
it is most successful in spontaneous and chronic cases rather than in the 
traumatic form (B). Aconite, has benefited many cases (P) ; its success war- 
rants further trial (W). Belladonna, successfully used in many cases ; the ex- 
tract internally, and locally to wound (Wa) ; Atropine, gr. T ^ injected into 
muscle (B) ; bleeding, vapor-baths, and large doses of Belladonna have cured 
tetanus (Tr). Nicotine, by rectum or hypodermically, appears to be useful in 
many cases (R) ; much evidence for it as the best remedy (P) ; effective but 
dangerous (B) ; Physostigma better (Wa). Physostigma, has been used with 
excellent results (P) ; the fluid extract by mouth if possible, at the very begin- 
ning, and must be pushed until just short of arresting breathing (B) ; evidence 
is discrepant (W). Apomorphine, may prove antagonistic (P). Curare, hypo- 
dermically, has much evidence for its power (P). Cannabis Indica, used with 
marked success in traumatic form (P) ; it is difficult to obtain an active extract 



THIRST THROAT. 853 

(W). Cocaine, and Morphine, of each a 5 per cent, solution, 3 syringesful 
hypodermically, immediately relieved and finally cured a bad case of idiopathic 
tetanus unrelieved for 3 days by chloral, morphine, etc. (Lopez). Gelsemium, 
has cured several cases (P); its spinal action is opposed to that of tetanus (B). 
Hyoscyamine, or Duboisine, gr. g\ gradually increased to gr. y 1 ^, is very efficient 
(Oulmont). Antipyrin, antagonizes excitability of the motor nerve centres, 
and has been used with benefit. Amyl Nitrite, used in 3 cases with marked 
benefit as spinal sedative (W) ; has been used with success (R). Morphine, 
hypodermically, deeply into tetanized muscles, and if possible to the point of 
entrance of the nerves, used with successful results (Demarquay) ; as ordinarily 
used is of no value (Wa). Tetanus Antitoxin, is unquestionably the most effi- 
cient remedy known for this disease [see page 180]. Conium, is indicated, 
but has not been successful (B). Water, as warm baths, and cold, or ice, af- 
fords only temporary amelioration (B). Spinal Ice Bag, extremely useful (R). 
Division, or stretching of any nerve-trunk connecting the wound with the spinal 
cord. [Compare Spasmodic Affections.] 

Thirst. 

Acid Drinks, allay thirst by promoting the secretion of the alkaline saliva ; 
but excessively used will derange the stomach (R). Bitters, in drinks with 
acids slake thirst most effectually (R) ; a weak infusion of Cascarilla or Orange- 
peel, acidulated slightly with HC1 acid, an efficient thirst-quelling drink for 
fever patients (Graves). Ice, sucked, is very grateful, and allays thirst in fevers 
(R). Tepid Drinks, are useful in the thirst of diabetes (Prout). Fruit Juices, 
or these made into drinks, but the most harmless agents must be used in mod- 
eration, and their consumption has to be checked, otherwise patients will take 
them to excess and may thus do themselves considerable injury (Fenwick). 

Throat, Sore. 

Aconite, when temperature high, half-drop doses of the tincture, every % hour 
for 2 hours, then every hour, will almost certainly prove efficacious (R) ; valu- 
able in ordinary sore throat (P). Belladonna, is very admirably adapted to the 
treatment of ordinary sore throat ; when much fever combine with Aconite 
(R, P). [See under Catarrh, Acute.] Nitre, dissolved in mouth, to abort a 
sore throat (Wa). Tannic Acid, as powder, gargle, spray (P); the Glycerite of 
Tannin, after acute inflammation ; in ulceration of aphthous sore throat daily 
when tendency to catarrh (R). Ipecacuanha, the wine as spray, in non-inflam- 
matory sore throats and hoarseness from congestion of vocal cords (R). Capsi- 
cum, Z) of tincture to 0}4 aquae as gargle, in some sore and malignant sore 
throats (R, P). Potassium Chlorate, in grain doses every half-hour (Smith). 
Alum, dry, or in solution (R). Myrrh, as gargle in ulcerated sore throat (P). 
Guaiac, the compound guaiac gargle [see page 576] is often very efficient in sim- 
ple sore throat and commencing tonsillitis. Chloral, internally and locally, is an 
excellent remedy for ulcerated sore throat (Brodnax). Cimicifuga, in simple sore 
throat (P) ; also in malignant forms when the mucous membrane is dry and 
spotted with inspissated mucus (R). Mercury, in acute tonsillitis, which see (R); 
the Bichloride as a gargle [formula on next page], in ulcerated forms of syphi- 
litic sore throat (Sir Chas. Bell). Rhus Glabra, a decoction, ^j to Oj boiled to 0}(, 
with Potassium Chlorate ^ss, is a very efficient gargle (W). Arsenic, in medic- 
inal doses, for sloughing of throat or malignant sores (R) : the Iodide is an 
excellent remedy for the so-called diphtheritic sore throat, gr. iij triturated with 
gr. xx of sugar of milk, one-half of which is dissolved in ^ivof water, and a 
teasp. given every hour or so. Methylene Blue, in simple, non-diphtheritic 
ulceration of the throat, patients would express themselves with delight as 
being cured, after one or two applications of the solution (Rose). Iodine, the 
tincture, locally to sores, whether syphilitic or not (R). Nitric Acid, undiluted, 



854 TIC DOULOUREUX TINEA CIRCINATA. 

to sloughs (R). Silver Nitrate, locally, in early stage of inflammation, may 
cut it short (R). Sulphurous Acid, by inhalation, spray, or fumigations for 
malignant sore throat, scarlatinal or otherwise (R). Water, cold compress 
nightly, to harden the throat when tendency to catarrh (R). Ice, constantly 
sucked (R). [Compare Diphtheria, Pharyngitis, Tonsillitis ; also the 
formulae for Gargles on page 576. J 

R . Tinct. Guaiaci Amnion , 1 & . Hydrarg. Bichlor., . . . gr. iv. 

Liq. Potassae, . . . . aagiij. Alcoholis, ^ij. 

Tinct. Opii ^ij. Solve, et adde — 

Aq. Cinnamomi, q. s. ad 3 viij. Decocti Cinchonse, Mellis Rosae, 

M. ft. gargarisma. 

Sig. — To be used as a gargle, every hour, 
in clergyman's sore throat. [Garner.) 



Tinct. Myrrhse, . . aa^ij. 

M. ft. gargarisma. Sig. — Gargle, to be 

diluted if too severe. (Sir C/ias. Bell.) 



Tic Douloureux. 

Croton-Chloral, has special effect on the 5th nerve (B) ; is palliative in doses 
of gr. v every y 2 hour till gr. xxx are taken (W). Salicylates, in large doses, 
cured a case of 12 years' standing. Stramonium, gr. X to A of tne extract 
every 3 or 4 hours for 4 or 5 doses, often affords decided relief; stop if narcotic 
symptoms appear (P). Arsenic, cures by influencing nutrition (B). Phosphorus, 
is useful in doses of gr. y^ to gr. -^ every 3 hours (R). Morphine, with Atro- 
pine, hypodermically, gives relief (B). Aconitine, has lately been given with 
good results (B). Antipyrin, and Acetanilid, are sufficiently analgesic to relieve 
the pain in many cases. Iodides, are promptly curative when tic is due to 
syphiloma of the nervous system, the pain being nocturnal chiefly (B). Cimi- 
cifuga, is frequently very effective (B). Turpentine, when rheumatic in origin 
or produced by fecal accumulations (B). Quinine, holds a foremost place in 
the list of remedies (Wa). Ammonium Chloride, in doses of 30 grains 4 times 
daily, is of great service in numerous cases, especially when the pain partakes 
more of a rheumatic than of a neuralgic character (Sir Thos. Watson). Can- 
nabis Indica, gr. % to yi rarely gr. j, of a good extract, is very effective and 
ranks in value next to morphine and atropine (Reynolds). Physostigma, a 
few drops of a solution of the extract, 1 in 30, or one or more gelatine discs of 
Physostigmine introduced within the eyelids of the affected side, effectively 
relieved or cured several cases (Munro). Chloroform, the liniment applied with 
friction is sometimes serviceable (Wa) ; a few drops by deep injection in the 
vicinity of the nerve trunk (B). Galvanization of the fifth nerve, gives decided 
relief to the pain, and frequently results in permanent cures in cases which be- 
long to the category of the so-called essential neuralgias (B). [Compare Hemi- 
crania, Neuralgia, Neuritis, Odontalgia.] 



Tinea Circinata — Ringworm of the Body. 

Mercury, the Bichloride, 1 part in 250 of water, as parasiticide application, 
after depilation (A) ; Calomel, as ointment, £j to the %, is useful (B) ; strong 
Citrine ointment rubbed in twice daily is often effectual (Wa) ; the ointment of 
the Red Oxide often cures ringworm on the body or limbs when other reme- 
dies fail (Wa). Carbolic Acid, 3} to the ^ of glycerin, or equal parts of each, 
is a very efficient application (B). Boric Acid, is an excellent topical applica- 
tion, especially in that form affecting the scrotum and inner side of the thigh 
(Watson). Copper Acetate, in ointment, gr. x to the ^, is a very effective 
application (B). Sulphites, are used in parasitic skin diseases to destroy the 
parasites (B). Sulphurous Acid, is better than Carbolic and safer (A); must 
be fresh to be of use (Bulkley). Cocculus Indicus, the decoction locally, after 
washing the skin well (P). Oil of Cade, the best depilatory known (A). 
Arsenic will not cure, but may do service as a nerve tonic or an improver of 



TINEA DECALVANS TINEA IMBRICATA. 855 

nutrition, in connection with other remedies (Bulkley). Iodine, as liniment 
once applied (R) ; with Oil of Tar, 1 to 4, is excellent (Wa). Kamala, used 
locally by the Hindoos (P). Tar Ointment, is used with good effect (P). 
Acetic Acid, strong, applied to ringworm of any part of the body except the 
scalp ; no treatment is easier, more speedy or certain in its action (R). 
Sodium Chloride, common salt in ointment is a very effective remedy [see under 
Tinea Tonsurans]. Cod-liver Oil, is a powerful auxiliary in weakly and 
cachectic subjects (Wa). Diet and Hygiene, are important; the food should 
be nutritive and abundant, especially animal fats; daily baths, out-of-door 
exercise. Fungus, is the Trichophyton tonsurans (A). 



Tinea Decalvans — Alopecia Areata. 

Parasiticide Lotions, must be used after epilation and washing of head daily 
with soft or black soap. Collodion, with Cantharidal Ether, equal parts, as a 
stimulant after the fungus is destroyed (A). Oxygen, locally applied to the 
scalp by a close-fitting rubber bag, to restore the hair [see under Alopecia]. 
Tonics, are necessary, especially for the nervous system (Bulkley). Fungus — 
the Microsporon Audouini (A) ; but I have never seen it, though having made 
repeated and thorough searches (Bulkley). 



Tinea Favosa — Favus. 

Mercury, is efficient when used early; the Bichloride, gr. xx to %) of simple 
cerate (B) ; or gr. ij to the % of water applied after each epilation (R). Myrtol, 
is curative of favus (B). Carbolic Acid, in glycerin or cod-liver oil, as a local 
application (B). Sulphurous Acid, as a parasiticide; Acidi Sulphurosi Dil. ^ss, 
Sodii Hyposulphitis £iij, Aquae q. s. ad ^xvj (Startin) ; is useful in favus, but 
when cases are unusually obstinate its action should be assisted by epilation (R). 
Simple Oils, to soften and facilitate the removal of scabs (R). Poultices, are 
useful preparatory to epilation (R). Iron, the tincture of the Chloride, internally 
in doses of rr\,x thrice daily for a child ten years old ; combined with cod-liver 
oil if the disease is associated with scrofula (Sir E. Wilson). Sulphur Iodide, 
in weak ointment, gr. xx to the ^, well rubbed in after removal of crusts, is the 
most reliable preparation of its class (Whitla). Epilation, must be resorted to 
and carried out with care and patience (Id). All the remedies useful for ring- 
worm of the scalp may be used against favus, and success depends rather upon 
the judicious way in which these agents are used one after the other than on 
the persistent use of any one of them (Id). It is clearly demonstrated that the 
disease is conveyed from the mouse to the cat and then to the children who 
play with the affected cat (Id). Fungus — the Achorion Schonleinii (A) ; a 
very rare affection in this country (Bulkley). 



Tinea Imbricata — Tokelau Ringworm. 

Iodine, the double strength liniment, freely applied, is the best treatment for 
natives (Mn). Chrysarobin, as ointment, gr. xx to the ^ of vaselin, for limited 
patches (Id) ; [see under Dhobie Itch]. Cassia Alata, the bruised leaves well 
rubbed in over the affected area (Id). Sulphur, as fumes or ointment, acts very 
slowly and unsatisfactorily (Id). Oiling the Body, is believed to be a prevent- 
ive (Daniels). Cleanliness of the skin and boiling or destruction of the clothing 
worn next it, to prevent recurrence (Mn). The disease is a form of body ring- 
worm peculiar to certain eastern tropical climates, is produced by a trichophyton, 
and is characterized by a concentric arrangement of closely set rings of scaling 
epidermis (Mn). 



( 



856 TINEA TONGUE. 



Tinea Tonsurans — Ringworm of the Scalp. 

Mercury, the Bichloride, gr. xx to the ^ of simple ointment, is an effective 
application when used early (B); must be used with caution. Carbolic Acid, 
3j to the % of glycerin (B). Sulphurous Acid, the acid of the B. P. with an 
equal part of glycerin, is useful; must be assisted by epilation when the affec- 
tion is obstinate (R) : or Startin's formula [see ante under Tinea Favosa]. 
Potassium Sulpho-cyanide, ^ss in glycerin ^j and water ^vij, as lotion applied 
on lint covered with oiled silk, after washing the patches twice daily with warm 
water and soap and drying (Gee). Sodium Chloride, in ointment, equal parts 
of common salt finely powdered and vaselin, thoroughly mixed, and well 
rubbed in night and morning after shaving the part, until the skin becomes 
very sore ; is most efficient even in apparently intractable cases (Perkins). 
Iodine, Z\\ to the ^ of the oil of wood tar, is an efficient application, producing 
no pain and preventing the extension of the disease (R). Arsenic Iodide, is 
the best constitutional remedy; gr. ^ increased to gr. \ for an adult, gr. ^ to 
^ for children, with alkaline lotions locally (Wa). Viola Tricolor, the leaves 
are employed in Italy for tinea capitis (P). Cocculus Indicus, a decoction lo- 
cally applied after washing the part well, is efficient (P). Quinine, dissolved in 
glycerin, or a mild mercurial pomade, as grease to the hair of the patient and 
uncontaminated members of the family, to prevent the sporules reaching un- 
affected parts (R). Oils, may be used to facilitate the removal of the scabs (R). 
Cleanliness, and free use of soap and water, is a sine qua non, and in some 
cases of tinea may be alone sufficient to produce curative results. Isolation of 
person, and brushes, towels, etc., necessary to prevent infection. Fungus — 
the Trichophyton tonsurans (A). 



Tinea' Versicolor. 

Iodine locally, preceded by washing with soft soap and warm water (Morris). 
Sulphurous Acid, diluted to one-fourth with water, or a strong solution of 
Sodium Hyposulphite, as local applications (Id). Benzol and lavender water, 
equal parts of each (Id). Chrysarobin and Salicylic Acid, dissolved in Trau- 
maticin or Collodion (Morrow) ; [see under Dhobie Itch for formula]. Fungus 
— the Micro sp or on furfur. 

Tongue. 

Potassium Chlorate, gr. v internally and 3j-ij ad Oj aquas locally ; in ulcers 
of tongue (Wa) ; also for rawness of tongue in advanced phthisis. Potassium 
Iodide, in syphilitic ulcers of tongue (D) ; and in hypertrophy (A). Potassium 
Bromide, 3j to Jvj water as wash, may soothe morbid sensibility of the tongue 
(A). Borax, Sodii Boratis gr. xl, Glycerini ^j, Aquas ^iv, as application in 
cracked tongue ( Wa). Iodine, the tincture locally by a fine brush, or as a 
gargle with 7 or 10 parts of water and some honey, has given uniform success 
in malignant ulcers (Wa). Aurum, internally and locally, has cured hyper- 
trophy of the tongue with induration thereof in scrofulous subjects, also stru- 
mous ulceration of the tongue. Conium, is thought to act specifically with 
benefit in ulcer of the tongue (Wa). Cinnamon, the oil as a powerful stimulant 
in paralysis of tongue (P). Ginger, Cochlearia, Pyrethrum, as gargles. Cloves, 
Mezereon, Pepper, as masticatories, in paralysis (P). Frenum, should be di- 
vided in tongue-tie; use blunt-pointed scissors, directing the points down close 
to the jaw, so as to avoid wounding the ranine artery (D) ; better to cut as little 
as possible, and directly backwards, as the artery of the frenum may proceed 
from the sublingual (Holmes). [Compare Glossitis, Ranula.] 



TONSILLITIS TONSILS. 



857 



Tonsillitis. 

Aconite, when high fever and elevated arterial tension, relieves greatly, gtt. 
ss-j of tincture every ^-hour or hour(B); every ^-hourfor 2 hours, then every 
hour, will almost certainly prove efficacious (R). Belladonna, of surprising 
efficacy, gtt. v of tinct. every 3 hours in ^ss aquae (P). Mercury, often speedily 
removes Calomel, gr. ^, or Hydr. cum Creta, gr. -| every 2 hours ; not in 
chronic forms (B) ; gr. y^ of Gray Powder every hour when tonsils almost meet, 
has marked effect ; the Oleate of Mercury and Morphine in obstinate and pain- 
ful tonsillitis (R). Silver Nitrate, locally may abort, if applied early (R) ; the 
solid stick, once thoroughly applied in the first stage, rarely fails to prevent 
suppuration (Howard). Guaiac, disagreeable, but very effective (P) ; ^ss doses 
of tincture every 4 hours has remarkable power; should be given in emulsion 
with mucilage or yolk of an egg (B) ; makes an excellent gargle, [see page 576 
for formula] : the tincture of Guaiac and glycerin, equal parts, in 3 doses every 
hour or two, gives excellent results in acute tonsillitis. Opium, gr. v-x of Dover's 
powder at bedtime, is in many cases curative (Shoemaker). Cocaine, in 10 per 
cent, solution, locally, at intervals of 15 minutes, removes pain at once and 
promotes resolution; a very efficient application in 5 or 10 per cent, solution, 
but causes temporary paralysis of palatal muscles, so that liquids regurgitate 
through the nose (Boeckel) : a strong solution painted freely over the affected 
tonsil in cases which commence on one side of the fauces, will cut short the 
attack in most cases and prevent suppuration. Emetics, at the very onset of 
the disorder, will sometimes succeed in cutting it short (Sir Thomas Watson). 
Alum, dry or in solution (R). Potassium Iodide, locally, gr. j-v to the ^, is 
useful (B). Potassium Chlorate, in grain doses every half-hour, very efficient 
(Smith). Capsicum, the dilute tincture in a gargle, or in powder applied on a 
swab, is useful in severe tonsillitis, especially in that accompanying scarlatina 
(W). Quinine, gr. x-xv will sometimes abort (B). Tannic Acid, is useful (P) ; 
as gargle, [see page 795]. Ice and wet pack, extremely grateful (B). Hydrogen 
Dioxide, the solution as gargle, is used with great benefit. Cold Wet Compress, 
around neck, covered with oiled silk and a dry bandage, applied nightly, is 
very useful. Sodium Bicarbonate, locally by wetted finger to surface of tonsils 
every five minutes for ^-hour, then every hour during the same day, will pre- 
vent necessity for lancing (Lyon Medical). Incision of the tonsils gives imme- 
diate and marked relief in all cases especially those which are not amenable to 
ordinary treatment. 



R. Tinct. Aconiti, gss. 

Tinct. Guaiaci. 

Syr. Zingiberis, . . . . aa^ss 

Syr. Simplicis, J ij. 



M. Sig. — £ss-ij every 2 hours, accord- 
ing to age. In severe cases, with high 
fever, bounding pulse, severe headache. 

(Shoemaker.) 



i 



Tonsils, Enlarged. 

Ammonium Iodide, 3ss in ^j of glycerin, applied every night by acamel's- 
hair brush, very efficacious (Wa). Barium Iodide, in hypertrophy of the tonsils, 
effects a rapid diminution in their size, even when indurated for years (Hale). 
Liquor Ferri Chloridi, diluted, 3j-ij to the §, painted over tonsils twice daily, is 
one of the most effective astringents (Mackenzie). Aluminum Sulphate, a 
saturated solution applied daily by a brush, as a mild caustic (W). Ergot or 
Ergotin, by injections into tonsils (Meigs). Zinc Chloride, as caustic, the most 
efficient and least annoying method ; a saturated solution applied on a wire 
cotton-holder to each crypt and held there a few seconds ; a few applications 
will shrink the gland in a week. Tannin, a strong solution touched daily to 
tonsils (H) ; a few sips of a saturated solution, :fss in ^iij aquae, slowly sipped,, 
will stop bleeding, if profuse (A) ; gr. xx to ^j aquas, hypodermically, as in 



858 TONSILS TORTICOLLIS TOXEMIA TKEMOR. 

nasal polypus. Silver Nitrate, touched daily to tonsils, will sometimes make 
them shrink (H). Catechu, a serviceable astringent gargle; the infusion gvj 
with tincture of Kino 3ij> as gargle (Wa). Oxgall, locally, is praised (Wa) ; is 
of real utility (W). Citric Acid, rubbed daily to tonsils, is highly praised in en- 
largement thereof. Excision of a part of the tonsil (H) : Mackenzie's double 
guillotine removes both tonsils at once ; hemorrhage seldom happens, ice will 
generally check it (A). Surgical measures should receive unprejudiced con- 
sideration, as the medical treatment is tedious in the extreme. 



Tonsils, Ulcerated. 

Coptis, the infusion as a gargle (B). Sulphurous Acid, dilute, locally by 
spray, or a solution of Sodium Sulphite 3j in water ^j (B). Potassium Iodide, 
will arrest syphilitic ulcerations at once (B). Carbolic Acid, a 5 per cent, wash 
with tincture of Myrrh, a good application by sponge to throat (Wa). Cimi- 
cifuga, a decoction of the root as a gargle (Wa). 

Torticollis. 

Cimicifuga, has curative efficacy (P). Capsicum, a handful of the crushed 
pods infused for 36 hours in a pint of hot or cold water, and applied on lint 
covered with gutta-percha (R) ; gives striking results (Wa). Opium, as lini- 
ment with friction, or an opium plaster, is often serviceable (Wa). Potassium 
Bromide, in large doses with Arsenic, may always be tried in the spasmodic 
form, which is sometimes one of the most obstinate complaints (Whitla). 
Gelsemium, some cases have been reported as cured by its hypodermic 
administration after tenotomy or myotomy had failed (Id) ; very large doses, 
Tt\,iij of Wyeth's fluid extract thrice daily, increased until eight times this 
amount is taken, so as to produce very pronounced physiological symptoms, 
in spasmodic torticollis (Weir Mitchell). Surgical Treatment, by stretching or 
resection of a portion of the spinal accessory nerve, has succeeded sometimes 
in spasmodic torticollis, but it has also failed, and being so unsatisfactory 
should not be tried except as a last resort (Whitla). Electricity, galvanization 
of the affected muscles and faradization of the opposed ones, quickly relieves 
(B) ; has given excellent results in spasmodic torticollis, and if resorted to 
early may succeed, but must be persisted in for some time (Whitla). 

Toxemia. 

Saline Injections, beneath the skin and into the veins, successfully used in 
various forms of toxemia, as diabetic coma and the anemia and collapse fol- 
lowing intestinal hemorrhage in cases of typhoid fever. The apparatus em- 
ployed is uncomplicated and the technic simple. Care must be taken to avoid 
air-embolism and the introduction of foreign bodies. If the patient is robust 
and his condition sthenic, with venous infusion on one side may be conjoined 
venesection upon the other. The object is to hasten the dilution and elimina- 
tion of the poison, both directly and through the skin and the kidneys particu- 
larly. The results are good in a certain proportion of cases and sometimes ex- 
traordinary, while the procedure is practically harmless (Hare). Deci-normal 
salt solution injected into a vein and filling the rectum with a saturated solution 
of Magnesium Sulphate (McKeown). [Compare Septicemia, Shock,Uremia.] 

Tremor. 

Hyoscyamus, the tincture in full doses will palliate mercurial tremor ; or 
Hyoscyamine, g'r. ^ gradually increased to -^ s (B). Hyoscine, is a useful drug 
in diseases having tremor as a marked symptom, as disseminated sclerosis, 



TRICHINIASIS TUBERCULOSIS. 859 

delirium tremens, etc., and is usually quite safe (Weatherly). Coniine, will con- 
trol excessive tremor in many instances. Gelsemium, in full doses may palli- 
ate excessive tremor ; a combination of Hyoscyamus, Conium and Gelsemium, 
the first to keep the brain quiet, the latter to quiet the nervous irritation at both 
the central and peripheral extremities (Lavers). Cocaine, influences alcoholic 
and senile tremor more favorably than any other remedy ; large doses and fre- 
quent administration are unnecessary (B). Veratrine, has been used success- 
fully in alcoholic tremor and that of disseminated sclerosis, also in the trembling 
weakness of typhoid fever (Ferris). Calcium Salts, were given by me in one 
case of tremor at the beginning of general paralysis, resulting in its cessation 
for several months (Br). Arsenic, n\Jj — iij of Fowler's solution, diluted with two 
parts of water and given hypodermically, was successful in several cases 
(Eulenberg). Phosphorus, in alcoholic and mercurial tremor (De Mussy). 
Silver Nitrate, gr. y&-uj daily, used in six cases of mercurial palsy with fairly 
rapid recovery (Sementini). Zinc Phosphide, is effective in the tremor of 
mercurial and arsenical poisoning (De Mussy); not so in the tremor of 
sclerosis (P). [Compare Chorea, Delirium tremens, Paralysis agitans ; 
also Bruntons Pharmacology, 3rd edition, page 133, for the Pathology of 
Tremor.] 

Trichiniasis. 

Benzol, in doses of rt^x, every hour or two, up to 3jss daily, followed by a 
brisk laxative, has been very successful in 27 cases, treated simultaneously 
(Putter). Purgatives, as Rhubarb and Senna, or an occasional dose of Calo- 
mel, to thoroughly evacuate the gastro-intestinal canal. Glycerin, in large 
doses, to destroy the worm by its hygroscopic qualities, has been recommended. 
The indications, in the stage of invasion, are to relieve the pains, to secure 
sleep, to combat the fever, and to support the patient's strength ; there are no 
medicines which have any influence upon the embryos in their migration 
through the muscles (O). 

Trismus. 

Aconite (A), Atropine (R), hypodermically. Cannabis Indica, has been 
used successfully in trismus neonatorum (B). Opium, rr\, y % doses of Laudanum, 
with Castor Oil and warm bath, in trismus infantum. Ether, Chloral, Gelsem- 
ium, Physostigma (B). Treatment of any kind is seldom effectual (D) ; is 
never effective (El). Trismus neonatorum, lock-jaw of the new-born infant, 
may be due to many causes ; one of which is bathing in very hot water. A 
certain midwife, whose hands could not distinguish the differences in tem- 
perature of the bath, sent me over 100 cases (Weber). 



Tuberculosis, Acute. 

Quinine, to subdue the fever, also Salicylic Acid for the same purpose, with 
repeated blistering over different parts of the chest and many dry cuppings of 
the lower limbs and the trunk morning and evening ; this, with wine and alco- 
hol, broths, jellies, milk and peptonized foods, is my plan of treatment for 
acute miliary tuberculosis, by which one case was absolutely cured (Jaccoud). 
Arsenic, appears to reduce the temperature gradually and is useful in many 
ways (R). Cold, to the surface of the abdomen, with ice sucked freely, the 
body sponged with iced vinegar and water, food and drinks to be iced, and 
even iced enemata sometimes ; with Quinine, gr. x-xxx once in 48 hours, or 
the pill of Quinine gr. j, Digitalis gr. ss, and Opium gr. }( , every 4 hours, fluid 
food every hour or half hour day and night, in acute miliary tuberculosis, may 
bring about a cure if energetically followed from the beginning (McCall 
Anderson). [Compare Phthisis.] 



( 



860 TUBERCULOUS AFFECTIONS TUMOKS. 



Tuberculous Affections. 

Arsenic, children affected with tuberculosis involving the lungs, intestines 
and peritoneum, have steadily and slowly improved and finally recovered 
under Arsenic treatment (R). Salicylic Acid, Unna's strongest plaster, applied 
repeatedly for several days, to remove the horny covering in tuberculosis 
verrucosa cutis ; this will remove much, and the rest is destroyed by the 
fuming Acid Mercuric Nitrate, applied to a small portion of the growth at a 
time, as it is painful (Crocker). Camphorated Naphtol, hypodermically in 
tuberculosis adenitis, tuberculosis of the testis and of the bladder, etc. [see 
page 388]. Potassium Cantharidinate, gr. g-i-Q to gr. -3^ hypodermically, 
produces an exudation of serum throughout the body, and may cause a con- 
centration at an affected spot of efficacious substances which would not ordin- 
arily find their way there, but it should not be employed when kidney disease 
exists (Liebrich). Hydrargyrum Thymol aceticum, in solution injected into 
the glutei muscles every eight days, followed after a few injections by Potassium 
Iodide, gr. iij thrice daily by the mouth, as a cure for tuberculosis (Tranjen, 
Ewald). Zinc Chloride, in dilute solution, deeply injected into the tissues sur- 
rounding tubercular deposits, in order to induce a condition of sclerosis fatal to 
the growth or existence of the bacilli; in tuberculosis of the epididymis and in 
spina ventosa a 1 in 20 solution ; for tuberculous disease of the joints, ribs and 
glands a 1 in 10 solution, of which 20 drops to be injected in a number of places 
around the periphery of the diseased part (Lannelongue). Iodoform, a 10 per 
cent, emulsion filled into the cavity after free opening and scraping, the cavity 
being then sewn up, gives excellent results in tuberculous abscesses (Billroth) ; 
a sterilized 10 per cent, emulsion made with glycerin or olive oil, injected every 
14 days or oftener into tuberculous joints and abscesses after thorough aspira- 
tion, also in tubercular empyema (Bruns) ; this may be well employed for all 
forms of local tuberculosis of soft parts, as the glands, testes and lungs (Tren- 
delenburg). Cod-liver Oil, is the remedy from which we can expect the most 
good in the tuberculous diathesis (Wa). Antitoxin, Paquin's serum has given 
good results in knee-joint tuberculosis (Cale) ; also in other forms [see page 
181]. Antiphthisin, is doing good service in cases of pure tuberculosis [see 
page 514]. Tuberculin, as a diagnostic agent for latent tuberculosis [see page 
513]. [Compare Laryngitis tubercular, Lupus, Meningitis tubercular, 
Peritonitis tubercular, Phthisis, Scrofulosis, Tabes mesenterica.] 



Tumors. 

Mercuric Bromide, in ]/ 2 grain doses, has benefited abdominal tumors (Wa). 
Chloroform, to aid in diagnosis of abdominal tumors when deep-seated, and 
when walls of the belly are hard and rigid ; also in phantom tumors (R). Pep- 
sin, hypodermically, to dissolve them. Hyoscyamus, the leaves as cataplasm 
or fomentations to painful tumors, afford great relief (Wa). Iron, the Liquor 
Ferri Chloridi is found to be valuable as a curative application to fungous or 
hemorrhoidal tumors (Wa). Galbanum, as plaster to indolent, non-malignant 
tumors, to diminish or cause their absorption (Wa). Electrolysis, is employed 
with more or less benefit in sebaceous tumors, lipoma, bronchocele, enlarged 
glands, etc. (Wa) : Apostoli's method for the dispersion of fibroid tumors ; it 
will dissipate pain, improve nutrition, and diminish their size without danger to 
life (Bigelow) ; the treatment of fibroid tumors by the galvanic current has of 
late been universally recognized by the profession (Massey) ; solid tumors, as 
goitre, enlarged glands and similar growths have been repeatedly cured by 
electrolysis (B). [Compare Cancer, Cysts, Glandular enlargement, 
Goitre, Polypus, Uterine tumors, Wen.] 



TYMPANITES— TYPHOID FEVER. 86l 



Tympanites. 

Turpentine, often greatly benefits (P, Wa) ; Z] every 6 hours in tympanites of 
typhoid, with prostration but without diarrhea (R). Asafcetida, in hysterical 
tympanites, internally or as enema, beneficial (P) ; also in that of fever (Wa). 
Capsicum, gr. ss-ij, every 4 hours (P). Cocculus Indicus, a few doses of the 
tincture will often succeed in the tympanites of peritonitis and enteric fever 
(P). Ginger, with drastic purgatives (P). Posture, relieves many bad cases 
promptly ; inversion or partial inversion of the patient, as in the knee-chest 
position, for 10 or 15 minutes, to cause the gravitation of the bowels upwards, 
thus straightening out the rectum ; or if this is not practicable, place the patient 
on one side and elevate the foot of the bed two or three feet (Sweetnam). 
Surgical Measures, by celiotomy and incision of the gut, should be done 
promptly, when cathartics, posture, enemata and the use of the rectal tube have 
failed to give relief (Porter). Puncture or Aspiration only in extreme cases and 
as a last resort, and then only in such cases which present no other cause for 
celiotomy than the tympany itself, as typhoid fever without perforation, pneu- 
monia, etc. (Id). [Compare Peritonitis, Typhoid Fever.] 

Typhlitis. 

Opium, of undoubted curative power (B). Purgatives, are inadmissible ; 
Epsom salt may be used, but no drastics (B). Leeches, should never be 
omitted when tenderness and fever begin (B). Ice-bag, over the swelling (B). 

Typhoid Fever. 

Guaiacol Carbonate, in two daily doses of 25 to 30 grains, is highly efficient, 
sixty cases treated thereby with no deaths ; is non-poisonous, but does not affect 
the temperature, hence antipyretics may be required (Hoelscher) ; is the princi- 
pal ingredient in the Woodbridge abortive treatment, which also includes Menthol, 
Thymol, Eucalyptol, Calomel and Podophyllum in combination [see formulae 
on page 863] ; aims at aborting the disease by intestinal antisepsis and elimina- 
tion ; Dr. Woodbridge and others report extraordinary success with this method. 
Guaiacol, 10 to 15 drops of pure Guaiacol painted over the skin of parts where 
it is readily absorbed is very efficient in reducing temperature when exceeding 
102 (Montagnon). Carbolic Acid, Z] with tincture of Iodine 3ij, of which mix- 
ture 1 to 3 drops every two or three hours, is a very good plan of treatment 
(Da C); all his cases during an entire year were treated with a mixture of 
Carbolic Acid and Chloroform, without the loss of a single case, by Dr. Quill 
of the Indian Army [see page 90]. Chloroform, the spirit in mixture of Car- 
bolic Acid, as above ; a y 2 per cent, solution of Chloroform will kill the bacillus 
of enteric fever (Werner). Copper Arsenite, in divided daily doses of gr. y^, 
commenced early and continuously used, will maintain a moderately low tem- 
perature, a good pulse rate, comparative freedom from great abdominal pain 
and tympanites, and will lessen materially the number of stools, while it greatly 
improves their character and consistence (Aulde) ; used in 90 cases with but 
one death ; leaves an excellent condition of the alimentary tract after the fever 
is over (Thomas). Salol is of great value as an intestinal disinfectant, promot- 
ing healing and preventing reinfection ; given in 5 to 10 grain doses, according 
to age, every 4 hours until the urine is tinged, then reducing the amount and 
frequency, but maintaining a faint coloration of the urine, has for ten years 
afforded me the most gratifying results (Bramwell) : it should not be given in 
the compressed tablet form for many reasons. Salophen has proved equally 
efficient. 

Nitro-hydrochloric Acid, is to be preferred over all other plans of treatment, 
20-drop doses in simple elixir, also Sulphuric acid for intestinal hemorrhage 



f 



862 TYPHOID FEVER. 

(Da C). Mineral Acids, are very useful generally, especially HC1 (Wa). 
Thymol may also be employed, in doses of gr. ss-ij in solution (Da C). 
Sulphurous Acid, is highly praised by Dewar, and has real antidotal power ; 
ti^ijss-xx every 4 hours according to age, continued for a week or ten days, 
until the patient's complaints show him to be saturated.; if diarrhea be present 
add Sulphuric Acid and Opium (Wilks). [Formulas on next page.] Cinnamon, 
the Oil is efficiently used to abort the disease [see page 277]. Potassium 
Bromide, is as much a specific for typhoid fever as Quinine Sulphate is for 
ague, aborting the fever in 8 or 10 days (Hawkins). Arnicais highly extolled ; 
its " picture " shows definite powers in this disease (P) ; small doses in asthenic 
conditions (B) ; when vital powers are greatly depressed (Wa). Baptisia is 
very useful in the early stage (W). Turpentine, invaluable when hemorrhage 
and extreme tympanites (P, R) ; rr^xxx-lx in Starch mucilage and n\,x of Tinct. 
Opii (P) ; tt^v-x frequently for hemorrhage or rr\,x every 2 hours in advanced 
stage, with dry tongue (R) ; when coma, stupor, it often arouses the vital 
powers (Wa) ; tt\,vij with gr. ^L of Morphine ; of especial value when marked 
fever and congested lungs, as well as for the tympany (Da C). Chloral, is the 
best drug for nervous symptoms, but must not be used when the heart is weak 
(Da C). Opium, small doses at night, for insomnia with delirium; also as in- 
jection for the diarrhea (R) ; in one case when vital powers seemed hopelessly 
depressed, gr. l / 2 caused improvement (Wa) ; for spreading tenderness (peri- 
tonitis), give 10-minim doses of the deodorized tincture, also gr. j in suppository 
every four hours (Da C). Belladonna, when contracted pupils, low, muttering 
delirium (B) ; is thought to counteract the poison of typhoid (Wa). Mercury, 
Corrosive Sublimate gr. y^ every 2 or 3 hours for the diarrhea ; Calomel in 
small doses at onset (R), gr. x in one dose the first day, gr. iij per diem for 3 
or 4 days, the German " specific treatment " (B). Bismuth, gr. x-xxv of the 
Subnitrate with gr. %-] of Opium every 3 hours for the severe diarrhea (Da C). 
Ergot, for intestinal hemorrhage, hypodermically if the symptoms are urgent 
(R) ; Ergotin, gr. ij-vj hypodermically, or gj of the fluid extract of Ergot, for 
intestinal hemorrhage (Da C). Tartar Emetic, with Opium, when wakefulness 
and delirium ; minute doses gr. T ^ frequently, are of great service (B) ; Anti- 
mony cuts the disease short with such certainty that it is almost doubtful 
whether the lesion of typhoid is specific or is not rather incidental or ad- 
ventitious (Lawrie) ; should be given with cardiac tonics. Digitalis, of value 
in many cases as a sustainer of heart power, but may be dangerous in the later 
stages (Anstie, Murrell) ; used by the Germans when there is no cardiac weak- 
ness ; gr. x-xx as antipyretic, over a period of 36 hours (P). Quinine, may 
have efficacy in typho-malarial fever, is less effective as the typhoid element 
predominates, useless in purely continued fevers (B) ; is justly abandoned, but 
may be used to maintain the circulation, in tonic doses, gr. vj-x in the 24 hours 
(Da C). Medicines should not be given in tablet or pill form, which are liable 
to cause irritation of the intestinal lesions. 

Antipyrin, Phenacetin, Acetanilid, are extensively used as antipyretics ; for 
the dangers depending on the extensive employment of the latter drug see 
page 79. Phenocoll Hydrochloride as an antipyretic, is used with marked 
success. Veratrum Viride, to reduce temperature (R) ; for delirium ferox (B) ; 
strongly recommended (Wa) ; its efficacy difficult to believe (S). Serpentaria, 
useful when much depression exists, cautiously if intestines at all irritable 
(B). Hydrastine, when copious sweats (P). Lead Acetate, with Opium, for 
the purging (R) ; also Alum (R). Lime-water, as an astringent and antacid, 
is efficient. Sodium Chloride, should not be withdrawn from the food (Wa). 
Aromatic Spirit of Ammonia, for great accumulation of mucus in the throat 
(Da C). Copper Sulphate, gr. ^, with Opium, gr. %. for the diarrhea (Da C). 
Strychnine, is the remedy for the functional palsies (Da C). Purgatives, only 
the very mildest, and they with the greatest caution (Wa). Medicine, will 
never abort a case of true tvphoid, its natural duration is from 28 to 30 days 
(Sir Wm. Jenner). Typhoid Antitoxin, has been used in a few cases, apparently 
with good results [see page 184]. Cold Baths, when the temperature rises 



TYPHUS FEVER. 



863 



above 102 , a most important agent (B) ; in mild cases, cold wet compresses or 
wet sheets, or washing with cold water; in severe cases, affusion, shower, or 
general cold bath, 50 to 55 F., or better 95 cooled gradually to 6o° (R) ; this, 
the Brand (more justly Currie's) method, increases the flow of urine and its 
toxicity, restoring the latter to normal and sometimes to double the normal, 
thereby clearing the system of a large quantity of toxins (Ausset). Stimulants, 
freely, with Quinine, for pyemic cases, showing joint complications [see under 
Synovitis].^ Aliment, by Milk alone, or alcohol with milk, eggs, broth (B) ; 
Coffee, a better stimulant than alcohol (P) ; Alcohol is needed to sustain the 
heart's action (Da C) ; Milk must be used with great caution ; if the curd be un- 
digested great evils arise ; give essence of meat alone (Sir Wm. Jenner) ; 
avoid the extremes; an absolute milk diet required if intestinal symptoms are 
grave ; no solid food until health is restored fully ; a scalded-milk diet exclu- 
sively may be depended on. Adjuvants, water, especially the abdominal 
compress, cleanliness, ventilation, absolute rest and quiet. Discharges should 
be received in vessels containing Carbolic Acid or a solution of Corrosive 
Sublimate, and buried instantly. [Compare Hemorrhage intestinal, Rec- 
tal ULCERATION, TYMPANITES.] 



R. Resin. Podophylli, . . . gr. -g^. 

Hydrarg. Chloridi Mitis, 

Guaiacoli Carbonatis, 

Mentholi, aagr. ■jfa. 

Eucalyptoli, ... q. s. 

Ft. tabella no. j. Sig. — One or more of 

these tablets every ]^. hour during the first 

3 days, to secure 5 or 6 free evacuations 

daily. {Wood bridge No. 1.) 

R . Resin. Podophylli, . . gr. -§\-^. 

Hydrarg. Chloridi Mitis, 

Mentholi, 

Thymoli, . . . aa gr. T X g. 

Guaiacoli Carbonat., . . gr. % . 

Eucalyptoli, . . . . q. s. 
Ft. tabella no. j. Sig. — One tablet every 
hour or two, after third or fourth day, re- 
duced so as to gradually lessen frequency 
of evacuations, until the temperature re- 
turns to normal. ( Woodbridge No. 2. ) 



R 



. Mentholi, .... 

Thymoli, .... 

Eucalyptoli, . . . 

Guaiacoli Carbonat., 
Ft. capsula no. j. Sig 



gr. ss. 
g r - j- 

gr. "J- 
-One capsule 



every 3 or 4 hours, alternating with the 
tablets, after the fourth or fifth day of treat- 
ment. All the medicines to be washed 
down with large draughts of distilled or 
sterilized water. {Woodbridge A'o.j 



R. Tinct. Iodi, 

Acidi Carbolici, . . . . aap. aeq. 
M. Sig.— gtt. j-ij every 4 or 6 hours. 
In typho-malarial fever, and in typhoid. 



R. 



M 



4 hours 

R 



Acidi Sulphurosi, 
Acidi Sulphurici Dil., . aa^ij. 
Tinct. Opii Deodor. , . . rrixx. 
Syr. Aurantii, .... giij. 

Aquae, q. s. ad J vj. 

Sig. — One-sixth to be taken every 



{Wilks.) 



Acidi Sulphurosi, .... n\xv. 
Syr. Aurantii, .... sjiij. 
Aquae, . . q. s. adg]. 

M. Sig. — For infants, one-sixth every 
four hours. {Wilks.) 



R. Ant. et Potassii Tartrat., . gr. j-ij. 

Morphinae Sulphat., . . . gr. ss. 

Aquae Laurocerasi, . . . ^j. 
M. Sig. — A teasp. every two, three 
or four hours. 



R . Quininaa Sulphatis, . . . gr. x. 
Acidi Hydrochlor. Dil., 
Vel Ac. Sulphurici Dil., . ^ ss. 

Syr. Aurantii, ±j. 

Aquae Cari, q. s. ad^v]. 

M. Sig. — A tablesp. in an equal quan- 
tity of water, every three or four hours. 

{Murchison.) 



i 



Typhus Fever. 

Phenacetin, is extensivelv used for the pvrexia. Baptisia, is said to have 
proved very useful (W). Belladonna, to cleanse and moisten the tongue ; 
controls the delirium, slows and strengthens the pulse, reduces the tempera- 
ture, shortens course of disease (R, P) ; in the early stages, relieves severity 
of symptoms (P) ; give when contracted pupils (Wa). Arnica, very highly ex- 



( 



864 ULCERS AND SORES. 

tolled (P, Wa). Hyoscyamus, for mild brain symptoms (P). Opium, fulfils 
many important indications; never give when pupils are contracted (Wa). 
Mineral Acids, their use recommended in all countries (Wa). Tartar Emetic, 
with Opium in the delirium with insomnia (R). [See under Typhoid.] Chloral, 
to produce sleep and allay violent delirium (R, Wa) ; its use has often been 
followed by amelioration of the symptoms (Wa). Antipyrin or Quinine, as 
antipyretics, it being more necessary than in typhoid to keep the temperature 
within safe limits (B). Podophyllin, gr. Y /e-)i as mild laxative at onset, when 
constipation, congestive headache, biliary derangement (P). Digitalis, in 
large doses, a favorite remedy in Germany (P). Rhatany, as tonic, in ad- 
vanced stages (P). Serpentaria, in low stage, delirium, watchfulness, tongue 
dry and brown, or black ; combine with Ammonium Sesquicarbonate (P) ; is 
given occasionally to excite diaphoresis and support the vital powers (Wa), 
Camphor, a remedy of considerable value, but contraindicated when flesh-red 
tongue, tender abdomen, diarrhea (W T a). Purgatives [see under Typhoid 
Fever]. Coffee, better than alcohol for the adynamia (P). Stimulants, are not 
needed under the use of mineral acids and a supporting diet in many cases 
(Wa) ; are needed sooner than in typhoid, as the adynamia is more profound 
and appears sooner (B). Diet, nutritious persistently, beef-tea, egg-nog, nutri- 
ent enemata. Isolation, imperative, as the disease is eminently contagious 
(B). [Compare Delirium, Typhoid Fever.] 



Ulcers and Sores. 

Arsenic, improves rodent ulcer (B). Belladonna, has a remarkable influ- 
ence over various ulcerative processes (P). Chloral, as lotion for sluggish sores, 
5 to 20 grains to the ;§ of water (Keyes) ; is highly efficient in ulcerated sore 
throat or ulceration from any cause (Brodnax). Mercury, Calomel finely levi- 
gated and dusted on, is highly efficient in ulcer of the conjunctiva; Calomel 
Ointment or Black Wash in scrofulous or tuberculous lupus, and in open scrofu- 
lous sores (R) ; Corrosive Sublimate, in 1 per cent, solution, as application to 
syphilitic ulcers (Fox) ; the Ung. Hydrarg. Nitratis, for serpiginous ulcerations 
diluted one-half, or the Iodide, gr. xx-xl to the ^ of vaselin, in syphilitic ulcer- 
ations (Keyes). Lime, as the Carbonate or Lime-water to check discharge ; the 
Sulphide when thin ichorous discharge ; the Phosphate has influence on scrofu- 
lous sores (R). Phytolacca, as a local application (B). Hamamelis, employed 
with satisfaction in varicose ulcers (Pf). Opium or Morphine, with glycerin, 
as an application to relieve pain (R) ; gr. j-ij, daily, also locally, has a decid- 
edly curative value in phagedenic and indolent ulcers ; not so useful in so- 
called irritable ulcers (Pf, P). Ichthyol, pure as oint. or with Lanolin, has done 
excellent service in ulcers of the leg. Thiol, the dry form, as dusting powder, 
has been of great benefit. Piperazin, in I per cent, solution, locally to gouty 
sores, relieves the pain and reduces the inflammation. Resorcin, in strong or 
supersaturated solution, locally applied to tuberculous and other ulcerations of 
the larynx, is efficient and painless (Tymowski). Tannin, or Glycerite of Tan- 
nin, to coat over wounds or discharging sores (R). Potassium Chlorate, in so- 
lution as a wash to clean and stimulate foul ulcers (R) ; in impalpable powder, 
a better application than Iodoform (B). Cinchona, powdered Bark dusted over 
foul, indolent, sloughing and gangrenous ulcers, promotes healing (R). Conium, 
locally, by means of a poultice, will ease pain and improve the sore (R). 
Chlorine, in solution as a wash for sloughing and indolent sores (R) ; the gas 
as a local stimulant to promote healing in old ulcers, is highly efficient ; [for the 
method of application see page 267]. Iodide of Starch, cold, as a poultice (R). 
Acetanilid, in fine powder, dusted on, is an excellent application to ulcers and 
sores, mucous patches and ulcers of the rectum [see page 79]. Lead, the solu- 
ble salts of lead as lotions to unhealthy over-secreting sores (R). Pyrogallic 
Acid, is an excellent application to venereal ulcers (Vidal). Nitric Acid, as 
escharotic, applied with a glass rod, Oil to protect the surrounding tissues, 



ULCERS AND SORES. 



865 



arrest by alkaline wash ; £j to Oj is a good acid lotion for washing (B) ; the 
lotion for indolent and painful ulcers (R). Hydrastis, internally and externally, 
employed with excellent results in rodent ulcer, and ulcers of legs, rectum, and 
uterus (R). Sanguinaria, locally, to repress fungous granulations of indolent 
ulcers, 1 part to 80 of glycerin (P). Carbolic Acid, and Salicylic, locally (B) ; 
the Glycerite of Carbolic Acid a good application to fetid sores (R) ; Carbolic 
Acid, pure, freely applied under chloroform anesthesia, as a powerful and 
penetrating caustic to destroy the diseased surface, in tropical sloughing 
phagedena (Mn). Balsams of Peru and Tolu, excellent (P). Camphor, dusted 
over indolent sores (R). Charcoal, locally to sloughing sores (R). Alcohol, 
locally to cover sores with thin protecting layer of coagulated albumin (R). 
Alum, dry or in solution, applied to relaxed and abundantly-secreting sores 
(R). Turpentine, internally for ulceration of bowels (P). Collodion, as pro- 
tective covering (P). Capsicum, a weak solution useful as a stimulant in 
scrofulous or fistulous sores (P). Savine, as acrid (not chemical) caustic (P). 
Potassa Fusa, or the milder Vienna paste, as escharotic ; to arrest its action use 
a dilute acid (B). Zinc Chloride, the most efficient escharotic consistent with 
safety (B). Zinc Sulphate, dried, dusted over sores (R). Iodoform, dusted 
over surface (B) ; prevents granulation in all ulcers, and does no good except 
to relieve pain (Gross). Aristol, is highly praised ; an excellent substitute for 
Iodoform, being quite as efficient, and odorless ; has given excellent results in 
treatment of indolent soft ulcers, syphilitic ulcerative processes, etc. Silver 
Nitrate, as caustic, quickly rubbed over surface (B) ; applied to unhealthy 
ulcers, also ulcers of the mouth (R). Copper Sulphate, to indolent ulcers : 
touch with a crystal, or frequently apply a solution, gr. ij-x to the ^ (R). Cop- 
tis, the infusion has high reputation (B). Chimaphila, Copaiba, Catechu, 
Myrrh, Rhatany, Rhubarb, Storax, Benzoin, Tar-water, locally, are useful (P). 
Oxygen, to atonic, painful ulcers (R) ; locally applied to ulcers [see page 410] 
is highly efficient (Stoker). Nuclein, locally applied, cured an ulcer of 20 years' 
standing in 4 months (Vaughn). Aurum, locally and internally, is highly 
recommended in scrofulous ulceration. Galvanic Couplet [see under Bed- 
sores]. Yeast, as a poultice (R) ; its action probably due to the Nuclein con- 
tained in it. Section of exposed nerve-filament, in irritable ulcer, by bistoury 
passed beneath the sore (Hilton). Cod-liver Oil, especially for ulcerations of 
the glands, or indolent ulcers with excoriated edges, lupus, etc. Water, is suf- 
ficient as dressing in the majority of cases. Hot Water, applied by the con- 
tinuous immersion therein of the affected limb, is perhaps the most efficient 
treatment of indolent ulcers of the leg or foot, resisting other applications; 
proved very successful in my Philippine experience for tropical ulcer and gan- 
grenous sores of the leg, fissures and sores of the feet, and similar affections. 
Rest and support of great value ; cleanliness, bandaging and recumbent posi- 
tion in ulcer of legs, facilitate recovery ; also daily washing to restore the lost 
vitality of parts; elastic stockings, and the Esmarch bandage in chronic cases. 
[Compare Chancre, Chancroid, Bedsores, Throat; Gastric, Intestinal 
and Uterine Ulceration ; Syphilis.] 



1 



B 



M 



Iodoformi, gij. 

Mucil. Acacise, ff\,xv. 

01. Menthse Pip., .... nyj. 

Glycerini, TT^xx. 

Sig. — For unhealthy ulcers. 

(Bronson.) 



R. Emplas. Plumbi, . . . . ;*ij. 
Ung. Hydrargyri, . . . . ^ss. 

Olei Cadini, 5jij. 

M. Sig. — Spread on linen, and apply to 
inflamed patches on palms from syphilis. 
(Bumstead and Taylor?) 

55 



I£ . Hydrarg. Chlor. Cor., . . gr. xv. 

Acidi Carbolici, ttlxx. 

Aquae, q. s. ad % iv. 

M. Sig. — For syphilitic ulcers, pack on 
cotton, and renew daily. (Fox.) 



R. Ung. Petrolei, . . . . J ij. 
Ung. Hydrargyri, . . . . ^iv. 

Olei Cadini, £ij. 

M. Sig. — Apply after removing scales 
to chronic palmar and plantar lesions. 

(Bumstead and Taylor.) 



I 



866 UREMIA URETHRAL STRICTURE. 



Uremia. 

Pilocarpine, as an active diaphoretic, on the first appearance ot uremic 
symptoms, as headache, drowsiness, convulsions ; also free purgation by salines 
or Elaterium (Y) ; a weak or fatty heart is a positive contraindication for this 
drug (B) ; it must not be used if edema of the lungs exists, as further edema 
and death will result (Whitla). Digitalis, the infusion internally, or a poultice 
of the leaves to the back and abdomen, to procure free action of the kidneys 
(B). Morphine, hypodermically, is most efficient (Loomis, Scanzoni) ; in acute 
not in chronic uremia (Pf ) ; is of remarkable value in uremic convulsions (B). 
Oxygen, by inhalation, 10 litres thrice daily, is used with success (Jaccoud) ; is 
as useful in practice as it is rational in theory (Carter) ; used with remarkable 
success in a very bad case of uremic coma (Macalister). Sodium Benzoate, 
15 grains 4 times daily, has been found very serviceable in threatening uremia 
(Whitla). Sodium Bromide with Chloral, in full doses, by the bowel, for 
uremic convulsions (Id). Potassium Salts given in Bright's Disease increase 
the danger of uremia, hence Sodium salts are preferred (Id). Naphtalin, also 
Iodoform and Charcoal, as intestinal disinfectants, as much of the toxic material 
in the blood has been reabsorbed from the bowel (Bouchard). Amyl Nitrite or 
Nitroglycerin, and brisk purgation, to relieve the dyspnea. Ether, in doses of 
gij by the mouth or 3ss hypodermically deep into the muscles (painful), for 
uremic dyspnea ; must be pushed to ^ij or iij in 24 hours before good results 
can be expected (Gallois) ; being rapidly eliminated it can be given in fairly 
large doses without causing intoxication. Colchicum, is an excellent deriva- 
tive in these cases and acts best when combined with other purgatives (B). 
Elaterium, gr. -^ to ^, to procure free watery evacuations — cautiously ! (B) ; 
the compound powder of Elaterin, gr. -| to iij, may be thrown on the tongue 
and washed down with a teaspoonful or two of water (Y). Saline or Hydra- 
gogue Cathartics, are of great importance to secure elimination by the intes- 
tinal canal and to relieve the blood-pressure (B) ; purgation by salines on the 
first appearance of uremic symptoms (Y). Transfusion, in uremic convulsions 
(B). Hot Saline Injections, into the cellular tissue [see under Shock for for- 
mula], gave excellent results in a case of chronic nephritis with uremia 
(Hare); used in 2 cases with good recoveries, the patients having been bled 
before administering the injections (Richardiere) ; is worthy of a wide trial and 
seems to offer a chance of recovery in many cases which otherwise would 
prove fatal. Hot Pack or vapor-bath, to induce powerful diaphoresis (B) ; the 
hot wet-pack or hot air bath, may be given daily or oftener when uremia is 
threatening. Milk is the only admissible food. Venesection, 10 to 20 ounces 
of blood from the arm gives striking relief in acute forms of uremia in the 
robust (Y) ; leeches to the temples for the headache (Id). [Compare Coma, 
Convulsions, Bright's Disease, Dyspnea, Scarlet Fever, and the Lists of 
Diaphoretics and Diuretics on pages 45 and 47.] 

Urethral Stricture. 

Aconite, is of great service in spasmodic stricture (P). Cocaine, locally by 
catheter (Smith). Buchu, in irritable urethra, spasmodic stricture, and gleet 
(P). Opium, in full dose or an opiate suppository, with fomentations and a 
warm bath, will often suffice in spasmodic stricture (CI). Catheterization, under 
an anesthetic in spasmodic stricture if other measures fail to relieve ; also for 
gradual dilatation in organic stricture, the safest and most generally applicable 
treatment (CI). Oil, injected before dilatation (Wa). Thorough Division, by a 
dilating urethrotome, the best operation for a radical cure ; 600 cases thus 
treated without a death or permanent disability (Otis). Electricity, a weak 
galvanic current, with negative pole to the stricture, will destroy it in 2 or 3 
sittings by electrolysis, and if carefully done, is the most efficient and least 
painful method of treatment for radical cure. 



URETHRITIS URINARY DISORDERS. 867 



Urethritis. 

Aconite, is used to advantage in urethral fever ; also for prevention of chill 
after passage of sound (Pf, W). Strophanthus, efficient in preventing rigors 
after instrumentation on the urethra, the tincture in doses of 5 minims (Fen- 
wick). Silver Nitrate, locally, very efficient in chronic urethritis in females 
(W). Tannin, on bougies, once a week for 15 minutes, most efficient for ure- 
thritis in the female (Wa). Zinc Sulphate, cast in sticks, for introduction into 
the urethra (Wa). Myrtol, internally, in chronic inflammation of the bladder 
and urethra (Br). Potassium Bicarbonate, with Potassium Acetate, aagr. x in a 
large cup of flaxseed tea or a glass of Vichy water, every 4 to 6 hours ; with 
absolute rest in bed, a calomel purge, and urination under hot water, sufficient 
for most cases of urethritis, which may arise from lithiasis, leucorrhea in fe- 
males, etc. ; many cases of so-called aborted gonorrhea were really simple 
urethritis (Otis). [Compare Gonorrhea.] 

Urinary Disorders. 

Aconite, of great service in sub-inflammatory retention from chill (P). Tur- 
pentine, in hematuria and chronic catarrh of the bladder, incontinence from 
atony, etc. (B). Strychnine, sometimes employed with marked benefit in reten- 
tion or incontinence of the old (P). Cantharis, frequent or involuntary mictu- 
rition, especially when coughing, in women from weakness of sphincter; one 
or two drop doses (R). Cannabis Indica, in retention from spinal diseases (R) ; 
Diuretin, a remarkably efficient diuretic in cardiac and renal dropsy, 15 grains 
several times daily will increase the urine three and fourfold. Digitalis, holds 
high rank as a diuretic, 3j or ij of the infusion night and morning, or oftener 
if necessary ; in sudden suppression from cold or damp, or after scarlatina if 
danger threatens (P). Benzoic Acid, or Sodium Benzoate, in 10 to 15-grain 
doses, to render alkaline urine acid, and check the formation of phosphates 
(B) ; this acid and its salts are among the very few agents by which morbid 
alkalinity of the urine can be neutralized. Salol, is quicker in this respect than 
the benzoates [see page 64]. Nitro-hydrochloric Acid, dilute, gtt. x-xv thrice 
daily in water, for phosphatic deposits (Mears). Ammonium Carbonate, in 6- 
grain doses, 3 or 4 times a day, to render acid urine alkaline. Triticum, a 
favorite remedy with Sir Henry Thompson, in pint doses daily of its infusion 
or decoction, ^ij-iv ad Oj, for strangury, cystitis, and many other complaints 
connected with the urinary apparatus. Alkalies, to neutralize acid urine, 
and control chronic cystitis ; the Liquor Potassas preferable to the bicarbon- 
ates, tartrates, and citrates, which all have diuretic action and increase the fre- 
quency of micturition ; Liquor Potassae mixed with the tinctures of Hyoscyamus 
or Belladonna, may undergo chemical changes, but the combination materially 
controls painful and frequent micturition in bladder troubles (Thompson). 
Buchu, renders more help than any drug known in incontinence or retention 
from catarrh of bladder implicating the ureters and even the kidneys (P). 
Water, copious injections are beneficial in some cases of suppression (R). 
Diet, a vegetable diet has a powerful influence to alkalinize an acid urine ; also 
fruit, milk and fish [see page 64]. Compare the Lists of Diuretics and other 
agents acting upon the urine, on pages 46 and 64 ; also the articles entitled 
Bladder irritable, Bladder paralysis of, Chyluria, Cystitis, Dia- 
betes insipidus, Dysuria, Dropsy, Enuresis, Hematuria, Lithiasis, 
Nephritis, Oxaluria, Uremia, Urethral Stricture. 



R. Acidi Benzoici, ^ij. 

Sodii Boratis, ziij. 

Aquse, . . 3 v j- 

M. Sig. — A teasp. in water, thrice 
daily, to keep urine acid. (Emmett.) 



R. Ext. Belladon. Fl., . . . gss-j. 

Ext. Buchu FL, %'). 

Spt. yEtheris Nitrosi, . . gij. 
M. Sig. — A teasp. 3 or 4 times daily, 
for dysuria in women. 



868 



URINE, CLINICAL EXAMINATION. 



R. Pulv. Scillse, 

Pulv. Digitalis, 
Hydrarg. Chlor. 
M. ft. pil. no. xij. 

diuretic twice daily. 



Mitis, aa gr. xij. 
Sig. — One pill as a 
{Sir A. Clark.) 



R 



M 



Potassii Citratis, . . . . ^j. 
Sodii Bicarbonat., . . . gv. 

Syr. Limonis, t ^j. 

Aquae, q. s. ad^iv. 

Sig. — A teasp. every 2 hours, 



to 



render the urine alkaline. 



[Roberts.) 



R. Tinct. Digitalis, 3 ss -j- 

Spt. yEtheris Nitrosi, . . ziij. 
Liq. Ammon. Acetat., . . Sss. 

Aquae, q. s. ad£x], 

M. Sig. — One-sixth every 3 hours, to 

re-establish the renal secretion. ( Goodeve. ) 



R. Potassii Bicarb., .... giijss. 

Acidi Acetici, g vj. 

Aquae, Ijiij. 

M. Sig. — Teasp. doses as required, as 
a diuretic. Each dose contains about gr. 
x of Potassium Acetate. 



Urine, Clinical Examination. 

Urine for Examination should be that passed in the morning, or a sample ot 
all passed during the 24 hours. 

Quantity. Normal quantity is about 50 fl. oz. in 24 hours, from which there 
may be considerable variation either way, according to the quantity of sweat, 
the fluidity of food used, etc. 

Specific Gravity. If possible, take the mixed urine. Normal sp. gr. is about 
1.018, 2. e., 18 grains of solids in each fl. oz. If sp. gr. is high, suspect sugar ; 
if low, suspect albumin. 

Color and Specific Gravity. Urine pale and copious, of sp. gr. 1.030 and 
above, indicates the presence of sugar. Pale and copious, sp. gr. below 1.018, 
is seen in hysteria, convulsions, nervous diseases. Color high, urine scanty, 
sp. gr. above normal, — in fevers and the uric acid diathesis. Color high, urine 
scanty, sp. gr. below normal, — in Bright's disease. Urine is colored very yel- 
low or greenish-yellow, by Bile and by Rhubarb : dark, with odor of violets, 
by Turpentine : dark, muddy, smoky, by blood and strong coffee : black, by 
disintegrated blood, putridity of the urine, Tar, Creosote : olive-green or smoky, 
by Carbolic Acid and Salol : brown, by Arbutin : green, by Indigo and Salicylic 
Acid : dark-green, by Karin and Thymol : dark-blue, by Methylene Blue : bluish- 
violet, by Resorcin : violet, by Juniper : greenish-yellow, reaction acid, by San- 
tonin : reddish-purple, reaction alkaline, by Santonin : blood-red, by Hema- 
toxylon : magenta, by Fuchsin : reddish-brown, by Sulphonal. 

Smell, — fragrant, indicates Cystine or Sugar : a fetid smell indicates alka- 
linity : the smell of violets indicates Turpentine. 

Reaction, — of 24 hours' urine in health is always acid, but it may be alkaline 
shortly after a meal. It is often alkaline from medicine or disease. If exces- 
sively acid, examine for crystals of uric acid. If alkaline, let the test-paper dry, 
so as to ascertain whether the alkali be fixed or volatile. 

Albumin by Heat and Nitric Acid. With Acetic Acid, or dilute Ammonia, 
make the urine slightly acid, if alkaline or neutral. If a precipitate appear on 
boiling, it may be Albumin or Phosphates. Add a drop or two of Nitric Acid ; 
if the precipitate dissolve, it is phosphates ; if not, it is albumin. If a deposit 
or turbidity disappears on heating, it consists of Urates ; if not, add a drop of 
Nitric Acid ; if now dissolved, we have Phosphates ; if not, Cystine. Other 
Tests are Potassio-Mercuric Iodide, Sodium Tungstate, Potassium Ferro-cy- 
anide, Acetic Acid, and Picric Acid ; but the above described one, if carefully 
done, will give as good results as any. 

Tests for Albtimin are interfered with by the presence in the urine of Alka- 
loids, Analgen, Antipyrin, Benzoic Acid (contained in Benzoin, Benzoates, 
Balsams of Peru and Tolu, Cranberries, Plums, Styrax), Benzosol, Chloroform, 
Copaiba, Hypnone, Oil of Santal, Piperazin. 



URINE, CLINICAL EXAMINATION. 869 

Bile Pigment and Bile Acids, if necessary. Vogel's color-table. Marechal's 
Test, as follows : Put 3] of urine in a test-tube, and permit one or two drops of 
Tinct. Iodi to trickle down along the side of the tube, held horizontally nearly, 
so that the two fluids may touch, but not mix. If bile pigment be present, a 
fine green color will at once be developed below the red Iodine layer. Noel's 
Test, Pettenkofer's Test, Nitric Acid Test, Oxide of Silver Test. 

Chlorides. Add a drop of Nitric Acid, and then Silver Nitrate until a pre- 
cipitate ceases to form. Thus estimate the amount of Chlorides. 

Sugar, if necessary. Urine containing sugar is usually light-colored, froths 
readily when poured from one vessel to another, and has a high specific gravity. 
Fehling 's Test, as follows : Add to the boiling urine a few drops of freshly- 
prepared Alkaline Cupric Tartrate Volumetric Solution (Fehling's Solution). 
If sugar be present, a yellow, orange or red precipitate of Cuprous Oxide will 
form, 10 cc. of the solution being reduced by gramme 0.05 of diabetic sugar 
(anhydrous glucose). For the preparation of Fehling's solution, see page 296. 
Much more convenient is Dr. Piffard's Cupro-Potassic Paste, or Dr. Pavy's 
Cupric Test Pellets (see Tyson on Urine, page 57), or Wyeth's Compressed 
Tablets for preparing Fehling's Solution ; a box of the latter costing only 50 
cents, and obtainable in any good drug-store. The writer has used these tab- 
lets for several years with great satisfaction. 

Pavys Solution is a modification of Fehling's ; is equally good for qualitative 
and volumetric testing, and is intended for those who prefer the apothecaries' 
weights and measures to the metric system. It is made in the same manner 
as Fehling's, 100 minims corresponding to l / 2 grain of diabetic sugar, and con- 
sists of Copper Sulphate, gr. 320 ; Potassium Tartrate (neutral), gr. 640 ; Caus- 
tic Potash, gr. 1280; and distilled Water, f% 20. Other Tests for sugar are 
Bbttcher's Bismuth Test, the Fermentation Test, Moore's, Trommer's, Haines', 
the Picric Acid and the Indigo-Carmine. They are all useful, but will not be 
detailed here, as one good method is all that the average practitioner wants. 

Tests for Sugar are interfered with by the presence in the urine of Acetani- 
lid, Antipyrin, Ammonium salts, Arbutin (contained in Epigea, Kalmia, Uva 
Ursi, etc.), Benzoates, Betol, Bromides, Camphor, some Carbohydrates (e. g. 
animal gum), Chloral, Chloroform, Copaiba, Creatinine, Cubeb, Glycerin, 
Glycosuric Acid, Iodides, Morphine, Phenacetin, Pyrocatechin, Rhubarb, 
Rumex, Salicylic Acid (contained in Salicylates, Oil of Wintergreen, Oil of 
Betula and Salol), Senna, Serum-globulin, Sulphonal, Turpentine, Urethan, 
Uric Acid and Urates. Of the foregoing, those which actually reduce the 
Fehling's solution are Acetanilid, Antipyrin, Chloral, Chloroform, Copaiba, 
Glycerin, Morphine, Rhubarb and Salicylic Acid. 

Temporary Glycosuria may be produced by poisoning with Alcohol, Amyl 
Nitrite, Carbonic Oxide, Chloral, Hydrocyanic Acid, Morphine, Sulphuric Acid. 

Acetone. Add to the urine a drop of an aqueous solution of Magenta 
decolorized by Sulphurous Acid. If Acetone is present a violet color is pro- 
duced, the intensity of which is proportional to the amount of acetone. In 
dilute solutions the coloration does not appear until after four or five minutes. 
If the amount of acetone be very minute the urine may be distilled, the first 
portion coming over being examined. In this way a very minute proportion 
of acetone may be detected (Chautard). 

Urea. Place a drop of urine on platinum-foil, add a drop of Nitric Acid, 
and leave undisturbed in a cool place for a minute or two. If the urea is in 
excess, crystals of Uric Nitrate form immediately. To ascertain the percentage 
of urea, use the Ureameter of Doremus, or that of Mayhew, manufactured 
by Mayer and Meltzer of London, or the Ureometer sold by Parke, Davis & 
Co. If the latter is used the Sodium Hypobromite solution should be em- 
ployed rather than the Chlorinated Soda solution, as the former gives the best 
results. These instruments are simple and accurate enough for clinical pur* 
poses. 'Bartley's Ureometer is probably the most accurate. 



< 



1 



870 



URTICARIA. 



Mucus and Pus resemble each other so closely under the microscope, that it 
is almost impossible for any one, except an expert, to distinguish between them 
thereby. Mucus is more cloudy and flocculent to the naked eye than Pus, 
which is generally of a stringy consistence and thickish yellow appearance at 
the bottom of the vessel. The supernatant liquid being poured off, and an 
equal bulk of Liquor Potassae added, the deposit, if containing much pus, be- 
comes gelatinized, and so tough that it cannot be poured out. If Mucus, Acetic 
Acid added coagulates it, forming delicate molecular fibres. 

Other Deposits are best examined with the microscope, and compared with 
good plates, rather than with printed descriptions. The plates in Hoffmann 
and Ultzmann on Analysis of the Urine, will answer the wants of most general 
practitioners, but the text follows the metric system. The urinary deposits 
may be classified thus : — 



In Alkaline Urine 
only. 


In Alkaline or Acid 
Urine. 


Organized Deposits. 


Calcium Phosphate 
Ammonium Urate 
Ammoniaco- 
magnesian, or 
Triple Phosphates. 


Uric Acid 

Urates 

Phosphates 

Oxalates 

Cystine. 


Mucus Torulae 
Pus Sarcinse 
Blood Vibriones 
Tube-casts Bacteria 
Spermatozoa, etc. 



Necessary Apparatus. A dozen Test-tubes. Alcohol lamp. A small porce- 
lain dish. 2 watch-glasses. A sheet of platinum foil, }( inch square. 3 pipettes 
of different sizes, to be used only for urine. A 2 oz. graduate. Urinometer 
(Squibb's). Ureameter (one of the 4 named on p. 869). Litmus-paper, blue 
and red. The reagents mentioned above. A little Grape-sugar, for use in 
testing the Fehling's solution. A Physician's Pocket Reagent Case, intended for 
urinalysis at the bedside, is put up by Parke, Davis & Co., and sold at the low 
price of $1.50. It contains a set of Dr. Oliver's Test Papers or Pellets (pre- 
ferably the latter), a color scale, specific gravity beads, two test-tubes, a pipette, 
and full directions for the use of the reagents. 

The foregoing directions comprise all that the average practitioner will usu- 
ally perform in the matter of urinary analysis. For fuller instructions the 
reader is referred to one of the numerous manuals on the subject, among 
which may be mentioned Da Costa on Medical Diagnosis, Chapter vii, — 
Tyson on the Practical Examination of Urine, — and Sir Henry Thompson's 
Clinical Lectures on Diseases of the Urinary Organs, Lecture xxiv. 



Urticaria. 

Antipyrin, internally, is promptly efficient in urticaria, also in the urticaria- 
like eruptions of children. Chloroform, as ointment to allay itching (R). 
Potassium Cyanide, or Hydrocyanic Acid (R). [See under Prurigo.] Nitric 
Acid, as dilute wash, controls itching and prevents wheals (R). Benzoin, the 
compound tincture painted on the skin for itching (R). Benzoic Acid, gr. viij 
in ^iv aquae, as a lotion (Squire). Sodium Phosphate, in doses of 60 to 80 
grains every 3 hours, is a valuable agent in this affection (Wolff). Zinc Car- 
bonate and Zinc Oxide, aa 3jss, Carbolic Acid ^ss, Lime-water ^ij, Rose-water 
to make ^iv, as a lotion applied freely and frequently for the itching (Id). 
Sodium Salicylate, gr. ij every l / z hour, is remarkably efficient (Smith) ; gr. xx 
thrice daily is effective. Copaiba, in full doses will produce urticaria, but drop- 
doses every )/ z hour will sometimes control it (Smith). Strychnine, with emetics 
and purgatives, when the affection is chronic (Guibout). Colchicum, in gouty 
persons (R). Lead, in lotions to ease itching (R). Alkalies (R). [See under 
Prurigo.] Warm Baths, may be employed with benefit. 



UTERINE CONGESTION AND HYPERTROPHY. 87 1 



Uterine Affections. 

Cimicifuga, to prevent miscarriage in irritable uterus and prolapsus (R) ; 
promises to be a valuable remedy in uterine affections (Wa) ; is remarkably 
efficient in neuralgia and sympathetic pains arising from an irritable uterus, no 
matter what their precise character (P). Belladonna, with Tannin, as supposi- 
tory in uterine neuralgia (R) ; as vaginal or rectal injections, in neuralgic or 
inflammatory pains (Tr). Arsenic, in irritable uterus, of decided benefit; gr. 
^q ter die, after meals (Wa). Carbonic Acid, injected up the vagina for neu- 
ralgia of the uterus (R). Opium, with Starch as injection into the rectum, will 
subdue the pain of uterine diseases (R) ; gives more speedy relief than any 
other remedy in irritable uterus, but long-continued is one of the worst (Wa). 
Iodized Phenol, has proved the most generally efficient agent for intra-uterine 
use during eight years' experience, applied by hard rubber probes wound with 
cotton-wool ; it removes cervical mucus, gives freedom from pain, softens and 
dilates the cervix, heals abrasions, removes induration and villosities, regulates 
the menses, improves appetite and digestion, acts as a general alterative, over- 
comes barrenness, etc., if used long enough, but rapid results are not attainable 
by any method of treatment (Battey). Lead, as plaster, for pain in the back 
due to uterine disease (R). Chloroform, spray, in uterine neuralgia (R). Aqua- 
puncture, has had extraordinary success in uterine colic (B). Baths of warm 
salt water remarkably useful in nervous or inflammatory hysteralgia (Tr). [See 
Abortion, Amenorrhea, Climacteric, Dysmenorrhea, Endometritis, 
Hemorrhage post-partum, Leucorrhea, Menorrhagia, Menstrual Dis- 
orders, Metritis, Metrorrhagia, Prolapsus uteri, etc.] 

Uterine Cancer. 

Conium, useful as a palliative, 3iij-i y ad Oj aquae, as injection for the ex- 
treme pain of uterine cancer (Wa). Arsenic, small doses for a long time, with 
a strong solution of Iodine and Glycerin locally (Atlee) ; is believed to retard 
the growth of uterine cancer (Br). Carbonic Acid, injected vaginally, to relieve 
the pain (R). Opium, stands first in the list of palliatives, quieting irritation, 
allaying pain (Wa). Morphine, the specific action thereof upon the uterine 
circulation should be utilized in hopeless cases of this disease (Lutaud). [See 
page 405.] Carbolic Acid, a weak solution as injection, an excellent cleanser, 
healer, disinfector and allayer of pain (R). Bromine, the best escharotic for 
destruction of the mass (E). Glycerite of Tannin, checks discharge and stench ; 
is still better if mixed with glycerite of Carbolic Acid (R). Iodoform, with 
cocoa-fat as bolus inserted into excavation produced by cancer.(R) ; gr. v-x in 
each bolus (W). Iodine, the saturated tincture thoroughly applied to the 
entire surface of the mass, is frequently of great use in checking hemorrhage, 
and seems to temporarily check the extension of the disease (E). Chloral, as 
anodyne, will agree with most persons (E) ; relieves the pains (W). Chloro- 
form Spray, for some minutes (R). Cannabis Indica, to allay the pain (W). 
Thyroid Extract, used internally with apparent curative results in three cases 
of carcinoma of the cervix (Bell). Surgical Measures, are to be advised, as 
medicines can only serve as palliatives. 

Uterine Congestion and Hypertrophy. 

Aurum Salts, often beneficial in chronic metritis with scanty menstruation 
(B). Ergotin, long continued, successful in chronic metritis ; lessens con- 
gestion (B) ; long continued has produced remarkable results in fibroids and 
polypi and chronic metritis, large, spongy, subinvoluted uterus (P) ; by inter- 
stitial injection into the cervix, has been of great benefit (G). Carbolic Acid, 
undiluted, on cotton-wrapped probe, no better treatment for uterine catarrh (B). 
Iodine, has proved the most valuable of all remedies as a local stimulant and 



i 



872 UTERINE DISPLACEMENTS TUMORS. 

a reliable alterative and excitant of uterine contraction ; use a saturated tinc- 
ture to any part not exposed to the air (E) ; maybe injected into cervix (G). 
Iodo-tannin, or Iodoformi 3j, Ac. Tannici §j, a serviceable application in many 
inflammatory and hypertrophic conditions; Iodoform suppositories in chronic 
metritis (P). Potassium Bromide, our main stand-by in uterine troubles ; 
aside from its soothing properties it seems to divert the blood from the womb, 
and to lessen uterine congestion (G) ; a specific cure for simple subinvolution, 
the benefit being derived from the potash (Tait). Digitalis, in subinvolution 
(B). Glycerin, on cotton tampon to cervix as a local hydragogue (Thomas). 
Glycozone, as an application in tumefied conditions of the cervix and uterus, 
is far superior to pure glycerin (Edson). Potassa, Caustic Potassa and Potassa 
cum Calce, are said to be effective in chronic metritis ; must be used cautiously 
(B). Chromic Acid, a strong solution to interior of uterus, a very useful appli- 
cation. Ipecacuanha, in subacute metritis of the puerperal state (Tr). Iron, 
locally in uterine catarrh (R) ; as a tonic, Iron and other restoratives, a cardinal 
rule in the treatment of all uterine disorders ; with Ergot, Quinine, Arsenic or 
Potassium Bromide, whenever the womb as a whole is congested or hyper- 
trophied ; Syr. Ferri Iodidi, with Cod-liver Oil, wins half the battle (G). Zinc 
Valerianate, in 2- to 4-grain doses thrice daily, is one of the best nervines in 
these cases (G). Mammary and Parotid Extracts, used with signal benefit as 
internal remedies in several cases of subinvolution and menorrhagia (Bell). 
Scarification, after dry cupping, in chronic metritis (Thomas). Electricity, in 
chronic congestive enlargement, a galvanic current of moderate intensity, slowly 
interrupted (B). Water, hot injections or douche, also cold alternately, one of the 
most effective measures, a gallon very hot ter die (R) ; especially valuable in con- 
gestion, which is generally venous ; elevated hips a necessary part of treatment 
(E) ; cold water is often better than hot (G). Rest, to the patient and the 
organ, is of prime importance, abdominal bandage, skirt-supporters, pessary 
if anteversion or retroversion, abstinence from sexual intercourse (Thomas). 

R. Ext. Humuli, %]. I R. Iodi, 



Elix. Ammon. Valerianate 
Syr. Lactucarii, ... aa ^ ss 
M. Sig. — A dessertsp. at bedtime, or 
during the day when needed, as an anti- 
spasmodic. (Goodell.) 



Potass. Bromidi, . . . aa gr. xx. 

Tinct. Iodi, gj. 

Aquae Destillat., . q. s. ad'&'w. 
M. Sig. — TT\,xxx to be injected into the 
cervix by 3 to 5 punctures. ( Goodell. ) 



Uterine Displacements. 

Anteversion, without prolapsus, is not a malposition (E). Ice, locally when 
parts inflamed (R). Hot-water injections, to give tone to the vessels, essential ; 
also valuable after reduction of malpositions (E). Mechanical Means, only 
reliable or safe in retroversion and prolapse ; the sound, as a means to restore 
a retroverted uterus to position, cannot be regarded as free from risk, even in 
skillful hands (E). Pessaries, harmful unless expertly fitted ; should be adjusted 
so as to restore the uterus to the normal line, where the circulation will be least 
obstructed, not too high ; should never be employed where cellulitis exists (E). 
Cotton Roll, as a substitute for the orthodox pessary, is far superior; use 
Borated Cotton in flat sheets, rolling it into a roll 2 inches long by 1 inch 
diameter, and saturating in Boroglyceridi ^j, Alumini Acetatis ^j, Glycerini 
Pur. q. s. ad Oj ; if an astringent is required, the Acetate may be replaced by 
Alumini Sulphas (Wylie). [Compare Prolapsus Uteri.] 



Uterine Tumors. 

Mercury, the Bichloride in small doses, long continued, of undoubted value 
in treatment of fibrous or polypoid growths ; gr. y 1 ^ every 6 hours, sometimes 
restrains the hemorrhage when other remedies fail (Wa). Calcium Chloride, 



UTERINE ULCERATION — UVULA VACCINATION. 8/3 

in 30-grain doses thrice daily, has by prolonged use cured uterine fibroids 
(Hewitt) ; calcines uterine arteries, also those of the body generally, and is 
dangerous (Tilt, Wells). Ergotin, hypodermically for fibrous tumor (R); 
gr. ij-vj on alternate days, give excellent results (B) ; nine cases of fibroid 
treated thus by Hildebrandt with good results (P) ; this method often causes 
great pain and severe local inflammation (W) ; one grain each of Ergotin 
and Ferri Sulphas Exsiccat., in pill thrice daily, persistently, for uterine 
fibroids, using for the hemorrhages a tampon saturated with tincture of Iodine 
or Monsel's solution (Parvin). Opium, has specific action upon the uterine 
circulation, and in bleeding from hopeless cases of cancer or fibroid tumors 
should be used freely, regardless of the opium habit (Editorial, N. Y. Medical 
Record, Dec. 10, 1887). Mammary Extract, used as an internal remedy with 
signal benefit in two cases of uterine fibroid (Bell). Ammonium Chloride, in 
fibrous tumors, gives more benefit than any other remedy, gr. x, twice or thrice 
daily, for weeks and months consecutively (Atlee). Ferrous Subsulphate, in- 
jected to restrain bleeding, cautiously ! (B). Saline Mineral Waters, especially 
those at St. Catherine's, Canada, are useful (B). Aliment, carefully regulated, 
chiefly animal food, with recumbent posture while flowing, and long-continued 
use of Ergot in small doses, may accomplish something (E). 

Uterine Ulceration. 

Hydrastis, quickly improves ; the fluid extract undiluted as a topical appli- 
cation in uterine and vaginal leucorrhea, ulcerations and erosion of cervix (B). 
Carbolic Acid, pure, over the surface twice a week in simple ulceration (R). 
Silver Nitrate, a serviceable application, but is often abused (B) ; the solid stick 
applied to surface, after cleansing and drying with cotton-wool (Wa). Alum, 
as hip-bath, ft) j ad Cj, and vaginal injection, is of great utility in ulcerations 
of the os uteri, or of the uterine cavity (Recamier). Glycerin 25, Alcohol 12^, 
and pure Creosote 1 part, an excellent application to ulcers of the neck. Gly- 
cozone, as an application to ulcerated cervix, is far superior to pure glycerin 
(Edson). [See under Leucorrhea, for manner of application.] Bismuth 
Subnitrate, with enough glycerin to make a thick cream, is the best of all appli- 
cations for ulceration of the os and cervix uteri (Suesserott). Vegetable 
Astringents, infusions or decoctions of Galls, Oak-bark, Hamamelis, Geran- 
ium, Alum-root, etc. ; the Glycerite of Tannin, or Iodoform and Tannin, 
packed around the cervix (B). 

Uvula. 

Tannin, Rhatany or Zinc, as astringent lozenges, for relaxed uvula (A). 
Cocaine combined with extract of Krameria, in a pastille, is often very effectual 
as a local astringent for elongated uvula (Hall) ; a 20 per cent, solution applied 
by the spray or brush, will often suffice to give relief in acute uvulitis (Id). 
Ammonium Bromide, gr. xx ad ^j aquae, as gargle, is one of the best applica- 
tions, being as soothing as it is astringent (Muirhead). Amputation of the 
elongated part (A) ; after applying a 20 per cent, solution of cocaine, by 
Mackenzie's uvulatome, or the uvula may be seized with forceps and a portion 
cut off with scissors (Hall) ; the hemorrhage may be severe and may recur 
some hours after the operation, but will be arrested by slowly sipping a mixture 
of Tannin £vj, Gallic Acid Z'\] and Water ^j (Mackenzie). 

Vaccination. 

Aconite, internally with Belladonna Ointment locally twice daily for erysipe- 
latous redness after vaccination (R). Zinc Oxide, dusted over, to allay the 
subsequentlocal irritation (Wa) ; with Pulv. Amyli, equal parts, over the surface. 
Lead Acetate, £j to Oj water, as lotion for irritable pock (Foster). Carbolic 
Acid, 3j to Oj water, as lotion for excessive redness, with burning and itching. 



1 



874 VAGINISMUS VARICOSIS. 



Vaginismus. 

Ether, by inhalation as anesthetic, to ascertain cause, usually a displace- 
ment, fissure, or cellulitis (E). Thiol j and Glycerol ij, in which soak a tampon 
and apply for vaginal irritation (Bloom). Iodoform, in suppository when red- 
ness and excoriation ; but Belladonna, the extract I part with 8 or 9 of fresh lard, 
when pain alone (Gallard). Tents, to gradually dilate the vagina, may be im- 
pregnated with various sedatives (Id). Hygiene, sun-baths, hot-water injections, 
fresh air, removal from husband, etc. (E). Operation, Sims', removal of hymen 
with scissors and insertion of glass plug till parts are healed, when the cicatrix 
is to be divided, etc. (E) : Atthill removed a narrow strip of mucous membrane 
on each side of the vaginal orifice with marked success in a very severe case. 
Cocaine, in ointment with Morphine and Conium, -smeared over the painful 
spot with the finger ; or in a pessary with Iodoform and extract of Belladonna, 
may give speedy relief (Whitla). 



Vaginitis. 

Silver Nitrate, in solution, gr. xl to the ^, applied within the cervical canal 
and over the vaginal mucous lining (E). Pinus Canadensis, the concentrated, 
colorless extract, locally, has a very soothing effect in acute vaginitis. Tannin, 
the glycerite in chronic vaginitis of children (R). Emollients, with Opium, as 
injections (Goodell). [Compare Gonorrhea, Leucorrhea.] 



Varicella. 

Ammonium Acetate, in diaphoretic and antifebrile mixture. [See under Fe- 
ver, Simple, for formula.] Inunction, with Camphorated Oil, or thin starch, 
to relieve itching and allay inflammation (P). Aconite, is of great value (B). 
Water, hot and cold baths and packs are of great utility ; cold, if hyperpyrexia ; 
cold compress if sore throat ; hot or warm pack when free diaphoresis required 
(B). Diet, no animal food, milk best, with careful attention to the bowels, 
patient to be kept cool with light covering, and use of a mattress rather than 
a feather bed, is all the treatment required (A). Saline Mixture, if high fever. 
Quinine, during convalescence. Complications are to be treated symptom - 
atically. 

Varicocele. 

Hamamelis, appears to have permanently cured one case (R). Ergot, gr. 
ij-vj of Ergotin hypodermically, the needle to be inserted among the affected 
veins, care being taken not to puncture a vein, is effective ; severe pain follows 
for a few hours (R). Water, cold douche to the perineum and buttocks, with 
suspension of testicles in cold water (R). Radical Cure, consists in obliterating 
the veins by wire ligatures, etc. (CI). 



Varicosis. 

Hamamelis, is employed with satisfaction in varicose veins and ulcers (Pf ). 
Digitalis, by fomentation, in acute inflammation from varicose ulcers (R). 
Ergotin, injected alongside of vein, but not within it, has cured (B). Bandage, 
or elastic stocking ; with cold sponging and rubbing upwards, as palliatives 
(CI). [Compare Hemorrhoids, Ulcers.] 



VARIOLA VERTIGO. 875 



Variola. 

Treatment, in no way differs from that of the other eruptive fevers. Stokes' 
three indications for treatment are accepted by other authorities and are: (1) 
exclusion of air, (2) keeping the parts in a permanently moist state so as to pre- 
vent hardening of the scabs, (3) lessening of local irritation (Whitla). Quinine, 
small doses in adynamic states, larger doses when hyperpyrexia (B). Iron and 
Quinine, in large doses by the mouth, also Ergotin by deep parenchymatous 
injection, and Turpentine by the bowel, in the hemorrhagic form of the disease 
(Whitla) ; these two drugs are the most valuable antiseptics in variola (Moore). 
Opium, low, muttering delirium ; not so much used now as formerly (B) ; Mor- 
phine in the insomnia of the advanced stage, once or twice only, but not when 
copious salivation or mucous expectoration (Wa). Vaccinia Antitoxin, has been 
used in a few cases with much success by Beclere [see page 184]. Cimicifuga, 
is given internally by some, who assert that it prevents pitting (R). Mercury, 
in ointment or plaster, to prevent pitting in semi-confluent, or barely confluent 
cases (Wa) ; formerly used (R). Camphor, is said to restore the eruption, if 
retrocedent; in confluent malignant smallpox, camphor alone, or with Opium, 
may be used for great depression of the vital powers (Wa). Belladonna, suc- 
cessfully used both as prophylactic and curative agent (Erasmus Wilson) ; 
gr. %-] every 3, 4, or 6 hours, to dilatation of pupil and some stupor, found 
effectual (Wa). Carbolic Acid, is used with decided advantage (Wa) ; [see 
under Measles] ; has been much used on theoretical grounds, but not with 
success (B). Ammonium Carbonate, has had cheering success (Wa) ; [see 
under Scarlet Fever]. Chloral, temperature high, much delirium and rest- 
lessness (B). 

External Applications, as powdered starch, flour, or Zinc Carbonate, 3 parts 
to 1 of Zinc Oxide with Olive Oil ; cold or tepid water with vinegar, sponged 
over body twice or thrice daily (Wa). Diet, tea and dry toast, raw eggs beaten 
in cold milk, beef-tea, grapes, roasted apples, ripe fruits in season ; cold water 
may be drank freely. Fats, bacon fat smeared over the face, to allay itching 
and prevent pitting. Silver Nitrate, on a sharp-pointed stick, inserted into 
each vesicle after rupture, to prevent pitting (B); or simply paint skin with a 
solution of gr. xx to the ^ (R). Iodine, the tincture to prevent pitting, is painted 
ten times over face if on first day of eruption, 12 if on the second day, 12-16 
times if on third day (B). Collodion, or solutions of India-rubber or Gutta- 
percha in Chloroform, to prevent pitting ; or cotton-wool dipped into Lime lini- 
ment, applied to face or neck (R). Carron Oil [see page 235], makes a good 
dressing for the face. Salicylic Acid, £j m a quart of hot water, applied by 
sponging to the skin and by gargle to the throat every 4 hours, also used internally 
if much diarrhea, is my treatment and I have not lost a case of variola since 
adopting it (Pope). Eucalyptus, the Oil as inunction from the very commence- 
ment of the disease, is to be strongly recommended as an antiseptic application 
to the skin (Whitla). Water, as cold baths and cold pack, of great utility (B) ; 
packing especially on retrocession of rash (R). [Compare Vaccination.] 



Vertigo. 

Digitalis, in small doses, alternately with tincture of Larch, and a long 
course of Iron Citrate and Strychnine, in essential vertigo, without any other 
head symptoms, and with general depraved nutrition, the most effectual treat- 
ment (Wa). Potassium Bromide, often controls paroxysmal vertigo, without 
coexistent spasm, or organic brain-disease (Wa). Ammonium Bromide, in 
an effervescing form with Cascarilla, for vertigo from overwork, when there 
are usually restlessness, insomnia, depression of spirits, with a sense of impend- 
ing evil (Wa). Alkalies and Bitter Tonics, give the best results in vertigo 



1 



876 VOMITING. 

of gastric origin. Sodium Bicarbonate, after meals, tonics before meals. 
Strychnine, with Iron, thrice daily, gives good results. Corrosive Sublimate, 
in small doses, with attention to the bowels and diet. Cod-liver Oil, for giddiness 
of the aged, when no serious brain-disease (R). Aurum, in vertigo and ver- 
tiginous sensations connected with gastric disorders or due to cerebral anemia, 
which are often removed by a course of the salts of gold (B). Quinine, in 
aural vertigo, Meniere's disease, 10 to 15 grains daily, continued with intervals 
for several weeks (Charcot). Electricity, the constant current daily, anode 
over cervical vertebrae, cathode over the ear, the current strength being gradu- 
ally increased to toleration and continued from 3 to 5 minutes at a sitting, is 
of great benefit in aural vertigo, ameliorating the condition in most cases. 
Nitro-glycerin, gives good results in epileptic vertigo (Br). Vertigo, is usually 
symptomatic of disorder of the stomach, or of the liver (cholemia), sometimes 
of general debility, rarely of disease of the brain (H). 



Vomiting. 

Arsenic, in many forms of gastric vomiting, especially that of alcoholism 
and chronic ulcer (B), and in the vomiting of cholera (R) ; gtt. ss of Fowler's 
solution, every y 2 hour for 6 or 8 doses, often relieves vomiting after a debauch, 
the morning vomiting of drunkards, and that of pregnancy (Smith). Nux 
Vomica, stands next to Arsenic, is useful in many ways (B) ; may be given 
with Ipecac, especially when tongue coated (R). Ipecacuanha, in small doses, 
will arrest certain kinds — a curious fact ; especially useful in certain forms, 
rry of Vinum Ipecac, every y 2 hour or more (B, R, P) ; in sick stomach of 
nervous origin, minute doses are of undoubted value (W). Cocaine, in doses 
of gr. }£ thrice daily, controlled the vomiting of gastric carcinoma, after all 
other means failed (Meigs) ; 10-minim doses of a 4 per cent, solution every 
hour, of inestimable value in the vomiting of yellow fever (Jennings) ; in 2 
per cent, solution sprayed high up the nasal passages [see under Nausea]. 
Potassium Nitrate, one of the surest remedies against vomiting and nausea, 
gr. % in ^ss of cold water every 4 or 5 minutes until relieved, in all cases 
except reflex ones and those due to irritant poisons (Moore). Mercury, gr. y 2 
of Gray Powder every two hours, especially in children with clayey stools (R) ; 
Calomel, gr. j to Oj aquae, first dissolved in ^j of Lime-water, a teasp. every 
ten minutes for the regurgitation of food in nursing children (Smith). Opium, 
will arrest many kinds, best in that of biliary or renal calculi, dysmenorrhea, 
sea-sickness, pregnancy ; Morphine, hypoder. gr. -^ to ^ (P). Codeine, in 
doses of gr. %, usually answers exceedingly well in vomiting from almost 
any cause (Braithwaite). Bryonia, for bilious vomiting and headache (P). 
Veratrum Album, in vomiting and purging of summer diarrhea (R). Hydrocy- 
anic Acid, often very serviceable in nervous vomiting, acts promptly if at all 
(R). Hydrobromic Acid, 3ss in ^j of water, four times daily, useful for the 
vomiting due to gastric ulcer. Chloroform, nvj-v, on sugar, for noninflam- 
matory vomiting (R) ; [see under Yellow Fever for formula]. Bromides, 
in cerebral vomiting only ; not in the gastric form (B) ; Potassium Bromide in 
that of uterine disease (W) ; Strontium Bromide is excellent in vomiting due 
to various causes ; gr. x-xv twice daily with meals. Phenocoll, with Piperazin, 
gr. xv of each daily in a pint or more of carbonated water, was of great service 
in a case of uncontrollable vomiting which had resisted every known remedy. 
Menthol, has successfully checked persistent vomiting after all the usual 
remedies had failed in the hands of many well-known observers ; rt\,x of a 20 
per cent, solution in Olive Oil, dropped on powdered sugar, each dose being 
about 1 grain (Weil). Sulphurous Acid, fflv-gj, well diluted, or less effec- 
tively Sodium Sulphite ; Sulphites often curative in vomiting of sarcinae and 
acid matter, due to acid fermentation of starchy elements (B). Cocculus 
Indicus, efficient in cephalic vomiting (P). Iris, in vomiting with blinding 
right supraorbital pain, liver deranged (P). Bismuth, in many forms of vomit- 



VOMITING OF PREGNANCY. 



877 



ing in children, especially when from gastric catarrh (R). Carbolic Acid, 
with or without Bismuth (B) ; in nervous vomiting (W). Creosote, in the 
vomiting of cancer, gastric ulcer, etc. (R) ; gtt. j-ij (W). Cinnamon or Cloves, 
will check vomiting (P). Calumba, in vomiting from kidney disease and renal 
calculi ; frequently allays that of pregnancy and dentition (P). Serpentaria, 
for bilious vomiting (P). Cerium Oxalate, in that of pregnancy and from 
cancer (B) ; gr. j every three hours (R). Ammonium Carbonate, may relieve 
vomiting when the ejected matter is acid (B). Peptenzyme, is highly efficient. 
Pepsin, for vomiting of food after meals, gr. x-xv before or during meals. 
Lime-water, is a favorite remedy for vomiting, especially in children : Milk 
and Lime-water often relieve when other methods fail (B). Sodium Bicar- 
bonate, 3ss-j to a pint of milk, for infants, especially if constipated (R) ; the 
effervescing soda powders in the vomiting of acute diseases and the exanthe- 
mata (B); the severe vomiting of acute disease is often controlled by 3 doses 
in plenty of hot water. Kumyss, proves effective when no other food will be 
retained. Carbonated Water, is an efficient remedy. Ice, sucked, with hori- 
zontal posture, also absolute rest and quiet (Wa) ; iced champagne, ^ss every % 
hour (B). Alcohol, iced brandy or champagne in spoonful doses every Yz hour 
in vomiting of cholera, pregnancy, and delirium tremens (B). Counter- 
Irritation, at epigastrium (R). Nutrient Enemata, [see under Enemata]. 
[Compare the list of Anti-emetics, on page 49, also the articles entitled 
Cholera, Hematemesis, Nausea, Sea-sickness, Vomiting of Pregnancy.] 



R. Ac. Hydrocyan. Dil., . . gj. 
Aquse Laurocerasi, . . . ^ij. 
M. Sig. — A teasp. every 2 hours, for 
nervous vomiting. 



R. Ac. Hydrobromici Diluti, ^ij. 

Sig. — Half a teasp. in a wineglassful 
of water, 4 times daily. 



Vomiting of Pregnancy. 

Ipecacuanha or Nux Vomica, either will generally succeed where the other 
fails (R) ; no other remedy of equal value to Ipecac (P) ; [see under Vomiting] . 
Nux Vomica, is useful but often fails, gtt. ss-j every hour or two in water (R); in 
very minute doses (S) ; gtt.ij-iij of the tincture every two or three hours, or 
gtt. x before each meal, with very hot water as a drink, is the best treatment 
(Parvin). Arsenic, Fowler's solution, gtt. j before each meal, will often relieve, 
when vomiting of food, retching and straining, with blood and pain (B). Creo- 
sote, checks the vomiting (R). Carbolic Acid, drop-doses of crystals, liquefied 
by heat, in mucilage ter die (Wa). Staphisagria, has subdued when other 
remedies failed (P). Cerium Oxalate, gr. j every three hours (R) ; ordinary 
doses far too small, give as high as 10 grains (B). Morphine, hypodermically, 
in severe vomiting (R). Pepsin, has been used with success. Ingluvin, seems 
almost specific (B). Potassium Bromide, is often efficacious (W) ; 3ss doses 
thrice daily, exceedingly effective in the combined diarrhea and vomiting of 
pregnancy; the first dose should be given an hour before rising. Strontium 
Bromide, proved entirely successful in severe cases ; gr. xv in water with 
meals, twice daily, for a month. Hydrocyanic Acid, often the best remedy (P) ; 
[see under Vomiting]. Copper Sulphate, sometimes effective, not more than 
gr. -^ ter die (B). Iodine, tt\,v of the tincture in ^ss of sweetened water 
repeated in l / z hour, of magical effect in a bad case which had resisted every 
other treatment ; is often useful (B). Menthol, has proven very successful 
in obstinate cases [formula on next page]. Cocaine, locally to cervix, 
cured a most intractable case of several months' duration, though it failed 
when used internally (Boys) ; has given excellent results when used internally 
in triturates of t x q grain each [or see formula on next page] : a 2 per cent, solu- 
tion sprayed high up the nasal passages [see under Nausea]. Calumba, as 
tincture often useful, drop-doses every hour or two (B). Bismuth, and Car- 
bolic Acid are effective (B). Atropine, frequently effective (R) ; never failed 



878 



VULVA AND VULVITIS WARTS. 



to give relief in many years of using it (Boys). Ether, sprayed over the epi- 
gastric region and the corresponding part of the spinal column, for 3 to 5 
minutes every 3 hours, gives immediate relief (Lubelsky). Pop-corn, is a god- 
send to this complaint, having acted marvelously in several cases in which I 
have used it (Sweringen). Peptenzyme, is said to be very efficient. Aconite, 
in full doses, is often very successful (W). Dilatation, of the cervical canal, 
by the index finger, is regarded as extremely efficient, and reasonably safe ; it 
may bring on abortion, if too extensive, but from records of several cases 
since 1875, li ma Y De said that it is a safe and sure remedy (Copman). Ice- 
bag to spine, an efficient measure (R). Vesication, a single blister over the 4th 
and 5th dorsal vertebrae, never failed for many years to put an end at once to 
the sickness of pregnancy for the whole remaining period of gestation (Harkin). 



R . Atropinae Sulphatis, . . . gr. j. 

Morphinae Sulphatis, . . . gr. iv. 

Acidi Sulphurici Aromat., ^iij. 

Aquae, 5 v. 

M. Sig. — Ten to twenty drops, thrice 
daily. (Boys. ) 



. Bismuthi Subnitrat. , 

Cerii Oxalatis, . . 

Morphinae Sulphatis, 

Syrupi, et Acaciae, q. 

M. ft. emulsum. Sig.— 

>ur until vomiting ceases. 


. . . gr. clx. 
. . . gr. xl. 
. . gr.jss. 
s. ad %i). 
-A teasp. every 
(Van Vahah.) 



R . Mentholi, gr. xx. 

Alcoholis, 3 vjss. 

Syr. Simplicis, . q. s. ad # ^ij. 
M. Sig. — ^j every hour. (Potter.) 



&. Cerii Oxalatis, gr. xij. 

Ipecacuanhas, gr. xv. 

Creosoti, gr. xxiv. 

M. Ft. pil. no. xij. Sig. — One pill every 
hour. (Goodell.) 



R. Cerii Oxalatis, gr. xxiv. 

Ext. Hyoscyami, . . . . gr. xxxvj. 

M. Ft. pil. no. xij. Sig. — One pill twice 

daily. ( Goodell. ) 



R. Cocainae Hydrochlor., . . gr. xv. 

Acidi Carbolici, ix\x. 

Aq. Cinnamomi, . . . . ?ss. 

Syr. Zingib., . . q. s. ad £). 
M. Sig. — 10 drops gradually increased 
to 20, in a little water every hour until re- 
lieved, then every 2 or 3 hours. (Potter.) 



Vulva and Vulvitis. 

Sodium Hyposulphite, an unfailing remedy in lotion for aphthae of the vulva 
(R). Arsenic, much used for eczema (T). Lead Acetate, a concentrated solu- 
tion in glycerin locally for eczema of vulva (T). Alum, as lotion in vulvitis of 
children ; gr. lx to Oj aquae, or less strong if found to increase discharge (R). 
Lead, solutions of the Acetate as wash, after the acute stage has subsided. 
Lime-water, as wash (R). [Compare Pruritus, Prurigo, Vaginitis.] 



Warts. 

Chrysarobin, a ia per cent, solution in ether or liquor gutta-perchae, after 
having pared the wart down with fine glass-paper; is a specific application 
(Fitz). Thuja, is highly effective for the cure of warts having a narrow base 
and a pendulous body; the strong tincture applied locally thrice daily, also tt\,v 
in a wineglassful of water internally night and morning (P). Iron, the tincture 
of the Chloride and dilute HC1 Acid, equal parts applied night and morning, 
very effective (Bulkley). Nitric Acid, 3j-ij of the dilute acid to a pint of water, 
as wash to keep small syphilitic warts constantly moist (R). Sabina, as caustic 
(P) ; 1 part to 2 of Alum (Wa). Rue, the Oil, with honey, locally (P). Arsenous 
Acid, as a caustic; enough to be used to excite active inflammation ; or Liq. 
Arsenicalis painted over warts (R) ; may be taken internally (B). Mercurial 
Ointment, containing 5 per cent, of Arsenic, or a plaster having in each 8 
square inches 154 grains of Arsenic and yy grains of Mercury (Unna). Tannin, 
and Burnt Alum, equal parts, powdered over warts twice daily, gives good 
results. Chromic Acid, gr. c to 25J aquae, with a glass rod, to saturate diseased 



WEN WORMS. 879 

growth ; remove any superfluous acid, dress with dry lint (R, Wa). Mercuric 
Nitrate, locally (R). Silver Nitrate, as caustic, but is usually too superficial (R). 
Dermal Curette, is much used in Vienna to remove warts by enucleation. 
Strangulation by tying a string tightly around the base, will cause them to 
drop off in a few days. Heat, is a most thorough measure for their radical 
removal ; it may be best applied by touching the wart 3 or 4 times daily with 
the hot end of a cigar ; the first few applications only give pain. Caustic 
Alkalies, locally (R) ; a saturated solution of Potassa Fusa, carefully applied 
by a brush or sponge fastened to the end of a stick, is to be preferred (Wilson). 
[Compare Condylomata.] 

Wen. 

Extirpation, the least troublesome and most speedily effective method. Run 
a scalpel through it, seize the cut edge of the cyst, and gently tear it out with a 
touch or two from the knife. Dressing of lint and Carbolic Oil to cause suppu- 
ration and contraction (D). 

Worms. 

Santonin, the best anthelmintic, a laxative in the morning, fast all day, a dose 
of Santonin, gr. ss-v, and Calomel, or Troches of Santonin, j-x, at bedtime, 
a Senna draught next morning, for ascarides (P) ; for round and thread-worms, 
give in Castor Oil by mouth, or as injection (R). Iron, the syrup of the Iodide 
internally and a solution of the tincture locally, for ascarides (B) ; the Tinct. 
Ferri Chlor. gss ad Oj aquae, a good injection for thread-worms, coagulating 
their albumin (R). Quassia, the infusion an effectual injection, conjoined 
with simple bitters internally, for ascarides (R). Lime-water, as injection for 
thread-worms (R) ; ^iij-iv repeated, for ascarides (Wa). Sodium Chloride, in 
3ss doses on empty stomach, expels ascarides and prevents reproduction (Wa). 
Quinine, as a tonic, also cold sponging, out-door exercise and judicious diet ; 
useful probably by preventing the production of the abundant mucus which 
favors the growth of worms (R) ; especially useful for ascarides, also as injec- 
tion for thread-worms and teniae (Wa). Ignatia, for convulsive symptoms (P). 
Eucalyptus, as injection, for ascarides (B). Aloes, are efficacious for ascarides 
(P). Scammony, for thread-worms in rectum (R) ; with Calomel, effective 
(Wa). Tannin, as Catechu, Kino, Red-gum, Rhatany, Hematoxylon in injec- 
tions, to destroy thread-worms (R). Alum, as solution for injection (R). Am- 
monium Chloride, to prevent formation of thick mucus which serves as nidus 
for worms (R). Valerian, especially when convulsions (R). Myrtol, is efficient 
against ascarides and round worms (B). Thymol, is almost specific against 
the ankylostomum duodenale, given in doses of gr. x-xxx, well triturated and 
in capsules, repeated 3 or 4 times ; but no alcoholic drink afterwards lest the 
drug be absorbed and poisoning ensue (Mn). Filix Mas, to be taken on an 
empty stomach for tape-worm, and followed by a purge (P). Pepo, ^ij as 
emulsion, taken fasting, one of the most efficient remedies against teniae (B). 
Pelletierine, the alkaloid of Granatum, is by far the best vermifuge for a tape- 
worm, repeated after a week for a second worm, as many as 3 having been 
found in one patient (Da C) ; gr. xv-xx of the Tannate, followed in a few 
hours by Castor Oil (R). Chloroform, a very efficient teniafuge, Z] m Ej of 
mucilage, after 20 hours' fast, followed one hour later by %') of Castor Oil, this 
is an adult dose, Z] should never be exceeded . (Wilde). Kamala (Rottlera), 
excellent for teniae, requires no purge (P) ; gr. cl-clxxx for an adult (Wa). 
Cusso, the fluid extract in dose of 3ij to ^j, or the same quantity of the flowers 
infused in ^iv of boiling water, for both varieties of the tape-worm [see page 
299J. Naphtalin, an excellent all-round anthelmintic, of high value for as- 
carides and teniae, thoroughly reliable for all kinds of intestinal worms, giving 
prompt and complete results invariably, with entire absence of all unpleasant 
symptoms ; a single dose of gr. xv removed tape-worms entire (Mirowicz) ; 



< 



1 



88o 



WOUNDS. 



for adults a dose of Castor Oil should follow, but for children it is preferable 
to give both together (see page 387). Potassium Iodide, gr. xxxvj, Iodine, gr. 
xij, Water £j, ten drops thrice daily in water, caused the expulsion of a tape- 
worm 11 yards long, of which there were no previous symptoms, and proved 
successful in other cases (Newington). Ailanthus, a decoction of the fresh 
bark, for teniae (B). Turpentine, as poison for tape- and thread-worms (R) ; for 
teniae (Wa). Tonics, as Iron, Cod-liver Oil, etc., to restore the intestinal canal 
to a healthy condition (R). [Compare Chyluria, also the List of Anthel- 
mintics on page 36. J 



R • Chloroformi, 

Ext. Filicis Maris, . . aa^j. 
EmulsiOl. Ricini (50 per 

cent.), giij. 

M. Sig. — One dose after 24 hours' fast- 
ing. Acts just as well if the Male Fern be 



omitted. 



R. 



{Smith.) 



Ext. Spigeliae Fl., . . . j|j. 
Ext. Sennse FL, . . . . gss. 
M. Sig. — A teasp. to a child of 3 to 5 
years. {Smith.) 

R. Ext. Spigeliae et Sennae Fl.,^j. 

Santonini, gr. viij. 

M. Sig. — A teasp. to a child of 5 years. 

{Smith.) 



R. Granati Corticis, . . ^ij. 

Ft. infusum. Sig. — To be taken before 
11 A. M. , and followed after 2 hours by — 

R. 01. Ricini, Jiij. 

01. Terebinth., .... gj. 
Ext. Filicis Maris ^Ether. , gj. 
M. ft. haustus. 



Fasting unnecessary. 



( Wilde.) 



R 



Magnesii Sulphat., . . . ^ ij. 
Sodii Chlondi, . . . . ^ss. 
M. Sig. — An ounce in half a glass of 
water, with gtt. v of Carbolic Acid, night 
and morning, for ascarides. Persevere. 

{Barkley.) 



Wounds. 

Arnica, is very useful for external bruises and cuts, also for internal injuries ; 
unites surfaces very rapidly after amputations ; the infusion or decoction best 
(P) ; very effectual (Wa). -Aconite, valuable in surgical fever (P). Bismuth 
Subiodide, dusted into a wound one of the most efficient antiseptics, non-irri- 
tant, and a prompt stimulant of granulation ; an excellent dressing for wounds 
after approximation of the edges, the powder to be dusted thickly over the 
edges, and thoroughly covered with flexible collodion. Dermatol (Bismuth 
Subgallate), is an excellent non-irritant vulnerary, having great stability and 
valuable drying and bactericidal qualities. Europhen, is an ideal application 
to sores and wounds, also for the many protective requirements of minor 
surgery ; is used as a dusting powder, or as a 5 to 10 per cent, ointment, with 
Lanolin as a base. Aristol, is very efficient, or a mixture of Aristol and 
Europhen, equal parts of each ; Aristol is an excellent substitute for Iodoform, 
and odorless. Acetanilid, in fine powder dusted over the surface of wounds 
and other breaches of tissue [see page 79]. Alumnol, a powerful astringent, 
desiccant and antiseptic, reaches the deep recesses of wounds [see page 144]. 
Iodoform, powdered and dusted over sloughing wounds, irritable and ill- 
conditioned ulcers and sores (B) ; Iodoform 1, Collodion 9 parts, painted on a 
superficial wound while edges are held together (Gross) ; may be painted over 
edges when stitched together ; gives excellent results. Mercury, the Bichloride, 
gr. vijss to quart j of hot water, stirred with a stick, makes a solution of 1 to 
2000 ; the best of all antiseptics for washing a wound or cavity, and for 
saturating the dressings. Carbolic Acid solutions [see page 84] check suppu- 
ration and correct fetor (B) ; its employment as an antiseptic has become 
much restricted and most surgeons have abandoned it. Boric Acid, in lotion 
or ointment successfully used as dressings for wounds, a solution of 1 in 133 
arresting the activity of bacteria; is applicable for the same purposes as car- 
bolic acid (B). Boro-glyceride, in aqueous solution, 1 to 40, as a lotion for 
wounds. Sulphurous Acid, in solution, diluted or not, constantly applied (R) ; 
in solution or by fumigation, is regarded by some as superior in efficacy to car- 



YELLOW FEVER. 



881 



bolic acid, and less irritant (Wa). Salicylic Acid, Thiersch prefers it to car- 
bolic ; may be applied pure in powder to gangrenous and sloughing wounds 
(B). Formalin, is now the favorite surgical antiseptic [see page 324] ; but 
cannot replace the Bichloride of Mercury. Aloes, pulverized fine, is an 
efficient dressing for wounds, closing them and favoring cicatrization, also 
relieving the pain at once, requires removal only at long intervals (Millet). 
Nitric Acid, as escharotic for gangrene (B). Turpentine, one of the most 
efficient applications in hospital gangrene (B). Balsam of Peru, excellent for 
closing recent wounds (P). Benzoin, the basis of all the healing balsams (P). 
Aloes, topically as a slight stimulant; often purges (R). Gum Tragacanth, a 
thick aqueous solution to granulating surfaces, to protect them from the air 
(Wa). Opium, internally to quiet intestinal movements in wounds of the 
abdomen (R) ; forwards the reparative processes (P). Tannin, or Glycerite of 
Tannin, to coat over wounds (R). Collodion or Liquor Gutta-perchae, to secure 
primary union of incised wounds (B) ; as protective covering (P). Ammonium 
Carbonate, gr. v hypodermically in the vicinity of wounds caused by poisoned 
arrows, repeatedly used with success in saving life by Dr. Parke, the surgeon of 
Stanley's last expedition in Africa. Galvanic Couplet, to wounds of indolent 
form (B). Alcohol, an excellent antiseptic dressing when suppuration ; favors 
cicatrization of open wounds (B). Poultices, are often abused ; of Yeast or 
Charcoal best for foul wounds (B). Water, in universal use as dressing ; cold 
water often abused, hot-water dressing as advocated by Hamilton, promises 
better results (B). Turkish Baths, for pain in the seat of old wounds (R). 
Ice and Salt, applied to wounds prevent inflammation (R). [Compare Bed- 
sores, Gangrene, Hemorrhage, Inflammation, Septicemia, Surgical 
Fever, Ulcers.] 



R . Acidi Tannici, . . . . ; 
Alcoholis Absolut., . . 2 

yEtheris, . : 

Collodii, . . . . . 1 

M. Sig. — Styptic Collodion. 



R. Collodii, gj. 

Olei Ricini, 

Acidi Carbolici, . . . aa t ^ss. 
M. Sig. — Carbolized Collodion, for use 
on wounds. 



Yellow Fever. 

Treatment must all be done at the beginning, no time to be lost ; cold 
sponging early and frequently repeated, Calomel, Quinine and Salines at the 
start, Potassium Acetate for the kidneys, Morphine for gastric irritation, the 
feet to be in mustard water (Da C). Diaphoretics and Diuretics, also Laxa- 
tives, are very important throughout the disease (Da C). Pilocarpine, in dose 
of gr. % hypodermically, in the first stage, carried to the induction of emesis and 
catharsis, as well as that of diaphoresis, the most efficient treatment known, 
absolutely jugulating the paroxysm (Habersmith). Mercury, a Calomel purga- 
tive, gr. ss, 2 or 3 times on the first day, followed by a warm-water enema, is 
good treatment (B) ; has many advocates, and many opponents (Wa) ; should 
generally be abstained from (S). Duboisine, gr. ^ f subcutaneously, the most 
efficient hypnotic and calmative (B). Turpentine, when cardiac weakness, 
depression of vaso-motor system, dissolved state of the blood, rr\,x-3ss ; small 
doses, with Tinctura Ferri Chloridi, in the hemorrhagic form (B). Quinine, has 
some strong evidence in its favor as an abortive agent, one large dose, gr. 
xxx-xl, with Opium at outset (Wa) ; is not a specific ; may hasten recovery in 
mild cases (S); gr. xx per rectum, to reduce temperature (B). Lime-water, 
with milk, has been found efficient for the vomiting (Wa). Capsicum, to obvi- 
ate the black vomit, is highly spoken of (Wa). Cocaine, for the vomiting, 
nothing equals it in efficiency, it also acting as a diuretic, 10-minim doses of a 
4 per cent, solution, by mouth, every hour for 2 or 3 doses, acts like a charm 
(Jennings). Chloroform, for the vomiting, a few drops to prepare the stomach 
for reception and retention of food ; its effects transitory, has to be repeated 

56 



882 



YELLOW FEVER. 



before each meal (Wa) ; the Ammoniated Chloroform in zymotic pyrexia, its 
action is sedative, analgesic and antipyretic (Richardson). Carbolic Acid, by 
stomach and hypodermically, remarkably efficacious, even after the ominous 
"coffee-grounds" vomit (Lecaille). Chlorodyne, is excellent for restlessness, 
insomnia, irritability of stomach (A). Veratrum Viride, gtt. j-x hourly, accord- 
ing to age, till pulse and temperature are subdued; successfully used in con- 
nection with Mercury, etc. (White and Ford). Alkalies, to counteract the 
hyperacidity of the gastric and intestinal contents ; Sodium Bicarbonate gr. 
cl, Hydrargyrum Chlor. Corr. gr. j^, in a quart of water, of which ^jss is 
given every hour; of 301 white cases so treated only 7.3 per cent, diea, and 
of 72 blacks all recovered (Sternberg) ; this plan of treatment promises well 
(Mn). Morphine, is dangerous and must be avoided (Id). Stimulants, only 
in the typhus form (B) ; in third stage must be bold, prompt, and continued 
(Da C). Diet, of the blandest description (A) ; Milk and Lime-water, half 
and half, in small quantities, is the best aliment ; in convalescence, the utmost 
care is necessary in giving aliments (B). Rest is very important (Da C). Iced 
Champagne, in tablespoonful doses every % hour, for the vomiting (B). Pur- 
gation, throughout the disease (Da C) ; is beneficial at the very onset, but 
must not be repeated nor given at all after the second day of the disease (Mn). 
[Compare Remittent Fever.] 



R. Potassii Carbonat., . . . gr. xx. 

Tinct. Opii Camphorat., . gj. 

Aquae, ^ v "j- 

M. Sig. — ^j every hour or two, as a 
diaphoretic. [Dickson.) 



R . Chloroformi, 

Tinct. Camphorae, . 
M. Sig. — Two drops 
the vomiting. 



. aa £ss. 

as required for 



APPENDIX 



LIST OF CONTRACTIONS AND LATIN PHRASES USED IN 
WRITING PRESCRIPTIONS, WITH THE CORRESPONDING 
ENGLISH EQUIVALENTS. 



Contraction. 


Word or Phrase. 


English Equivalent. 


aa. 


Ana 


Of each. 


Abd. 


Abdomen, gen. inis 


The belly. 


Abs. feb. 


Absente febre 


Fever being absent. 


Ace. 


Accurate 


Accurately. 


Acerb. 


Acerbus, a, urn 


Sharp, sour, harsh (to the taste). 


Acerbit. 


Acerbitas, gen. atis 


Sourness. 


Ad 


Ad {pi'ep. gov. ace.) 


To, up to. 


Ad concil. gust. 


Ad conciliandum gustum 


To suit the taste. 


Ad 2 vie. 


Ad duas vices 


At twice taking. 


Ad sec. vie. 


Ad secundum vicem 


For the second time. 


Ad 3 tiam vie. 


Ad tertiam vicem 


For the third time. 


Add. 


Adde, Addantur 


Add, Let them be added. 


Add. 


Addendus, Addendo 


To be added, By adding. 


Add. c. trit. 


Adde cum tritu 


Add with trituration. 


Ad def. an. 


Ad defectionem animi 


To fainting. 


Ad grat. acid. 


Ad gratam aciditatem 


To an agreeable sourness. 


Ad grat. gust. 


Ad gratum gustum 


To an agreeable taste. 


Adhib. 


Adhibendus 


To be administered. 


Adjac. 


Adjacens 


Adjacent. 


Ad lib. 


Ad libitum 


At pleasure. 


Admov. 


Admove, Admoveatur 


Apply, Let it be applied. 


Ad part, dolent. 


Ad partes dolentes 


To the painful (aching) parts. 


Ad sat. 


Ad saturandum 


To saturation. 


Adst. feb. 


Adstante febre 


The fever being on. 


Adv. 


Adversum 


Against. 


JEg. 


y£ger 


The sick one, the patient. 


Aggr. feb. 


Aggrediente febre 


While the fever is coming on. 


Agit. 


Agita 


Shake, stir. 


Agit. 


Agitetur 


Let it be shaken or stirred. 


Agit. ante sum. 


Agita ante sumendum 


Shake before taking. 


Agit. vas. 


Agitato vase 


The vial being shaken. 


Alb. 


Albus, a, um 


White. 


Aliq. 


Aliquot 


Some. 


Alt. 


Alter 


The other. 


Alt. hor. 


Alternis horis 


Every other hour. 


Alut. 


Aluta 


Leather. 


Alv. 


Alvus 


The belly, the bowels. 


Alv. adst. 


Alvo adstricta 


The bowels being confined. 


Amp. 


Amplus 


Large. 


Ampul. 


Ampulla 


A large bottle. 


App. 


Appone, Applica 


Apply, Lay or put on. 


Aq. 


Aqua, gen. se 


Water. 



i 



88 3 



884 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction 


Word or Phrase. 


1 
English Equivalent. 


Aq. astr. 


Aqua astricta 


Frozen water. 


Aq. bull. 


Aqua bulliens 


Boiling water. 


Aq. com. 


Aqua communis 


Common water. 


Aq. ferv. vel calid. 


Aqua fervens vel calida 


Hot water. 


Aq. fluv. 


Aqua fluviatilis 


River water. 


Aq. font. 


Aqua fontana vel fontis 


Spring water. 


Aq. gelid. 


Aqua gelidus 


Cold water. 


Aq. mar. 


Aqua marina 


Sea water. 


Aq. niv. 


Aqua nivialis vel nivalis 


Snow water. 


Aq. phag. 


Aqua phagedsenica 


Yellow wash. 


Aq. pluv. 


Aqua pluvialis 


Rain water. 


Aq. pot. 


Aqua potabilis 


Drinkable water. 


Aq. satur. 


Aqua saturni 


Lead-water. 


Aq. urb. 


Aqua urbis 


City water. 


Aqual. 


Aqualis 


Pertaining to water. 


Aquil. alb. 


Aquila alba 


Calomel. 


Aut 


Aut 


Or. 


B. A. vel Bal. ar. 


Balneum arense 


Sand-bath. 


B. M.vel Bal. mar. 


Balneum maris 


Salt-water bath. 


B. V. vel Bal. vap. 


Balneum vaporis 


Vapor-bath. 


Bals. 


Balsamum 


Balsam. 


B. B. 


Barbadensis 


Barbadoes. 


Bene 


Bene 


Well, good. 


Bib. 


Bibe vel Bibatur 


Drink (ihou), Let it be drank. 


Bid. 


Biduum 


Two days. 


Bis 


Bis 


Twice. 


Bis die 


Bis in die vel dies 


Twice a day. 


Bol. 


Bolus 


A large pill. 


Bon. 


Bonus 


Good. 


Brach. 


Brachium 


The arm. 


Brev. 


Brevis 


Short. 


Bull. 


Bulliat vel Bulliant 


Let it (or them) boil. 


But. 


Butyrum 


Butter. 


C. 


Cum 


With. 


Cserul. 


Cseruleus, gen. i 


Blue. 


Calef. 


Calefactus, gen. i 


Warmed. 


Calom. 


Calomel vel Calomelas 


Mild Chloride of Mercury, Calomel. 


Calor. 


Calor, gen. oris 


Heat, warmth. 


Cap. 


Cape, Capiat 


Take (thou), Let him take. 


Cap. quant, vis 


Capiat quantum vis 


Let him take as much as he will. 


Capil. 


Capillus, gen. i 


A hair. 


Capsul. 


Capsula, gen. ze 


A capsule. 


Caput 


Caput, gen. Capitis 


The head, Of the head. 


Carbas. 


Carbasus, gen. i 


Linen, lint. 


Caute 


Caute 


Cautiously. 


Cc. 


Centimeter cubicum 


Cubic centimeter. 


Ccu. 


Cucurbita 


A cupping-glass. 


Celer. 


Celeriter 


Quickly, immediately. 


Cena 


Cena vel Coena 


Supper. 


Chart. 


Charta 


Paper. 


Chart, cerat. 


Charta cerata 


Waxed paper. 


Chartul. 


Chartula 


A small paper. 


Chin. 


Chininum 


Quinine. 


Cib. 


Cibus, gen. i 


Food, victuals. 


Circit. 


Circitu 


Near, around, about. 


Cit. 


Cito 


Quickly. 


Cito disp. 


Cito dispensetur 


Let it be dispensed quickly. 


Clar. 


Clarus, a, um 


Bright, clear. 


Claus. 


Clausus, a, um 


Closed, inclosed. 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



885 



Contraction. 


Word or Phrase. 


English Equivalent. 


Coch. , Cochleat. 


Cochleare, Cochleatim 


A spoonful, By spoonfuls (^j). 


Coch. amp. 


Cochleare amplum 


A dessertspoonful ( 3 i j ) . 


Coch. mag. 


Cochleare magnum 


A tablespoonful ( ^ ss). 


Coch. med. 


Cochleare medium 


A dessertspoonful ( 3 i j ) . 


Coch. parv. 


Cochleare parvum 


A teaspoonful ( gj). 


Coct. 


Coctio 


Boiling. 


Cog. 


Cogantur 


Let them be combined. 


Col. 


Cola 


Strain. 


Colatur. 


Colaturge 


Of the strained liquor. 


Colat. 


Colatus 


Strained. 


Colent. 


Colentur 


Let them be strained. 


Colet. 


Coletur 


Let it be strained. 


Coll. 


Collum, gen. i 


The neck. 


Collun. 


Collunarium, gen. i 


A nasal wash. 


Collut. 


Collutorium 


A mouth-wash. 


Collyf. 


Collyrium 


An eye-wash. 


Coloret. 


Coloretur 


Let it be colored. 


Commis. 


Commisce 


Mix together. 


Commod. 


Commode 


Rightly, properly, suitably. 


Comp. 


Compositus 


Compound, compounded. 


Con., Concis. 


Concisus 


Cut. 


Concus. 


Concuscus, gen. i 


Shaken. 


Concut. 


Concuti, Concutiatur 


Shake, Let it be shaken. 


Conf. 


Confectio 


Confection. 


Cong. 


Congius 


A gallon. 


Conquas. 


Conquassando 


By vigorous shaking. 


Cons. 


Conserva, Conserve 


A converse ; Keep, preserve. 


Consperg. 


Consperge 


Dust, sprinkle. 


Contere 


Contere 


Rub together. 


Cont. rem. 


Continuentur remedia 


Let the medicines be continued. 


Contus. 


Contusus 


Bruised. 


Coq. 


Coque, Coquantur 


Boil, Let them be boiled. 


Coq. ad med. con- 


Coque ad medietatis con- 


Boil to the consumption of half. 


sump. 


sumptionem 




Coq. S. A. 


Coque secundum artem 


Boil according to art. 


Coq. in S. A. 


Coque in sufficiente aquae 


Boil in sufficient water. 


Coq. simul 


Coquentur simul 


Boil them together. 


Cor 


Cor, gen. cordis 


The heart, Of the heart. 


Cort. 


Cortex, gen. corticis 


The bark, Of the bark. 


Cot. 


Cotula 


A measure. 


Cox. 


Coxa 


The hip. 


Cras 


Cras 


To-morrow. 


Cras mane sumend. 


Cras mane sumendus 


To be taken to-morrow morning. 


Cras nocte 


Cras nocte 


To-morrow night. 


Cras vesp. 


Cras vespere 


To-morrow evening. 


Crast. 


Crastinus 


For to-morrow, early. 


Cru. 


Cruor 


Blood, gore. 


Cucur. 


Cucurbitula 


A cupping-glass. 


Cuj. 


Cujus, Cujus-libet 


Of which, Of any. 


Cum 


Cum 


With. 


Curs. hod. 


Cursu hodie 


During the day. 


Cyath., C. vinar. 


Cyathus, vel C. vinarius 


A wine-glass (^j-ij)- 


Cyath. these 


Cyatho theae 


In a cup of tea. 


D. 


Dies, Dosis 


A day, A dose. 


Da, Det. 


Da, Detur 


Give, Let it be given. 


De 


De {prep. gov. ablative) 


From, down. 


Deaur. pil. 


Deaurentur pilulae 


Let the pills be gilded. 


Deb. spiss. 


Debita spissitudo 


To a proper consistence. 


Deb. 


Debitus, a, um 


Due, proper. 



( 



886 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Dec. 


Decanta 


Pour off. 


Decern 


Decern, decimus 


Ten, The Tenth. 


Decoct. 


Decoctum 


A decoction. 


Decoq. 


Decoque 


Boil down. 


Decub, 


Decubitus 


Lying down. 


De d. in d. 


De die in diem 


From day to day. 


Dein 


Dein vel Deinde 


Thereupon; afterward, then. 


Deglut. 


Deglutiatur 


Let be swallowed. 


Dej. alv. 


Dejectiones alvi 


Stools. 


Dejic. 


Dejiciatur 


Let be purged. 


Dent. 


Dentes ; Dentur 


The teeth ; Let them be given. 


Det. in dup. 


Detur in duplo 


Let twice as much be given. 


Dext. 


Dexter, Dextra 


The right. 


Dieb. alt. 


Diebus alternis 


Every other day. 


Dieb. tert. 


Diebus tertiis 


Every third day. 


Dies vel D. 


Dies, gen. diei 


A day. 


Dig. 


Digere, Digeretur 


Digest, Let it be digested. 


Diluc. 


Diluculo 


At break of day. 


Dil. 


Dilue, Dilutus, a, um 


Dilute (thou), Diluted. 


Dim. 


Dimidius, a, um 


One-half. 


D. P. vel Dir. prop. 


Directione propria 


"With a proper direction. 


Disp. 


Dispensa, Dispensetur 


Dispense, Let it be dispensed. 


Div. in p. seq. 


Dividatur in partes 
eequales 


Let it be divided into equal parts. 


Divid. 


Dividendus, a, um 


To be divided. 


Dol. 


Dolor, Dolore 


Pain, In pain. 


Don. 


Donee 


Until. 


Don. alv. dejec. 


Donee alvus dejecerit 


Until the bowels move. 


Don. alv. sol. ft. 


Donee alvus soluta fuerit 


Until the bowels shall be opened. 


Don. dolor neph. 


Donee dolor nephriticus 


Until the nephritic pain is removed. 


exulav. 


exulaverit 




Don. hab. colat. 


Donee habeas colaturae 


Until you have of strained liquor. 


Don. len. dol. 


Donee leniatur dolor 


Until the pain is relieved. 


Don. sint res. 


Donee sint residuae 


Until there is ... of residue. 


Dos. 


Dosis 


A dose. 


Dr., 3 


Drachma 


A drachm (60 grains). 


Dulc. 


Dulcis, Dulcitas 


Sweet, Sweetness. 


Dup. 


Duplico 


In duplicate. 


Dur. dolor. 


Durante dolore 


While the pain lasts. 


Ead. 


Eadem (fem.) 


The same. 


Eburn. 


Eburneus 


Made of ivory. 


Ejusd. 


Ejusdem 


Of the same. 


Elect. 


Electuarium 


An electuary. 


Em. 


Emesis 


Vomiting. 


En., Enem. 


Enema, Enemata 


A clyster or enema, Enemas. 


Epistom. 


Epistomium 


A stopper, bung. 


Et 


Et 


And. 


Etiam 


Etiam 


Also, besides. 


Evan. 


Evanuerit 


Shall have disappeared. 


Ex 


Ex {gov. ablative) 


From, out of. 


Ex quib. sum. 


Ex quibus sumatur 


From which are given. 


Ex mod. p. 


Ex modo praescripto 


After the manner prescribed. 


Ex paul. aq. 


Ex paululo aquae 


From (In) a very little water. 


Ex parte 


Ex parte 


Partly. 


Exhib. 


Exhibeatur 


Let it be exhibited. 


Exper. 


Experime 


Try (thou). 


Ext. 


Extende, Extendatur 


Spread, Let it be spread. 


Ext. sup. alut. 


Extend e super alutem 


Spread upon leather. 


Ext., Extr. 


Extractum, gen. i 


An extrart. 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



887 



Contraction. 


Word or Phrase. 


English Equivalent. 


Extr. 


Extrahe, Extrahatur 


Extract (thou), Let it be extracted. 


F. 


Fac 


Make (thou). 


F. L. A. 


Fiat lege artis 


Let it be made by the rules of art. 


F. pil. xij 


Fac pilulas duodecim 


Make 12 pills. 


Far. 


Farina 


Flour. 


Fas. lint. 


Fascia lintea 


A linen bandage. 


Fascic. 


Fasciculus 


A small bundle. 


Febr. 


Febris 


Fever. 


Febr. dur. 


Febre durante 


During the fever. 


Fem. intern. 


Femori interno 


To the inner thigh. 


Ferv. 


Fervens, gen. entis 


Hot. 


Fict. 


Fictilis, e 


Earthen, An earthen vessel. 


Fil. 


Filtra 


Filter (thou). 


Filt. 


Filtrum, gen. i 


A filter. 


Fistul. arm. 


Fistula armata 


A syringe ready for use. 


Flav. 


Flavus, a, um 


Yellow. 


Flor. 


Flores {pi.) 


Flowers. 


Fluid, vel Fl. 


Fluidus 


Liquid. 


Fol. 


Folia, gen. orum 


Leaves. 


Form. 


Formula, Formentur 


A prescription, Let them be formed. 


Frig. 


Frigor, gen. oris 


Cold. 


Frust. 


Frustillatim 


In small pieces. 


Ft. 


Fiat, Fiant {pi.) 


Let it {or them) be made. 


Ft. cerat. 


Fiat ceratum 


Let a cerate be made. 


Ft. chart, xij 


Fiant chartulae duodecim 


Let 12 powders be made. 


Ft. collyr. 


Fiat collyrium 


Let an eye-wash be made. 


Ft. emuls. 


Fiat emulsum 


Let an emulsion be made. 


Ft. en. 


Fiat enema 


Let an enema be made. 


Ft. inject. 


Fiat injectio 


Let an injection be made. 


Ft. pil. xij. 


Fiant pilulae duodecim 


Let 12 pills be made. 


Ft. pulv. 


Fiat pulvis 


Let a powder be made. 


Ft. pulv. xij. 


Fiant pulveres duodecim 


Let 12 powders be made. 


Ft. sol. 


Fiat solutio 


Let a solution be made. 


Ft. suppos. viij 


Fiant suppositoria octo 


Let 8 suppositories be made. 


Ft. troch. xx 


Fiant trochisci viginti 


Let 20 troches be made. 


Ft. ung. 


Fiat unguentum 


Let an ointment be made. 


Ft. venesec. 


Fiat venesectio 


Let a bleeding be done. 


Fuerit 


Fuerit 


Shall have been. 


Fus. 


Fuscus, a, um 


Brown, dark. 


Garg. 


Gargarisma 


A gargle. 


Gelat. quav. 


Gelatina quavis 


In any kind of jelly. 


Ging. incid. 


Gingivas incide 


Lance (or cut) the gums. 


Gm. 


Gramma 


A gramme. 


gr- 


Granum, Grana 


A grain, Grains. 


gr. vj pond. 


Grana sex pondere 


Six grains by weight. 


Grad. 


Gradatim 


By degrees, gradually. 


Grat. 


Gratus 


Pleasant. 


Gros. 


Grossus, a, um 


Large, coarse. 


Grum. 


Grumus 


A clot (of blood). 


Gtt. 


Gutta, Guttae, Guttas 


A drop, Drops. 


Guttat. 


Guttatim 


By drops. 


Gtt. quibusd. 


Guttis quibusdam 


With a few drops. 


H. 


Hora 


An hour. 


Har. pil. 


Harum pilularum 


Of these pills. 


Haust. 


Haustus, gen. i 


A draught. 


H. p. n. 


Haustus purgans noster 


My own purgative draught. 


Hebdom. 


Hebdomada, Hebdomas 


A week. 


Herb. 


Herba, gen. ae 


An herb. 


Herb, recent. 


Herbarum recentium 


Of fresh herbs. 



< 



888 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Heri 


Heri 


Yesterday. 


Hie, Hsec, Hoc 


Hie, Hsec, Hoc 


This. 


Hirudo 


Hirudo, gen. inis 


A leech. 


Hirud. app. 


Hirudines appone 


Apply leeches. 


Hor. 


Hor a, gen. as 


An hour. 


Hor. decub. 


Horas decubitus 


At bedtime. 


Hor. j spat. 


Horae unius spatio 


After one hour. 


Hor. interm. 


Horis intermediis 


In the intermediate hours. 


Hor. som. 


Hora somni 


At the hour of sleep. 


Hor. xj matut. 


Hora undecima matutina 


At the eleventh hour of the morning. 


Id. 


Idem 


The same. 


Iden. 


Identidem 


Repeatedly, often. 


Idon. 


Idoneus, a, um 


Suitable, proper, convenient. 


Idon. vehic. 


Idoneo vehiculo 


In a suitable vehicle. 


111. 


Illico 


Then, immediately. 


Immit. 


Immitatur 


Let it be placed in. 


Imp. 


Impone 


Lay on, apply. 


Impr. 


Imprimis 


First, chiefly. 


In 


In 


In, within, upon, not. 


Inc. 


Incide, Incisus 


Cut (thou), Being cut. 


Ind. 


In dies 


Daily, or From day to day. 


Inde 


Inde 


Therefrom. 


In fun. 


Infunde 


Pour in. 


Infus. 


Infusum 


An infusion. 


Ing. 


Ingere, Ingerendus 


Put into, Putting into. 


Injec. 


Injectio 


An injection. 


Injic. enem. 


Injiciatur enema 


Let a clyster be injected. 


In lag. bene obt. 


In lagena bene obturator 


In a well-stoppered bottle. 


In loco frig. 


In loco frigido 


In a cold place. 


In mass. cog. 


In massam cogantur 


Let them be combined in a mass. 


In pulm. 


In pulmento 


In gruel. 


Instar 


Instar 


As big as, the size of. 


Int. 


Internus, a, um 


Inner, internal, between. 


Inter 


Inter 


Between. 


Intus 


Intus 


Inwardly. 


Invol. gelat. 


Involve gelatina 


Coat [or cover) with gelatin. 


Invor. 


Invoruntur 


Let them be moistened. 


Ita 


Ita 


In such manner. 


Iter. 


Iteretur, Iterentur 


Let it (them) be repeated. 


Jam 


Jam 


Now. 


Jentac. 


Jentaculum, gen. i 


Breakfast. 


Jucund. 


Jucunde 


Pleasantly. 


Jul. 


Julepum 


A julep. 


Juscel. 


Juscellum 


A broth. 


Juscul. 


Jusculum 


Soup. 


Jux. 


Juxta, Juxtim 


Near to, Close by. 


K. 


Kali, Kalium 


Potassa, Potassium. 


Kal. ppt. 


Kali praeparata 


Potassium carbonate. 


Lac. 


Lac, gen. Lactis 


Milk, Of milk. 


Lag. 


Lagena, gen. ae 


A flask, or bottle. 


Lam. 


Lamella 


Plate, leaf, layer, scale. 


Lan. 


Lana, gen. as 


Flannel, wool. 


Lang. 


Languor, gen. oris 


Faintness. 


Lapid. 


Lapideus, a, um 


Stony, made of stone. 


Larg. 


Largus, a, um 


Abundant, plentiful. 


Larid. 


Larid um, gen. i 


Lard. 


Lat. 


Latus, a, um 


Broad, wide. 


Lat. 


Latus, gen. eris 


The side. 


Lat. admov. 


Latere admoveatur 


Let it be applied to the side. 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Lat. dol. 


Lateri dolenti 


To the painful side. 


Lax. 


Laxus, a, um 


Loose, open. 


Lb., ib 


Libra 


A pound. 


Lect. 


Lectus, gen. i 


Abed. 


Len. 


Leniter 


Easily, gently. 


Len. ter. 


Leniter terendo 


By rubbing gently. 


Lev. 


Leviter 


Lightly. 


Lig. 


Ligatura 


A ligature. 


Linct. 


Linctus, gen. i 


A linctus, (taken by licking.) 


Linim. 


Linimentum, gen. i 


A liniment. 


Lint. 


Linteum, gen. i 


Lint, linen. 


Liq. 


Liquor, gen. oris 


A solution. 


Lot. 


Lotio 


A lotion. 


Lut. 


Luteus, a, um 


Yellow, golden yellow. 


M., nv 


Minimum, gen. i 


A minim. 


M. 


Misce 


Mix (thou). 


M. 


Manipulus, gen. i 


A handful. 


Macer. 


Macera 


Macerate (thou). 


Mag. 


Magnus, a, um 


Large. 


Man. 


Manipulus, gen. i 


A handful. 


Mane 


Mane (indecl.) 


Morning, in the morning. 


Mane primo 


Mane primo 


Early in the morning. 


! Manus 


Manus, gen. i 


The hand. 


Mass. 


Massa, gen. as 


A mass, a pill-mass. 


i Mat. 


Matula, gen. se 


A vessel, a chamber-pot. 


Matut. 


Matutinus 


In the morning. 


Med. 


Medius, a, um 


Middle. 


Mens. 


Men sura 


By measure. 


Mic. pan. 


Mica panis 


A crumb of bread. 


Min. 


Minimum 


A minim. 


M inut. 


Minutum * 


A minute. 


Mis. 


Misce, Miscetur 


Mix (thou), Let it be mixed. 


Mis. bene 


Misce bene 


Mix well. 


Mis. caut. 


Misce caute 


Mix cautiously. 


Mist. 


Mistura 


A mixture. 


Mit. 


Mitte, Mittatur, Mittantur 


Send (thou), Let it be sent, Let 
them be sent. 


Mit. sang, ad uncias 


Mitte sanguinem ad uncias 


Take away blood to 12 ounces at 


xij salt. 


duodecim saltern 


least. 


Mit. tal. 


Mitte tales 


Send of such. 


Mod. diet. 


Modo dictu 


As directed. 


Mod. pr. 


Modo prasscripto 


In the manner prescribed. 


Modic. 


Modicus, a, um 


Moderate-sized, middling. 


Mol. 


Mollis, Molle 


Soft. 


Mor. 


Mora, gen. as 


Delay. 


Mor. diet. 


More dictu 


In the manner directed. 


Mor. sol. 


More solito 


In the usual manner. 


Mort. 


Mortarium, gen. i 


A mortar. 


Natr. 


Natrium, gen. i 


Sodium. 


Ne tr. s. num. 


Ne trades sine nummo 


Do not deliver without the money. 


Necn. 


Necnon 


And also, and yet. 


Nig. 


Niger, nigra, nigrum 


Black. 


Nisi 


Nisi 


Unless. 


No. 


Numero, Numerus 


In number, A number. 


Noct. 


Noctis 


Of the night. 


Noct. maneq. 


Nocte maneque 


At night and in the morning. 


Non 


Non 


Not. 



i 



*This is medical Latin, or 
gesima pars horcE. 



bog-Latin." The proper Latin for a minute of time is Sexa- 



890 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Non repetat. 


Non repetatur 


Let it not be repeated. 


Noxa 


Noxa, gen. se 


An injury. 


Nucha 


Nucha 


The nape of the neck. 


Nunc 


Nunc 


Now. 


Nut. 


Nutricius, a, um 


Nutritious. ' 


Nutrit. 


Nutritus, gen. us 


Nutriment. 


Nux 


Nux, gen. nucis 


A nut. 


Nux mosch. 


Nux moschata 


A nutmeg. 


0. 


Octarius 


Apint(f xvj). 


Obd. 


Obduce 


Cover, conceal, coat. 


Obduct. 


Obductus, a, um 


Covered, coated. 


Obtrit. 


Obtritus, a, um 


Crushed. 


Occlus. 


Occlusus, a, um 


Enclosed. 


Oct. 


Octo, Octavus 


Eight, Eighth. 


Octup. 


Octuplus 


Eight-fold. 


Ocul. 


Oov\w%, gen. i 


The eye. 


Odor. 


Odora, Odoretur 


Perfume, Let it be perfumed. 


Odorat. 


Odoratus, a, um 


Perfumed, odorous. 


01. lini sine ig. 


Oleum lini sine igne 


Cold-drawn linseed oil. 


Ol. 0. Opt. 


Oleum olivae optimum 


Best olive oil. 


011a 


011a, gen. se 


A pot, a jar. 


Ollic. 


Ollicula, gen. se 


A little pot. 


Omn. hor. 


Omni hora 


Every hour. 


Omn. bih. 


Omni bihorio 


Every two hours. 


Omn. quadr. hor. 


Omni quadrante horse 


Every *^ hour. 


Omn. mane 


Omni mane 


Every morning. 


Omn. noct. 


Omni nocte 


Every night. 


Op. 


Opus 


Need, occasion. 


Opt. 


Optimus, a, um 


Best. 


Oryza 


Oryza, gen. ae 


Rice. 


Os 


Os, gen. oris 


The mouth. 


Ov. 


Ovum, gen. ovi 


An egg. 


P. 


Pondere 


By weight. 


P. P. A. 


Phiala prius agitata 


The bottle having been first shaken. 


P. r. n. 


Pro re nata 


Occasionally, as needed. 


Pab. 


Pabulum, gen. i 


Food. 


Pallid. 


Pallidus, a, um 


Pale. 


Pan. 


Panis, Pannus 


Bread, A cloth or rag. 


Par. , Pt. 


Pars, gen. Partis 


A part, Of a part. 


Para, Par at. 


Para, Paratus 


Prepare, Prepared. 


Pt. aeq. 


Partes aequales 


Equal parts. 


Pt. affect. 


Parte affecta 


On the affected part. 


Part. vie. 


Partitis vicibus 


In divided doses. 


Parv. 


Parvus, a, um 


Little. 


Parvul. 


Parvulus, a, um 


An infant, a parvule. 


Pastil. 


Pastillus, Pastillum 


A pastille, a lozenge. 


Pauc. 


Paucus, a, um 


Little, few. 


Paul. 


Paulatim 


Little by little, gradually. 


Pect. 


Pectus, gen. oris 


The breast. 


Pediluv. 


Pediluvium 


A foot-bath. 


Penicil. cam. 


Penicillum camelinum 


A camel's-hair pencil or brush. 


Per 


Per {prep. gov. accus.) 


Through, by means of, very. 


Peract. operat. emet. 


Peracta operatio emetici 


When the emesis is finished. 


Percalef. 


Percalefactus, a, um 


Thoroughly heated. 


Percol. 


Percola 


Strain through, percolate. 


Per deliq. 


Per deliquium 


By deliquescence. 


Per fistul. vit. 


Per fistulam vitream 


Through a glass tube. 


Perg. 


Perge, Pergetur 


Proceed, Let be continued. 


Perind. 


Perinde 


Just as. 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Permit, vir. 


Permittentibus viribus 


The strength permitting. 


Perpur. 


Perpurus, a, um 


Very clean. 


Pervesp. 


Pervesperi 


Very late in the evening. 


Pes 


Pes, gen. pedis 


The foot. 


Pess. 


Pessarium, Pessulum 


A pessary. 


Ph. 


Phiala, gen. ae 


A vial, a bottle. 


Pil. 


Pilula, gen. ze 


A pill. 


Pil. 


Pilus, gen. i 


The hair. 


Ping. 


Pinguis, gen. is 


Fat, grease. 


Pist. 


Pistillum, gen. i 


A pestle. 


Plac. 


Placebo 


I will satisfy (please). 


Plas. 


Plasma, Plasmetur 


Mould, Let it be moulded. 


Plen. 


Plenus, a, um 


Filled. 


Poc. 


Poculum, Pocillum 


A cup, A little cup. 


Pon., P. 


Pondere 


By weight. 


Pon. civ. 


Pondus civile 


Civil weight (avoirdupois). 


Pon. med. 


Pondus medicinale 


Medicinal (apothecaries') weight. 


Pone aur. 


Pone aurem 


Behind the ear. 


Post cib. 


Post cibos 


After meals. 


Post sing. sed. liq. 


Post singulas sedes liquidas 


After every loose stool. 


Postrid. 


Postridie 


On the next day. 


Pot. 


Potus,^«. us 


A drink. 


Prse 


Prae {prep. gov. abl.) 


Before, very. 


Praep. 


Praeparatus, a, um 


Prepared. 


Prand. 


Prandium, gen. i 


Dinner. 


Prid. 


Pridie 


On the previous day. 


Prim. man. 


Primo mane 


Very early in the morning. 


Primus 


Primus, a, um 


The first. 


Pro 


Pro {adv. and prep. gov. 
abl.) 


For, before, according to. 


Prop. 


Proprius, a, um 


Special, particular. 


Pro rat. set. 


Pro ratione setatis 


According to the age of the patient. 


Pro r. n. 


Pro re nata 


Occasionally, as needed. 


Prox. 


Proximo 


Nearest. 


Pug. 


Pugillus 


A pinch. 


Pulm. 


Pulmentum, gen. i 


Gruel. 


Pulv. 


Pulvis, gen. eris 


A powder. 


Pulv. gros. 


Pulvis grossus 


A coarse powder. 


Pulv. subtil. 


Pulvis subtilis 


A smooth powder. 


Pulv. ten. 


Pulvis tenuis 


A fine powder. 


Pulvz. 


Pulverizatus, a, um 


Powdered. 


Pur. 


Purus, a, um 


Pure, clean. 


Purg. 


Purgativus, gen. i 


A purgative, a purging. 


Pyx. 


Pyxis, gen. idis 


A small box, a pill-box. 


Q- 


Quadrans, gen. tis 


A fourth part, a quart. 


Q. lib. 


Quantum libet 


As much as you please. 


Q. p. 


Quantum placet 


( ( it a it a 


Q. q. 


Quoque 


Also. 


Qq. 


Quisque, Quaque 


Each, or Every. 


Qq. hor. 


Quaqua hora. 


Every hour. 


Q. s. 


Quantum sufficiat 


As much as is sufficient. 


Q. s. 


Quantum satis 


te.it an .1 


Q. v. 


Quantum vis 


As much as you please. 


Q. vol. 


Quantum volueris 


<< <« n a n 


Quad. 


Quadruplo 


Quadruple, in fourfold. 


Quam 


Quam 


As much as. 


Quart. 


Quartus, gen. i 


Fourth. 


Quat, Quater 


Quatuor, Quater 


Four, Four times. 


Quibus 


Quibus 


From which. 



i 



892 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Quinq. 


Quinque 


Five. 


Quint. 


Quintus 


The fifth. 


Quoq. 


Quoque 


Also. 


Quor. 


Quorum 


Of which. 


Quotid. 


Quotidie 


Daily. 


Quoties req. 


Quoties requiritur 


As often as is required. 


a 


Recipe 


Take (thou). 


Rar. 


Rarus, a, um 


Loose, thin, rare. 


Rat. 


Ratio, gen. onis 


Relation, proportion. 


Rec. 


Recens, gen. entis 


Fresh, recent, newly. 


Red. in pulv. 


Redactus in pulverem 


Reduced to powder. 


Redig. in pulv. 


Redigatur in pulverem 


Let it be reduced to powder. 


Reg. umbil. 


Regio umbilici 


The umbilical region. 


Rel. 


Relectus, a, um 


Opened, loosened. 


Reliq. 


Reliquus, gen. i 


Remaining, the remainder. 


Renov. 


Renova, Renovetur 


Renew, Let it be renewed. 


Renov. semel 


Renovetur semel 


Let it be renewed once only. 


Rept. 


Repetatur, Repetantur 


Let it (them) be repeated. 


Res. 


Res, gen. rei 


A substance, thing, affair. 


Resid. 


Residuus, a, um 


Residual, remaining. 


Respon. 


Responde 


Answer (thou). 


Retin. 


Retinetur 


Let it be withheld. 


Rict. 


Rictus, gen. us 


A wide (distended) opening. 


Rig. 


Rigidus, a, um 


Rigid, hard, inflexible. 


Rub. 


Ruber, Rubra, Rubrum 


Red, ruddy. 


Rudic. 


Rudicula, gen. se 


A spatula. 


Rudis 


Rudis, gen. is 


A stirring-rod. 


Rum. 


Rumen, gen. inis 


The throat. 


S. expr. 


Sine expressione 


Without expression. 


S. A. 


Secundum artem 


According to art. 


S. L. 


Secundum legem 


According to law. 


S. N. 


Secundum naturam 


According to nature. 


s. s. s. 


Stratum superstratum 


Layer upon layer. 


S. V. R. 


Spiritus vini rectificatus 


Alcohol. 


S. V. T. 


Spiritus vini tenuis 


Proof spirit. 


Sac. lac. 


Saccharum lactis 


Sugar of milk. 


Sac. sat. 


Saccharum saturni 


Sugar of lead. 


Sagp. 


Ssepe 


Frequently. 


Sal 


Sal, gen. salis 


Salt. 


Sal am. 


Sal amarum 


Magnesium sulphate. 


Sal mir. 


Sal mirabile 


Sodium sulphate. 


Sal vol. 


Sal volatile 


Ammonium carbonate. 


Saltern 


Saltern 


At least. 


Saltim 


Saltim 


By leaps. 


Sang. 


Sanguis, Sanguineus 


Blood, Bloody. 


Sap. 


Sapor, gen. oris 


A flavor, delicacy. 


Sat. 


Satis 


Enough, sufficient. 


Saturat. 


Saturatus, a, um 


Saturated. 


Scarif. 


Scarifica 


Scarify (thou). 


Scarif. expl. 


Scarificatione explicata 


Scarification having been effected. 


Scat. 


Scatula,£wz. se 


A box. 


Scil. 


Scilicet 


Namely. 


Scrup., ^ 


Scrupulum, gen. i 


A scruple (20 grains). 


Scut. pect. 


Scuto pectori 


For protection to the breast. 


Sec. 


Secundo, Secundum 


Secondly, According to. 


Secund. 


Secundus 


Second. 


Sed. 


Sedes, gen. is 


The fundament, the feces. 


Semel. 


Semel 


Once. 


Semidr. 


Semi-drachma 


Half a drachm. 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



893 



Contraction. 


Word or Phrase. 


English Equivalent. 


Semih. 


Semi-hora 


Half an hour. 


Sensim 


Sensim 


Gently, gradually, slowly. 


Separ. 


Separatim 


Separately. 


Sept. 


Septem 


Seven. 


Septim. 


Septimana 


A week. 


Sero 


Sero 


Late, at a late hour. 


Sesq. 


Sesqui 


One and a half. 


Sesqh. 


Sesquihora 


An hour and a half. 


Sesunc. 


Sesuncia 


An ounce.and a half. 


Sev. 


Sevum, gen. i 


Suet, tallow. 


Sex, Sext. 


Sex, Sextus 


Six, Sixth. 


Si 


Si 


If. 


Sic! 


Sic! 


So, thus. 


Sic. 


Sicca, Siccetui 


Dry (thou), Let it be dried. 


Sic. * • 


Siccus 


Dry, Dried. 


Sig. 


Signa, Signetur 


Write (thou), Let it be marked. 


Sig. nom. prop. 


Signatur nomine proprio 


Let it be written upon (marked) with 
its proper name. 


Sign. 


Signanter 


Clearly, distinctly. 


Sile hujus ! 


Sile hujus ! 


Keep silence concerning this. 


Simp. 


Simplex, gen. simplicis 


Simple, unmixed. 


Simul 


Simul 


Together. 


Sin. 


Sine 


Without. 


Sing. 


Singulorum 


Of each. 


Si non val. 


Si non valeat 


If it does not answer. 


Si op. sit. 


Si opus sit 


If necessary. 


Si vir. perm. 


Si vires permittebant 


If the strength will permit. 


Sit 


Sit 


Let it be. 


Sit in promp. 


Sit in promptu 


Let it be in readiness. 


Sitis, Siti 


Sitis, siti 


Thirst, For thirst. 


Sol. 


Solus 


Alone, only. 


Solat. 


Solatium, gen. ii 


A soothing, assuaging. 


Solit. 


Solitus, a, um 


Accustomed, ordinary. 


Solut. 


Solutus, a, um 


Dissolved. 


Solut. 


Solutio, gen. onis 


A solution. 


Solv. 


Solve, Solvetur 


Dissolve, Let it be dissolved. 


Solv. c. calor. 


Solve cum calore 


Dissolve with heat. 


Som. 


Somnus, gen. i 


Sleep. 


Spiss. 


Spissus, a, um 


Dense, hard. 


Spt. 


Spiritus, gen. us 


Spirit. 


Spt. vin. rect. 


Spiritus vini rectificatus 


Rectified spirit of wine (Alcohol). 


Spt. vin. ten. 


Spiritus vini tenuis 


Proof spirit. 


Spt. vinos. 


Spiritus vinosus 


Ardent spirit (of any strength). 


ss. 


Semis, Semissis, Semi- 


A half. 


St. 


Stet, Stent 


Let it (or them) stand. 


Stat. 


Statim 


Immediately. 


Stib. 


Stibium, gen. ii 


Antimony. 


Stillat. 


Stillatim 


By drops, drop by drop. 


Stom. 


Stomachus, gen. i 


The stomach. 


Strat. 


Stratum, gen. i 


Layer, stratum. 


Strat. superst. 


Stratum superstratum 


Layer upon layer. 


Suav. 


Suavis 


Pleasant, agreeable. 


Sub 


Sub 


Under, somewhat. 


Subact. 


Subactus 


Subdued, sinking. 


Sub fin. coct. 


Sub finem ccctionis 


When the boiling is nearly done. 


Subind. 


Subinde 


Frequently. 


Subtil. 


Subtilis 


Fine, smooth, nice. 


Sue. 


Succus, gen. i 


Juice, sap. 


Suggil. 


Sugillationi 


To the bruise. 



894 



LIST OF CONTRACTIONS AND LATIN PHRASES. 



Contraction. 


Word or Phrase. 


English Equivalent. 


Sum. 


Sume, Sumat 


Take (thou), Let him take. 


Sum. 


Sumatur, Sumantur 


Let it (them) be taken. 


Sum. tal. 


Sumat tal em 


Let him take one like this. 


Sumend. 


Sumendus 


To be taken. 


Summit. 


Summitates 


The highest points, summits. 


Sum. mane sum. 


Summo mane sumendus 


To be taken very early in the morning. 


Summ. 


Summus, a, um 


Highest, summit. 


Sup. 


Super, Supra 


Above, upon, over. 


Sup. bib. haust. 


Superbibendo haustum 


Drinking afterwards this draught. 


Suppos. 


Suppositoria, gen. ae 


A suppository. 


Suppos. rect. 


Suppositorise rectales 


Rectal suppositories. 


Suppos. ureth. 


Suppositoriae urethrales 


Urethral suppositories. 


Syr. 


Syrupus, ^vfTZ. i 


Syrup. 


T. d., vel T. i. d. 


Ter die, vel Ter in die 


Thrice daily. 


Tab. 


Tabella, gen. ae 


A lozenge, tablet. 


Tal. 


Talis, gen. is 


Of such, like this. 


Tarn 


Tam 


So far, in so far. 


Tan. 


Tandem 


At last, finally. 


Tant. 


Tantum, gen. i 


So much, so many. 


Teg. 


Tegmen, £•<?«. inis 


A cover. 


Temp. 


Tempus, gen. oris 


Time, temple. 


Temp. dext. 


Tempori dextro 


To the right temple. 


Ten. 


Tenuis 


Fine, weak, thin. 


Tep. 


Tepidus, a, um 


Tepid, lukewarm. 


Ter 


Ter 


Thrice, three times. 


Tere, Teret. 


Tere, Teretur 


Rub (thou), Let it be rubbed. 


Tere sim. 


Tere simul 


Rub (thou) together. 


Teres 


Teres, gen. etis 


Rubbed, smooth, polished. 


Tert. 


Tertius 


Third. 


Test. ov. 


Testa ovi 


An egg-shell. 


Thion. 


Thionas, gen. atis 


Sulphur, sulphate. 


Tinct., vel Tr. 


Tinctura,£v/z. se 


Tincture. 


Tinct. herb recent. 


Tincturae herbarum recen- 
tium 


Tinctures of fresh herbs. 


Tinct. theb. 


Tinctura thebaica 


Laudanum. 


Tr. 


Tres, Tria 


Three. 


Trid. 


Triduum,£V?«. ui 


The space of three days. 


Trit. 


Tritura, Trituretur 


Triturate, Let it be triturated. 


Troch. 


Trochiscus, Trochisci 


A lozenge, or troche, Lozenges. 


Turn 


Turn 


Then, next, furthermore. 


Turb. 


Turbidus, a, um 


Turbid, muddy. 


Tus. 


Tussis, gen. is 


A cough. 


Tuto 


Tuto 


Safely. 


Ubi 


Ubi 


Where, wherever, whenever. 


Uln. 


Ulna, gen. ae 


The arm, elbow. 


Ult. 


Ultime, Ultima 


Lastly, at the last. 


Ult. prsesc. 


Ultimo praescriptus 


The last ordered. 


Una 


Una 


Together. 


Unc, I 


Uncia, gen. ae 


An ounce. 


Unct. 


Unctus, a, um 


Anointed, besmeared. 


Unctul. 


Unctulus, a, um 


« a 


Ung. 


Unguentum, gen. i 


An ointment, unguent. 


Unguil. 


Unguilla,£v?«. ae 


An ointment-box. 


Urg. 


Urgens, gen. entis 


Pressing, urgent. 


Ust. 


Ustus, a, um 


Burnt. 


Ut 


Ut, Uti 


That, so that, in order that. 


Ut diet. 


Ut dictum 


As directed. 


Utend. more sol. 


Utendus more solito 


To be used in the usual manner. 


Utere 


Utere 


Use (thou), make use of. 



NUMERALS. 



8 95 



Contraction. 


Word or Phrase. 


English Equivalent. 


Vas 


Vas, gen. vasis 


A vessel, utensil, bottle. 




Vas vit. 


Vas vitreum 


A glass vessel. 




Vehic. 


Vehiculum, gen. i 


A vehicle, menstruum. 




Vel 


Vel {or Ve as a suffix) 


Or. 




Venaesec. brach. 


Venaesectio brachii 


Bleeding in the arm. 




Venen. 


Venerium, Venenosus 


A poison, Poisonous. 




Ver. 


Verus, a, um 


True, real, genuine. 




Vesp. 


Vesper, gen. eris 


The evening. 




Vesper. 


Vesperma, gen. se 


Supper. 




Vic. 


Vicis, Vices 


Change, changes. 




Vin. 


Vinum, gen. i 


Wine. 




Vir. 


Vires {pi. of Vis) 


Strength, vigor, life. 




Virid. 


Viridis, Viride 


Green. 




Vis 


Vis, gen. viris 


Strength, vigor, life. 




Vitel. . 


Vitellus, gen. i 


Yolk. 




Vitel. ovi 


Vitellus ovi 


Yolk of egg. 




Vitel. ovi sol. 


Vitello ovi solutus 


Dissolved in the yolk of an 


e g§- 


Vitr. 


Vitrum, Vitreus 


Glass, Of glass, glazed. 




Vol. 


Volatilis, Volatile 


Volatile. 




Vom. urg. 


Vomitione urgente 


Vomiting being severe. 





P'or Dangerous Abbreviations, see ante, page 546, under the title Prescriptions 



NUMERALS. 



Cardi 


NALS. 


Ordinals. 


Unus 


One. 


Primus 


First. 


Duo 


Two. 


Secundus 


Second. 


Tres 


Three. 


Tertius 


Third. 


Quatuor 


Four. 


Quartus 


Fourth. 


Quinque 


Five. 


Quintus 


Fifth. 


Sex 


Six. 


Sextus 


Sixth. 


Septem 


Seven. 


Septimus 


Seventh. 


Octo 


Eight. 


Octavus 


Eighth. 


Novem 


Nine. 


Nonus 


Ninth. 


Decern 


Ten. 


Decimus 


Tenth. 


Undecim 


Eleven. 


Undecimus 


Eleventh. 


Duodecim 


Twelve. 


Duodecimus 


Twelfth. 


Tredecim 


Thirteen. 


Tertius decimus 


Thirteenth. 


Quatuordecim 


Fourteen. 


Quartus decimus 


Fourteenth. 


Quindecim 


Fifteen. 


Quintus decimus 


Fifteenth. 


Sexdecim 


Sixteen. 


Sextus decimus 


Sixteenth. 


Septemdecim 


Seventeen. 


Septimus decimus 


Seventeenth. 


Octodecim 


Eighteen. 


Octavus decimus 


Eighteenth. 


Novemdecim 


Nineteen. 


Nonus decimus 


Nineteenth. 


Viginti 


Twenty. 


Vicesimus 


Twentieth. 


Viginti unus, vel. \ 
Unus et viginti j 


Twenty-one. 


Vicesimus primus 


Twenty-first. 


Vicesimus secundus 


Twenty-second. 


Triginta 


Thirty. 


Tricesimus 


Thirtieth. 


Quadraginta 


Forty. 


Quadragesimus 


Fortieth. 


Quinquaginta 


Fifty. 


Quinquagesimus 


Fiftieth. 


Sexaginta 


Sixty. 


Sexagesimus 


Sixtieth. 


Septuaginta 


Seventy. 


Septuagesimus 


Seventieth. 


Octoginta 


Eighty. 


Octogesimus 


Eightieth. 


Nonaginta 


Ninety. 


Nonagesimus 


Ninetieth. 


Centum 


One hundred. 


Centesimus. 


Hundredth. 



8 9 6 



GENITIVE CASE-ENDINGS VERBS. 



GENITIVE CASE-ENDINGS. 



Nom. 


Gen. 


Exceptions. 


a 


ae 


Cataplasma, Enema, Physostigma, Aspidosperma and Gargarisma, all have 
the genitive in -atis. Coca is unchanged, though the genitive Cocae is 
written by some authorities. Folia is pleural, gen. Foliorum. 


us 
um 

OS 

on 


i 


Rhus, Rhois ; Flos, Floris ; Bos, Bovis ; Limon, Limonis; Erigeron, -ontis. 
Fructus, Cornus, Quercus, Spiritus, Haustus, Potus, do not change, being 
of the 4th declension. 


as 


atis 


Asclepias, -adis ; Mas, Maris. 


is 


idis 


Pulvis, -eris ; Arsenis, -itis ; Phosphis, -itis ; Sulphis, -itis, and all salts 
ending in -is, have the genitive in -itis. 


o 


onis 


Mucilago, -inis; Ustilago, -inis ; Solidago, -inis. 


1 


lis 


Fel, Fellis; Mell, Mellis ; Sumbul, Sumbuli. 


en 
ps 
rs 

r 

X 


inis 

pis 
rtis 
ris 
cis 


Words which do not change in the Genitive. 

*Amyl. *Coca. Haustus. Quercus. 
Azedarach. Condurango. Hydrastis. Sago. 
Berberis. Cornus. Jaborandi. Sassafras. 
Buchu. Curare. Kino. Sinapis. 
Cannabis. Digitalis. Matico. Spiritus. 
Catechu. Fructus. Potus. 

* But some authorities give Amylis, Cocae. 



Pronunciation. 

Attention is particularly directed to the accentuation of words commonly mispronounced ; 
as, for example, acetas, angina, atropa, chimaphila [kimaphila), chldridum, codeia, co- 
nium, enema, iodidum, radicis, ricinus, sinapis, syrupus, eczema, umbilicus, abdomen, 
bromidum, paresis. 

Verbs. 

The Verbs used in prescription writing are nearly all in the imperative mood, giving 
directions to the compounder, and having their objects in the accusative case. Such are — 

Adde, add. Fac, make. Recipe, take. 

Cola, strain. Filtra, filter. Signa, write. 

Divide, divide.' Macera-, macerate. Solve, dissolve. 

Extende, spread. Misce, mix. Tere, rub. 

A few verbs are found in the subjunctive mood, taking their subject or predicate in the 
nominative case. The most usual are — 

Fiat, let be made. Bulliat, let boil. Dividatur, let be divided. 

Coletur, let be strained. Capiat, let take. Sit, let it be. 

Coloretur, let be colored. Detur, let be given. Sumahir, let be taken. 

Participles. 

Participles or Verbal Adjectives are occasionally used, and should agree with their 
respective nouns in gender, number, and case. Such are — 

Adhibendus, a> um, to be administered. Dividenaus, a, um, to be divided. 

Sumendus, a, um, to be taken. 



HYPODERMIC FORMULA. 



897 



Prepositions. 



Those in the first column require the noun following to be in the accusative case, — 
those in the second column require the ablative case. 

Ad, to, up to. 
In, into. 
Supra, upon. 
An 



of each,- 



Cu?n, with. 
Pro, for. 
Sine, without, 
-governs the genitive case. 



Sundry 
Bene, well. 
Bis, twice. 
Dein, thereupon. 
Et, and. 

Gradatim, gradually. 
Guttatim, by drops. 
In dies, daily. 
Da, give. 



Words and Phrases, 
No ft, not. 
Nwnerus, number. 
Octarius, a pint. 
Seme/, once. 
Simtd, together. 
Statim, at once. 
Ter, thrice. 
Quater, four times. 



IN MOST FREQUENT USE. 

Ad saturandum, to saturation. 
Numero, to the number of. 
Quantum sufficiat, as much as necessary. 
Pro re nata, according to need. 
In partes cequales, into equal parts. 
Redactus hi ptdverem, let be pulverized. 
Secundum artem, according to art. 
Non repetatur, let it not be repeated. 



Apomorphine. 

R . Apomorphinae Hydrochlor., gr. j. 

Div. in pulv. xvj. One to four in Tt\xx 
of water as required. 



HYPODERMIC FORMULA. 

Coniine. 
R 



R 



Atropine. 

. Atropine Sulphatis, . . . gr. j. 

Aquae Destillatae, .... £]. 
Solve. Sig. — For hypodermic use, Tt\vj 



Caffeine. 



B 



. Caffeinae Citratis, . . 

Aquae Destillatae, . . . 
Solve. Sig. — VC^xx contain gr. j 



gr. xxiv, 

Si- 



Carbolic Acid. 

R. Ac. Carbol. Purif., . . . gr. x. 

Aquae Destil., ^j. 

M. Sig. — rr^viij contain gr. y& of the 
acid, which may be given up to gr. ij or iij. 



Chloral. 



B 



Chloralis Hydratis, . . . £iv. 

Aquae Destil., ^j. 

M. Sig. — rr^xxx contain gr. x 
Chloral Hydrate. 



of 



Chloroform. 



R. Chloroformi Purif., . . . ^ss. 

Sig. — n\v-xv can be used as one deep 
injection. (See page 264.) The spirit is 
safer, in somewhat larger doses. 

57 



Coniinae Hydrobromat., . gr. j. 
Aquae Destillat., . . . . |j. 



M. Si 



Cocaine. 



. Cocainae Hydrochlorat., . gr. 
Aquae Destillatae, . . . . gij. 
Solve. Sig. — rr^xij contain gr. ss. 



Curare. 

R . Curare (Merck), . . . . gr. j. 

Acidi Acetici, rr^v. 

Aquae Destillatae, q. s. ad n\c. 
M. et filtra. Sig. — tt\x contain gr. ^. 



R. Curarinae Sulphat., . . . gr. j. 
Aquae Destillat. , . . . . J ss. 
M. Sig. — mTv contain gr. J^. 



Daturine. 



B 



Daturinae, 



gr. ss. 



Aquae Destil., 5j. 

Solve. Sig. — rr\jv contain gr. ^ixr- 
Dose, n\iv-x. 



Digitalin. 



B 



gr. ss. 



Digitalini, 

Alcoholis, 

Aquae Destil., aa^ij. 

Solve. Sig. — nyx contain gr. T ^. 
Dose, Ttyv-viij. 



< 



8 9 8 



HYPODERMIC FORMULAE. 



Duboisine. 

R. Duboisinae Sulphat., . . . gr. j. 

Aquae Destil., ^j. 

M. Sig. — TTLiv contain gr. ^o- 



Ergot and Ergotin. 

R . Extr. Ergotae Fluid. , . . . 
Filtra. Sig. — Dose, TT^x. 



R . Extracti Ergotae (Squibb), ^j. 
Aquae Destillat., . . . . ^j. 
Solve et filtra. Sig. — rr\,x contain gr. 
Dose, rr^x-xx. 



R. 



M 



Hyoscine, Hyoscyamine. 

Hyoscinae Hydrobrom., vel 
Hyoscyaminae Hydrobrom. , gr. j. 
Aquae Destillatae, . . . . Jjj. 
Sig. — TT^v contain gr. -^g. 



Mercury. 

R. Hydrarg. Chlor. Corr. , . gr. j. 
Aquae Destillat. , .... 5jj. 
M. Sig. — Tl\x contain gr. ^. 



R. 



Hydrarg. Chlor. Corrosivi, 


Ammonii Chloridi, 


. aa gr. nj. 


Misce et solve in — 




Aquae Destillatae, . . 


. . 3JSS. 


Dein adde — 




Albuminis Ovi, . . . 


. . 3jss. 


Aquae Destillatae, . . 


• • 3 V - 


Filtra, et adde — 




Aquae Destil., . . q. 


s. ad g x. 


Sig-— TT\j con tain sgr. ^ 


Dose,lTLiij-x 



R . Hydrarg. et Sodii Iodidi, . gr. iij. 
Aquae Destillatae, .... giijss. 
Solve. Sig. — TT^x contain gr. %. . Dose, 
rr^x every second day. 



R 



Morphine. 

Morphinae Sulphatis, . . . gr. xvj. 
AcidiCarbolici, TT\^iij _ 

Aquae Destillat., . . . . gj. 
Solve et filtra. Sig. — TT^vijss contain 
gr. %. {Antiseptic Magendie 1 s Solution.') 



Morphine and Atropine. 

R. Morphinae Sulphatis, . . . gr. xvj. 
Atropinae Sulphatis, . . . gr. ss. 

Acidi Carbolici, ^"j- 

Aquae Destillat., . . . . ^j. 
Solve et filtra. Sig. — TTLvijss contain gr. 

\l of Morphine Sulph., and gr. ^fo oi " 

Atropine Sulphate. 



R . Morphinae Sulphatis, . . . gr. xxiv, 

Atropinae Sulphatis, . . . gr. j. 

01. Amygdalae Amar., . . gtt. j. 

Aquae Destillat., . . . . ^ij. 

Solve. Sig. — TT^x contain gr. ^ of 

Morphine Sulphate, and gr. ■£% of Atropine 

Sulphate. (Didama's Solution.) 



R 



Physostigmine (Eserine). 

Physostigminae Sulph., . . gr. j 
Aquae Destillatae, .... |jj. 
Solve. Sig. — Tt\viij contain gr. ■£$. 



R. 



R. 



Pilocarpine. 

. Pilocarpinae Hydrochlor. , . 
Aquae Destillat., . . . . 
M. Sig. — rr^v contain gr. */£ 


gr. xvj 


Potassium Iodide. 

. Potassii Iodidi, 

Aquae Destillatae, . . . . 
Solve. Sig. — Dose, Tt\vj-xx. 


Si- 

3 iv. 



Quinine. 



R 



Quininae Disulph., . . . gr. 1 (50)- 
Ac. Sulphurici Dil., . . TTLc(loo). 

Ac. Carbolici, TT^v (5). 

Aquae Destillatae, . . . ^j. 
Solve. Sig. — 3J contains gr. vj. i^Lente.) 
Is irritant (B). 



R. Quininee Hydrobrom., . . gr. xlviij. 
Aquae Destillat., . . . . giv. 
Solve. Sig. — Ti^xx contain gr. iv. 



R. Quininae Bimur. Carbamidat., 
Aquae Destillatae, . . . aa^iv. 
Solve. Sig. — Y([x contain gr. v. 



Strychnine. 



R 



Strychninae Sulphat. , . . . gr. j. 
Aquae Destillatae, .... ^j. 
Solve sine alcohol. Sig. — rr^x contain 



R . Strychninae Nitratis, . . . gr. iij. 

Aquae Fervid., £x. 

Solve. Sig. — TT^x contain gr. ^V 

{Portugaloff.) 



PATENT MEDICINES. 



8 99 



PATENT MEDICINES. 

These formulae have been published from time to time in various journals and formu- 
laries, and are supposed to represent the preparations designated. The name of the 
author is appended in each case when known. 



Alcoholic Strength of Quack Bitters. 

Hostetter, 43. 20 

Drake Plantation, 30.24 

Rush, 34. 20 

Peruvian, 22.40 

Hoofland, 20.85 

Oxygenated, I 9- 2 3 

California Wine Bitters, 18.20 

Walker's Vinegar Bitters, 7.20 



Amick's Consumption Cure. 

The Amick advertisements appeared 
shortly after the publication of Dr. N. B. 
Shade's paper in this and other journals. 
Amick copied Shade's language, speaking 
of the " chemical " cure, etc., and, I believe, 
adopted Shade's methods of treatment. 
These were fully described by Shade, and 
consist in the use of Calomel, Iodoform, 
Guaiacol, etc. 

[Dr. Waugh, in Times and Register.} 



Ayer's Ague Cure. 

This, according to Churchill's analysis, is 
alleged to consist of a syrupy tincture of 
Peruvian Bark with Aromatics, each bottle 
holding six fluid ounces, and each fluid 
ounce containing 3.2 grains of amorphous 
Cinchona alkaloids, 3 grains Cinchonine, 
0.7 grain Cinchonidine, 0.8 grain Quinine, 
and one grain of Quinidine. 



Ayer's Cherry Pectoral. 



Morphinse Acetat., 



Vini Antim. et Potass. Tartrat. 



gr. iij. 



Vini Ipecacuanhas, . 
Tinct. Sanguinarise, 
Syr. Pruni Virginian. 



aa^in. 

. ^ iij. 



Ayer's Pills. 



Consist of Colocynth, Gamboge and 
Aloes, coated with Starch and Sugar. 



Ayer's Sarsaparilla. 

Alcohol, 

Fl. Extr. of Sarsaparilla, 
Fl. Extr. of Stillingia. . aa 
Fl. Extr. of Yellow Dock, 
Fl. Extr. of Podophyllum, aa 

Sugar, 

Potassium Iodide, .... 
Iodide of Iron, 



3 iij. 



3jss. 
gr. x. 



Mix. 



Brandreth's Pills. 

Podophylli Radicis, . . 
Extracti Podophylli, . . 
Extr. Phytolacca Baccse, 
Pulv. Caryophylli, . . . 

Cambogioe, 

01. Menthse Piperitse, 

Croci, 

Misce, fiat massa, et div. in pil. xxiv. 
[Hage 



• gr- 


X. 


• g r - 


X. 


• g r - 


XXX 


• g r - 


X. 


• gr- 


Ij-V 


• *uij. 


• gr- 


"• 



Castoria. 



Senna, 

Pumpkin seed, . . 

Rochelle salts, . . 

Wormseed, Levant, 

Sodium Bicarbonate, 

Anise Seed, .... 

Oil of Gaultheria, . 

Oil of Peppermint, .... dr. 

Sugar, av. oz. 

Water, enough to make . . fl. oz. 16. 

Exhaust the vegetable drugs by boiling 

with water, evaporate to the proper volume, 

and dissolve the sugar and other ingredients. 

[Western Druggist.) 



av. oz. 2. 

dr. 6. 

dr. 4. 

dr. 3. 

dr. 2. 

dr. I. 

dr. V 2 



8. 



Chlorodyne, Collis Browne's. 

Morphine Hydrochlorate, . gr. 6. 

Chloroform, dr. 6. 

Cannabis Indica, . . . , gr. 6. 

Prussic Acid (Scheele's), . TT^ 6. 

Treacle, to make, . . . . oz. I. 

Dose. — 10 to 30 minims. [Hygiene. 



I 



900 



PATENT MEDICINES. 



Clarke's Blood Mixture. 

Potassium Iodide, . . . . gr. 48. 

Chloric Ether, dr. 4. 

Liquor Potassse, Tt\, 30. 

Water, colored with Burnt 

Sugar, oz. 7^. 

Dose. — One tablespoonful four times a 
day. [Hygiene.') 



Ely's Cream Balm 

consists of Vaselin, I ounce ; Thymol, 3 
grains ; Bismuth Carb., 15 grains ; Oil Win- 
tergreen, 2 minims. The directions are to 
dip the little finger into the balm and insert 
up the nostrils, giving two or three full 
inhalations. {Medical Record.) 



Garfield Tea 

consists chiefly of Senna leaves and Couch- 
grass (Triticum), with aromatics. 

{Prof. Lengfield.) 



Hamburg Tea. 

Sennae Foliorum, . . . . pt. viij. 

Mannse, pt. iv. 

Coriandri, pt. j. 



Hamlin's Wizard Oil. 

Spt. Camphora?, J;j. 

Spt. Ammonise, 

Olei Sassafras, ... aa 3jss. 

Olei Caryophylli, . . . . 3 i j . 

Chloroformi, 

Olei Terebinthinse, . . aa ^ss. 

Alcoholis, . . *. q. s. ad %\. 



Helmbold's Buchu. 

Said to resemble the genuine. 

Short Buchu, oz. 9. 

Uva Ursi, oz. 4^. 

Liquorice root, ... . dr. 10. 
Macerate in 9 pints of boiling water, 
strain and add — 

Caramel, oz. 2. 

Molasses, oz. 8. 

Mix well and add — 

Cubeb (fluid extract), . . oz. 5. 

Alcohol, pints 2. 

Peppermint Oil, oz. 1. 

Water, sufficient to make, . pints 12. 

{Lillard's Prac: Hints and Formula.) 



Holloway's Ointment. 

Has in 159 parts — 

Olive Oil, 62^ parts. 

Lard, 50 

Resin, 25 

White Wax, \2.\ 

Yellow Wax, 3 

Turpentine, 3 

Spermaceti, 3 



Holloway's Pills. 



Have in 144 pills- 
Aloes, . . . . 
Rhubarb, . . . 
Saffron, . . . 
Glauber's Salt, 
Pepper, . . . 



. gr. 62. 
. gr. 27. 

• g r - 3- 

• g r - 3- 

• gr- 7- 
{Dorvalt.) 



Hostetter's Bitters. 

Sacchari Albi, 
Aurantii Corticis, 
Calami, 
Cinchonse, 

Gentianse, aa ibj. 

Rhei Pulv., E 1V ' 

Cinnamomi, ^ij. 

Caryophylli, ^j. 

Alcoholis Diluti, C ij. 

{Med. Bulletin, 1884.) 



The Keeley Gold Cure. 

The hypodermic injection, administered 
4 times daily for 3 weeks, contains Strych- 
nine (or Brucine) and Atropine (or Hyos- 
cine), with Codeine and Cocaine for the 
opium cases. The whiskey supplied to the 
victims contains about gr. -gL of Apomor- 
phine to each average drink. The " cross- 
shot " is an injection of Apomorphine. The 
"tonic" contains — 

Ammonium Chloride, . . gr. j. 

Aloin, gr . ij - 

Tinct. Cinchona? Comp., . jfiij. 

Water, to make, ^iv. 

{N. Y. Med. Record.) 



Laville's Gout Mixture. 



Calcium Chloride, Chino 






din, of each, . . 




grm. 


5- 


Extract of Colocynth, 




grm. 


2-5- 


Water, 




grm. 


»5- 


Alcohol, 




grm. 


100. 


Spanish Wine, . . 




grm. 


800. 


Made into a solution. 


A 


pill of very 


complicated composition is 


used in connec- 


tion with the gout remedy. 




{Hager. ) 


[See also page 285 , ante 


•] 







PATENT MEDICINES. 



901 



Morrison's Pills. 

Powdered Colocynth, . . . gr. 3. 

Powdered Gamboge, . . . gr. 6. 

Powdered Aloes, . . . . gr. 9. 

Cream of Tartar, . . . . gr. 12. 
Also syrup enough for 12 pills. Serious 
results are often produced by large doses of 
these pills. 



Orange Blossom. 

Zinc Sulphate, .... 

Alum, 

Expr. Oil of Almond, 

Extract of Hyoscyamus, 

White Wax, 

Oil of Theobroma, . . . 
Made into oblong suppositories, one inch 
long, one and a half wide and half an inch 
thick, weighing 32 grains each. 



• gr- 


60. 


• gr- 


15. 


• gr. 


90. 


• gr- 


I. 


• gr- 


30. 


• gr- 


180. 



Perry Davis's Pain Killer. 

Tinct. Capsici, 5j. 

Spt. Camphorae, 31J. 

Guaiaci Resinae, ^ ss. 

Alcoholis, ^iij. 

Tinct. Myrrhae, q. s. ut coloretur. 



Pierce's Favorite Prescription. 

Sabinae, Cinchonae, 

Agarici Albi, aa^ij. 

Cinnamomi, gr. xv. 

Coq. in aq. suff. et ft. decoct. ^ viij. 
Deinde cola, et adde — 

Sacchari Albi, ^ ss. 

Acaciae, ^j. 

Solve, et addantur — 

Tinct. Opii Deodorat., 

Tinct. Digitalis, . . . . aa^ss. 

01. Anisi, gtt. viij, in Alco- 
holis, ^j ss - 

Misce. [Hager 

Pierce's Golden Discovery. 

Ext. Lactuci, gj. 

Mellis, '%]. 

Tinct. Opii Deodorat., . . gss. 
Alcoholis Diluti, 

Aquae, aa^ iij. 

[Hager, 



Radam's "Microbe-Killer." 
Oil of Vitriol (impure),. . dr. 4. 
Muriatic Acid (impure), . dr. I. 

Red Wine, oz. I. 

Water, gall. I. 

{Eckels. 



Radway's Ready Relief. 
Tinct. Capsici, 
Aquae Ammoniae, 

Alcoholis, aa ^j. 

Linimenti Saponis, . . . ^iij. 

______ ( Hager. ] 

Radway's Resolvent. 
Vini Zingiberis, 
Vini Cardamomi, . . aa ^iij. 

Sacchari Albi, q. s. 

[Hager. ] 



Recamier Balm 


. 






Zinc Oxide, . . . 




lbs 


S- 


Glycerin, .... 








dr. 


2. 


Alcohol, .... 








oz. 


2. 


Mercuric Chloride, 








oz. 


4- 


Distilled Water, . 








qts 


64. 




(^ 


3oston 
am. 


He> 


raid.) 


Recamier Cre 




Rice Flour, . . . 




oz. 


48. 


Zinc Oxide, . . . 


. 




oz. 


60. 


Glycerin, ... 






oz. 


640. 


Cacao Butter, . . 






oz. 


48. 


Lard, 






oz. 


48. 


Mercuric Chloride, 






oz. 


4- 


Make 32 pints. 


[Bostot 


Herald.) 



Revalenta Arabica Food. 

Consists solely of Lentils ground up into 
a fine powder. [Stokes in " Hygiene. ") 

Sage's Catarrh Remedy. 
Salis Culinaris(Sodii Chlor.) , partes xx. 
Pulv. Camphorse, .... part. j. 

Acidi Carbolici, part. j. 

M. — To be dissolved in water and either 
injected or sniffed up the nose. 



Pulv. Hydrastis Canadensis, partes v. . 

Pulv. Indigo, part. ss. 

Pulv. Camphorae, 

Acidi Carbolici, . . . . aa partes ij. 

Sodii Chloridi, partes 1. 

[New Remedies.) 

Sanford's Catarrh Cure. 
According to an analysis made by Prof. 
A. B. Lyons for the New Idea, this prepa- 
ration is composed of distilled extract of 
Witch-hazel, containing a little Alcohol and 
Glycerin and some Morphine. The pro- 
portions of the constituents were not de- 
termined. {Nat. Druggist.) 



Seigel's (Mother) Syrup. 
Contains Aloes, gr. 30 to the oz. Also 
Borax, Capsicum, Liquorice, and Treacle. 
[Stokes in "Hygiene") 



902 



PATENT MEDICINES. 



Sequah's Oil. 

,„ Fish 

Oil, scented with a few drops of Oil of 
Camphor. {Stokes in "Hygiene") 



Sequah's Prairie Flower. 
Has to the ounce — 

Aloes, gr. 52^. 

Carbonate of Soda, . . . gr. 17^. 

Water, gr. 362^. 

and a few drops of the Tinctures of Capsi- 
sum and Myrrh. [Stokes in "Hygiene") 



St. Jacob's Oil. 

Gum Camphor, 

Chloral Hydrate, 

Chloroform, 

Sulphuric Ether, . 

.Tinct. of Opium, 

Oil of Origanum, 

Oil of Sassafras, . 

Alcohol, . . . 

Dissolve the Gum Camphor in the Oils 

and Alcohol, then add the other ingredients. 

Squibb says that it is a weak Aconite 

Liniment, also containing Ether, Alcohol, 

Turpentines,red coloring matter, and water. 

[Ephemeris, p. 114.) 



of each, oz. 1. 



of each, oz. 
• . . . 2fal. 



Swift's Specific, " S.S.S." 
Fluid Extr. of Smilax Sarsaparilla, 16 parts. 
Fluid Extr. of Stillingia Sylvatica, 16 parts. 
Fluid Extr. of Lappa Minor, . . 16 parts. 
Fluid Extr. of Phytolacca, . . . 16 parts. 
Tinct. of Xanthoxylum, .... 8 parts. 
[Registered Pharmacist.) 
Stearns' New Idea gives the following : 
Stillingia, Pokeroot, and Sarsaparilla, with 
Nitrate of Potash and a small quantity of 
Iron, and enough Alcohol to preserve it. 



Tamar Indien. 

According to the Repo.rt de Pkarmacie, 
the formula for this preparation is as fol- 
lows : — 

Tamarind (pulp), 450; powd. Sugar, 
40 ; powd. Sugar-of-milk, 60 ; pure Gly- 
cerin, 50 (all parts). Mix and evaporate 
to the consistence of a soft extract, then 
add powd. Anise, 10 ; Ess. Lemon, 3 ; Tar- 
taric Acid, 3 (all parts). Mix and divide 
into 100 boluses. Roll in the following 
mixture : Cream of Tartar, 5 ; White Sugar, 
35 ; Sugar-of-milk, 35 ; Tragacanth, 2 ; 
Tartaric Acid, 2 ; powd. Red Sandal, 25 
(all parts). Dry and put up in tin foil. 

[American Druggist. ) 



Thompson's Eye-Water. 


Copper Sulphate, . . 


. gr. 10. 


Zinc Sulphate, . . . 


. gr. 40. 


Rose-water, .... 


. pints 2 


Tincture of Saffron, . 


. drm. 4 


Tincture of Camphor, 


. drm. 4. 


Mix and filter. 





Van Buskirk's Sozodont. 

Saponis Albi, 3 ss. 

Alcoholis, ^j. 

Aquae, . . . gvj. 

Glycerini, spj. 

Olei Gaultheriae, 
Olei Caryophylli, 
Olei Menthae Piperitae, 

aa q. s. ad saporem grat. 
Cocci Cacti, q. s. ut coloretur. 



Calcis Praecipitat. , 
Magnesii Carbonatis, 
Iridis Florent. Radicis, . aa p. aeq. 
M. et triturat. [Hoffmann.) 



Vita Nuova. 

Cocaine, gr. 8. 

Pepsin (golden scale), . . gr. 48. 

Port Wine, gall. I. 

[Boston Herald.] 



Walker's Vegetable Vinegar Bitters. 

Aloes Socotrin, £ij. 

Guaiaci Resinae, % iv. 

Sassafras Mucil., . . . . ^j. 

Aceti, 3 ij- 

Aquae, . . . q. s. 

Coque, et ft. decoctum, ad ^ xix, 
deinde cola, et addantur — 

Sodii Sulphatis, . - . . . ^j. 

Acaciae, 3 ij. 

Spt. Anisi, 10 p. c, . . . Zij. 

Alcoholis, §j. 

M. Dose, ^ij. [Eberbach.) 

Warner's Safe Kidney and Liver Cure. 
In Germany each maker of patent medi- 
cines must furnish the government with 
the formula for the patent he makes. This 
is the one furnished by Warner for 
Kidney and Liver Cure." Each 
contains : — 

Extr. Lycopus Virginiana, 

Extr. Hepatica (herb), 

Extr. Gaultheria, . . 

Potassium Nitrate, . . 

Alcohol (90%), . . . 

Glycerin, 

Water sufficient to make one pint. 
[Formulary and Druggists' Magazine.) 



" Safe 
bottle 

308. 
322. 

VA- 

39- 
10. 



DIFFERENTIAL DIAGNOSIS. 



903 



TABLES OF DIFFERENTIAL DIAGNOSIS. 



Forms of Bright's Disease. 

Compared with Acute Nephritis and with each other. 







'u 
a 

3 



< 


(1) Acute 

Bright's 

Disease. 

Acute 

Parenchy. 

Nephritis. 


Chronic Bright's Disease. 


Clinical 
Phenomena. 


(2) Chron. 
Parenchy. 
Nephritis. 
{Large 
White 
Kidney.) 


(3) 

Fatty 

Kidney. 


(4) 
Amyloid 
or Waxy 
Kidney. 


(5) Chron. 
Interstitial 
Nephritis. 
( Cirrhotic 
Kidney.) 


g 




Quantity, . . . 


Normal 
or — 


- 


-or + 


Normal 
or — 


Normal 

or + 


Normal 

or + 


Reaction, . . . 


Acid. 


Acid. 


Acid. 


Acid. 


Acid. 


Acid. 


Color, 


Wine 

yellow. 


Dark 

smoky. 


Brown 

yellow. 


Pale. 


Pale. 


Clear. 


Sp. Gr., .... 


Normal 
or — 


High. 


- 


1.015-1.030 


— , above 

1. 010 


— 1. 010 


Urea, ..... 


Normal. 


— 


- 


- 


Normal 
or — 


Normal. 


Chlorides, . . . 


Normal. 


- 


- 


- 


Normal. 


Albumin {per 
cent.), .... 


To tO £ 


1 to 6 


y 2 to 2 


1 to 6 


A to % 

of 
globulin. 


vs to y z 


Casts, 


Hyaline 

and 
Epithel. 


Blood 
Epithel. 
Hyaline. 


Granular 
Hyaline. 
No blood. 


Fatty. 


Few and 
Hyaline. 


Very few. 


Sediment (ma- 
{croscopical), 


Mucus. 
Blood. 


Brown 

cells. 

Urates. 


Kidney 

epithelium. 

Blood. 

Lymph. 


Free oil. 


Seldom 

any. 


Seldom 
any. 


Dropsy, 


Seldom. 


Great, 

especially 

of face. 


Never 
absent. 


Great. 


Trifling. 


In last 
stages. 


Uremia 




Often 
great. 


Not 
marked. 


Rare. 


Rare. 


Great. 


Other Symptoms, 


Still. 

joints. 

Sacral 

pain. 

Lassitude. 


Fever. 


Tempera- 
ture low. 
No fever. 
Inflam. of 

serous 
membr's. 
Cardiac 

hyper. 


Face pale, 

puffy. 

Cardiac 

hyper. 


Emacia- 
tion, sal- 
low face, 
enlarged 
liver and 
spleen, 
thirst, 
diarrhea. 


Retinitis. 
Tense, 
quick 
pulse. 

Hyper, of 
heart. 


Prognosis, .... 


Favorable. 


Recovery 
or No. 2. 


Recovery 
(?) or No. 3. 


Always 
fatal. 


Depends 
on con- 
stitutional 
disease 
present. 


Un favor- 
able, but 
course 
perhaps 
long. 



Note. — The signs + and — in the line entitled Sp. Gr., respectively denote a specific gravity 
greater than 1.024, or less than 1.018. 



9°4 



DIFFERENTIAL DIAGNOSIS. 



Cancer. 



Cancerous {Alalignanf) Tumor. 



Are of constitutional origin. 

Have no cyst, but invade and convert the 

surrounding tissues. 
Cancer material is short-lived from rapid 

deterioration, but is rapidly reproduced. 
Severe increasing pain. 
Extend to remote parts, reappearing chiefly 

in lymphatic glands. 
Cancerous cachexia of general health. 
Recur after extirpation, fatal in end. 



Non-malignant Tumors. 

Origin, some local error of growth. 
Limited by a cyst ; may compress, but do 

not invade adjacent tissues. 
Have uncertain period of increase, after 

which may remain stationary. 
Usually no pain. 
Are local, have no disposition to spread. 

Impair functions of part pressed on. 
Do not recur. 



Scirrhus. 

Is hard. 

Appears mostly on female breast. 

Hard kernel, movable under skin. 

Becomes fixed to adjoining structures, 

which it puckers. 
Single and grows slowly. 
Course slow — 2 to 4 years. 
Never in the young. 



Encephaloma. 

Is soft and brain-like. 

Most frequently on the limbs. 

At first deeply seated, hard to recognize. 

Spreads through loose textures, which it 

pushes aside and distends. 
Has numerous tumors, grows rapidly. 
Generally fatal in I to 2 years. 
Often in the young, even at birth. 



Carditis, Endo- and Peri-. 

Endocarditis. Pericarditis. 



Blowing sound. Excited heart action. 
Slight if any increase of percussion dullness. 
Impulse strong. 

Sounds normal or more distinct except at 
site, where a murmur is heard. 



Friction sound. Excited heart action. 
Marked increase in effusion stage. 
Wavy and feeble. 
Feeble and muffled ; no blowing sounds. 



Cerebral, 



Concussion. 

Patient can be roused ; pupils react. 
Breathing seldom stertorous. 
Urinary action normal. 
Symptoms appear soon after accident. 



Compression. 



Complete insensibility ; motionless pupils. 
Breathing usually stertorous. 
May be either retention or incontinence. 
Frequently do not. 



Chancre and Chancroid. 



Chi 



Commences about 3d week after coitus. 
First as a papule, abrasion, or crack. 

Generally indurated (rarely not). 

Develops slowly. 

Discharge slight, unless irritated. 

Is soon limited and seldom phagedenic. 

Edges sloping, not undermined. 

Scanty serous secretion. 

Sore remains solitary, and cannot be multi- 
plied. 

Followed by numerous buboes, rarely sup- 
purating, never furnish inoculable pus. 



Chancroid, 



In 24 hours to 3 days. 

First as a red spot, then a pustule, then a 
suppurating sore. 

Not on an indurated base. 

Develops rapidly. 

Suppurates profusely. 

Tends to invade surrounding tissues, or be- 
come phagedenic. 

Edges undermined. 

Discharge is purulent and copious. 

May be transplanted at will, and is seldom 
single. 

A single bubo may appear and suppurate. 



DIFFERENTIAL DIAGNOSIS. 



905 



Cholera. 



Asiatic. 
Preceded by painless diarrhea. 
Not directly from error in diet. 
First pain shooting down thighs. 
Prostration rapid and overwhelming, and 

out of ratio to evacuations. 
Rapid reduction of surface temperature ; 

high temperature in cavities. 
Evacuations like rice-water from the first. 

Cramps commence in extremities. 
Veins congested ; tongue, lips and extremi- 
ties livid purple. 
Urine albuminous. 



Simple. 
Seizure sudden. 
Generally is from error in diet. 
First pain is abdominal (colic). 
Prostration gradual, less marked than the 

vomiting and purging. 
Gradual reduction of surface temperature ; 

internal temperature normal. 
Discharges bilious, causing burning and 

smarting pain ; colorless only at very last. 
Cramps commence in abdomen. 
Not so. 

Not so. 



Croup and Diphtheria. 



Croup. 

Premonitory hoarse, metallic cough, with- 
out illness. 

A child's disease. 

Tenacious mucus covering the swollen 
membrane. 

A local disease. 



Diphtheria. 

Premonitory illness, marked by chills, fever 
and sore throat, without cough. 

Attacks adults as well. 

Distinguished by a false membrane, and 
the Klebs-Loeffler bacillus. 

A blood poison ; great general depression. 



Epilepsy and Hysteria, 



Epilepsy. 

Loss of consciousness is sudden, complete. 

Livid face, frothy saliva escapes, eyelids 
half open, eyeballs rolling, teeth grind- 
ing, tongue biting ; more or less insensi- 
bility of pupils to light. 

Countenance is distorted. 

Patient shows no feeling. 

Aura epileptica may precede attack. 

Short paroxysm, followed by heavy coma- 
tose sleep and dull intellect. 

Frequently occurs at night. 

Not necessarily of uterine connection, 
though a paroxysm often occurs at the 
menstrual period. 



Hysteria. 



Gradual and partial or apparent. 

Face flushed, or complexion unaltered, no 
froth on lips, eyelids closed, eyeballs 
fixed, no grinding of teeth, or biting of 
tongue; pupils react readily. 

Is not. 

Sighs, or laughs, or sobs. 

Globus hystericus. 

Longer paroxysm ; patient not sleepy, usu- 
ally wakeful and depressed in spirits. 

Rarely occurs at night. 

Often connected with uterine or menstrual 
disorders. 



Gout and Rheumatism. 



Gout. 



Affects chiefly the small joints, especially 

the metatarsal joint of the great toe. 
Occurs from 35-50 years of age ; rarely 

before puberty. 
Most frequent in men, and often the result 

of idle, intemperate and luxurious life. 
Is strongly hereditary. 
Chalk-stones (sodium urate) in external 

ear, on tips of fingers, or elsewhere. 
Uric Acid in the blood, absent from urine. 
A fit often affords temporary relief. 
Bronchitis common. 
Is confined to the temperate zone. 



Rheumatism. 
Large joints chiefly implicated. 

Occurs generally in young adults. 

Affects both sexes equally, and equally the 

poor and the rich. 
But slightly so. 
Not so. 

Lactic Acid in the blood. 

Quite the contrary. 

Not so. 

Is ubiquitous — prevails in all climates. 



906 



DIFFERENTIAL DIAGNOSIS. 



Pleurisy and 

Pleurisy. 

Sharp pain, friction sound, dry cough, im- 
paired chest motion. 

In stage of effusion, obliteration of inter- 
costal spaces, enlargement of the side, 
viscera displaced. 

Dullness, with enfeebled or absent respira- 
tion, voice, and fremitus. 

Sputa frothy, rarely any rales. 
Febrile symptoms slight usually. 
Temperature irregular, rarely high. 



Pneumonia. 

Pneumonia. 

Dull pain, crepitant rale, cough followed 

by expectoration. 
In stage of hepatization none of these signs 

are present. 

Dullness, with marked bronchial respira- 
tion, distinct thoracic voice, increased 
vocal fremitus. 

Sputa rusty color, rales common. 

Febrile symptoms severe. 

Sudden elevations and falls, high tempera- 
ture not uncommon. 



Scarlet 

Scarlet Fever. 
Incubation, I day to weeks. 

Fever, great heat of skin, 
and frequent pulse, un- 
abated during eruption. 

Brilliant stare. 
Sore throat, rarely coryza 
or bronchitis. 

" Raspberry " tongue, red. 

Temperature may be 105 - 
106 to loth day, subsides 
gradually, falls on 5th, 
loth, and 15th days. 

No secondary fever. 

Eruption on second day, not 
rough, first on neck and 
chest, spreads rapidly, 
white streak on pressure 
with nail. 

Eruption uniform, or in 
large patches, inter- 
spersed raised spots and 
some vesicles ; rash scar- 
let, on its seventh day 
very complete desquama- 
tion in large patches. 

Cerebral symptoms are fre- 
quent and grave. 

Pneumonia rare, pleurisy 
more frequent. 

Sequelae : Bright's disease, 
dropsy ,deafness, conjunc- 
tivitis, phthisis, chronic 
diarrhea; glandular en- 
largements. 



Fever, Measles and 

Measles. 
Incubation, 7 to 14 days. 

Same fever rather increased 
by eruption. 



Liquid, watery eye. 
Coryza and bronchitis very 

constant, sore throat 

rarely. 
Tongue coated, may be red 

at edges. 
I03°-io6° before eruption, 

remains high for I to 2 

days thereafter, then falls 

suddenly. 
No secondary fever. 

Eruption on fourth day, on 
face, rough, spreads grad- 
ually, the streak lasts 
only a short time. 

Eruption in crescentic 
patches, lasts about 5 
days, then partial des- 
quamation, scales very 
fine. 



Smallpox. 

Smallpox. 

Incubation, 6 to 20 days, 
average, 10. 

Fever often violent, bound- 
ing pulse, pain in loins ; 
all are greatly relieved by 
eruption. 

Eyes injected, face red. 

Sore throat often, also a dry 
cough. 

Tongue coated, and swollen, 
may be red at edges. 

Before eruption often 106 , 
then rapidly sinks to loo° 
in 36 hours ; rises during 
the secondary fever. 

Secondary fever always. 

Eruption usually on third 
day, at first on lips, fore- 
head and hands, spreads 
rapidly. 

Eruption is first papular, 
then vesicular, finally 
pustular ; pustules matur- 
ate on 8th day of erup- 
tion. 



Not so. 

Pneumonia a frequent com- 
plication. 

Sequelae : chronic bronchi- 
tis, phthisis, conjunctivi- 
tis. 



Cerebral symptoms are fre- 
quently seen. 

Pneumonia not a very fre- 
quent complication. 

Sequelae : chronic diarrhea, 
glandular enlargements, 
various eye diseases. 



DIFFERENTIAL DIAGNOSIS. 



907 



Typhus and Typhoid. 



Typhus Fever, 
Attacks quickly, incubation 9 days. 

Occurs at any age. 

Rare among the higher classes, except 

those exposed. 
Mulberry Eruption on 4th and 5th day, on 

extremities, lasts until the close. 



Brain chiefly affected ; bowels often but 
little so ; abdomen natural, evacuations 
dark, but never bloody (these are occa- 
sionally reversed). 

Contracted pupils, dusky face. 

Pulse and temperature rise to 120 and 105 
until 3d day, high for 6 days, then fall. 

Lasts 2 to 3 weeks. 
Relapses rare. 

Death from coma or congestion of the 
lungs, in 1st or 2d week. 

Arises from destitution, over-crowding, 
bad ventilation, is highly contagious, and 
generally epidemic. No microbe deter- 
mined. 

Post-mortem : changes not constant, the 
most frequent are dark blood, enlarged 
spleen, soft heart. 



Typhoid {Enteric) Fever. 
Commences slowly, incubation about 13 

days. 
Most common in youth and childhood, 

rare after the age of 40. 
As common among the rich as the poor. 

Rose Eruption on 7th to loth day, isolated, 
flattened papules, few, on abdomen and 
back, in successive crops which fade 
and disappear. 

Bowels chiefly affected, evacuations ochre- 
color and watery, sometimes hemorrhage 
or even ulceration, abdomen tumid. 

Dilated pupils, cheeks flushed. 

Pulse and temperature rise and fall inde- 
pendently, and without uniformity, but 
both are usually high to the 15th day. 

Lasts 4 to 6 or more weeks. 

Relapses frequent. 

Death from asthenia, pneumonia, hemor- 
rhage or perforation of intestine, in or 
after 3d week. 

From poisoned drinking water, putrid ani- 
mal matter, bad drainage ; is not conta- 
gious, often sporadic. Eberth' 's bacillus 
present in the intestinal lesions, the 
spleen, liver, blood, etc. 

Post-mortem : morbid Peyer's patches, en- 
larged mesenteric glands, ulcerated mu- 
cous coat of intestines; enlarged and 
soft spleen, ulcerated pharynx. 



Cerebral. 
Little or no nausea, vomiting continues 

after stomach is emptied. 
No tenderness on pressure over the liver or 

stomach. 
Pulse infrequent and hard. 
Tongue clean, breath sweet, conjunctivas 

normal or injected, headache primary. 

Constipation generally obstinate. 
No salivation. 



Vomiting. 

Gastric or Hepatic. 

Nausea relieved by vomiting, returns when 
food is taken. 

Liver and stomach are tender, pressure pro- 
duces inclination to vomit. 

Pulse frequent and weak. 

Tongue furred, breath offensive, conjunc- 
tivae often yellowish, headache secon- 
dary as to time. 

Griping abdominal pain, diarrhea and 
clay-colored stools. 

Increased salivation. 



Yellow and Bilious 

Yellow Fever. 
Duration short, ends in 3 to 7 days. 
Incubation 5 to 9 days. 
A disease of one paroxysm, terminating in 
recovery or collapse. 



Remittent Fevers. 

Bilious Remittent. 
Lasts 9 days or more. 
Incubation may extend to months. 
A disease of several paroxysms, with inter- 
vening remissions. 



< 



908 



SPECIFIC GRAVITIES AND VOLUMES. 



Yellow Fever. 
Very severe nausea and vomiting, early 

epigastric tenderness. 
Black vomit, due to gastric hemorrhage. 
Hemorrhages from various parts. 
Tongue clean, or slightly coated. 
Pulse variable, slow at end. 
Eye injected and humid. 
Supra-orbital pain, pain in back and in 

calves of legs. 
Rarely delirious, mind clear generally. 
Urine albuminous, usually suppressed. 
Convalescence rapid, no sequelae. 
Muscular prostration slight. 
Mortality high, disease epidemic. 
Treatment unsatisfactory. 
Autopsy : inflamed or congested stomach, 

enlarged yellow liver, filled with oil 

globules, muscular fibres of heart are 

often disintegrated. 



Bilious Remittent. 

These symptoms are not so severe, nor do 
they occur so early. 

Bilious vomiting. 

No hemorrhagic tendency. 

Tongue heavily coated. 

Pulse quick until convalescence. 

Eye natural. 

Headache, sense of fullness in head, often 
no loin or leg pains. 

Delirium frequent, mind dull. 

Not so. 

Convalescence slow, tedious sequelae. 

Muscular prostration greater. 

Mortality slight, disease endemic. 

Very amenable to treatment. 

Autopsy : stomach congested, rarely in- 
flamed, liver olive or bronze hue, not 
fatty. 



TABLE OF SPECIFIC GRAVITIES AND SPECIFIC VOLUMES. 

(Temperature at 59 F. , except when otherwise stated. Where the sp. gr. is variable, 
the mean specific gravity is stated.) 



Liquid. 


Specific 
Gravity. 


Specific 
Volume. 


Liquid. 


Specific 
Gravity. 


Specific 
Volume. 


Acid, Acetic, 

Acid, Acetic, Dil., . . . 
Acid, Hydrobromic (34 

percent.), 

Ac. Hydrobrom. Dil., . . 
Ac. Hydrochloric, . . 
Ac. Hydrochlor. Dil., . . 

Acid, Lactic, 

Acid, Nitric, 

Acid, Nitric, Dil., .... 

Acid, Oleic, 

Acid, Phosphoric, . . . 
Acid, Phosphoric, Dil., . 
Acid, Sulphuric, .... 
Ac. Sulphuric, Dil., . . . 
^Ether, 


1.048 
1.008 

1.303 
1.077 
1. 163 
1.059 
1.213 
1.414 

1-057 
.900 
1. 710 
1 -057 
1.835 
1.070 

•725 
.820 
.812 
•937 
•93o 
1. 000 
.960 
.901 
.670 
1.268 
1.490 
1.470 
1.250 
1. 160 
1-387 


•954 
.992 

.767 

.928 

.860 

.952 

.824 

.709 

.946 

1. in 

.584 

.946 

•545 

•934 

1.379 

1. 219 

1.231 

1.066 

1 -075 

1. 000 

1.042 

1. 109 

1-493 

.788 

.671 

.680 

.800 

.862 

.721 


Liq. Ferri Tersulph., . 

Liq. Potassae, 

Liq. Sodae, 

Mel (Honey), .... 
Oleum Adipis, .... 
Ol. Amyg. Expres., . . 
Ol. Aurant. Cort., . . . 
Ol. Bergamottae, . . . 
Ol. Caryophylli, . . . 

Ol. Copaibae, 

Ol. Cubebae 

Ol. Eucalypti, .... 
Ol. Gaultherias, .... 
Ol. Gossyp. Sem., . . . 
Ol. Lavandulae, .... 

Ol. Limonis, 

Ol. Lini, 

Ol. Menthae Pip., . . . 

Ol. Morrhuae, 

Ol. Olivas, 

Ol. Ricini 

Ol. Rosmarini, .... 

Ol. Sassafras, 

Ol. Sesami, 

Ol. Terebinthinae, . . 
Spt. ^Etheris Nitrosi, . 
Spt. Frumenti, .... 
Spt. Vini Gallici, . . . 

Syrupus, 

Vinum Album, .... 


1.320 

1.036 

1-059 

1-375 

.915 

.917 

.850 

' .883 

1.065 

.900 

.920 

.920 

1. 180 

.925 

.886 
.858 
•936 
.910 
.923 
.916 
.960 
.905 
1.080 
.921 
.862 

.839 
.920 

•933 
I.3I7 
1.000 


•757 

•965 

•944 

.727 

1.092 

1. 09 1 

1.176 

1. 132 

•939 

1. in 

1.086 

1.086 

.838 

1. 08 1 

1.128 

1. 165 

1.06S 

1.098 

1.083 

1.092 

1.042 

1.104 

.925 

1. 194 

1.160 

1. 191 

1.086 

1. 071 

•759 
1. 000 


Alcohol, at6o° F., . '. .^ 
Alcohol, at 77 F., ... 
Alcohol, Dil., at6o° F., . 
Alcohol, Dil., at 77 F., . 
Aqua Destil., at 59 F., . 

Aq. Ammoniae, 

Aq. Ammon. Fort., . . 


Carbon Disulphide, . . 

Chloroform, 

Chloroformum Venale, . 

Glycerin, 

Liq. Ferri Acet. , .... 
Liq. FerriChlor., .... 



CHLORODYNE. 



9O9 



CHLORODYNE. 

A Comparison of Ten Formula therefor, the Quantities being calculated 
for each to a Four- Ounce Mixture, or ttl 1920. 







Quantity of each article in a Siv mixture, as per the formula of 


Articles. 


d 

V 

'3 
cr 
en 


i 

w 
a 

C/3 


•M- 

5 

JS 

O 


d 

CO 

5 
(A 


d 

s 


* 
* 

6 
U 

d 




i 


"o 

M 


**T 
u 

w 


% 



M 


U 


Morphine Hydro- 
chlorate, . . . 

Chloroform, . . . 

Ether, 

Cannabis Indica, 
Tincture, . . . 

Cannabis Indica, 
Extract, .... 

Hydrocyanic Acid, 
2 p. c. , . . . . 

01. Menthse Piper- 
itae, 

Capsicum, Fluid 
Extract, .... 

Capsicum, Tinc- 
ture, 

Capsicum, Oleo- 
resin, 

Alcohol, .... 

Hydrochloric 
Acid, 

Sugar, Burnt, . . 

Glycyrrhiza, Ex- 
tract, 

Acacia, Mixture, . 

Tragacanth, Mucil- 
age, 

Theriaca, or Syr. 
Fusci, .... 

Syrup, 

Glycerin, .... 

Water, 


g r - 

"i 
*i 

gr- 
*l 
"I 
TTl 

"I 

m, 

g r - 

gr- 
«l 

"L 

"I 

"I 

"I 

"I 


236 

59 

118 

2 

236 

147 

236 
1033 


16 
192 

96 

192 
6 

290 

384 

760 
760 


16 

240 

32 

16 
4 

810 

818 


3 2 
37 2 

248 

5o 
10 

4 
904 

126 

i26 


33K 

375 
250 

5o 
8 

37 

1010 

62 

128 


14 
207 

207 

42 

7 

7 
690 

760 


16 

240 
120 

20 

90 

7 
120 

30 
20 

903 
150 

240 


'A 

247 

62 

123 
2 

247 
154 

247 
992 


4 
240 

60 

120 
2 

240 
240 

240 

q. s. 


24 
240 

24 
48 

1632 


Morphine Hydro- 
chlor. in ttVxv, . 


gr. 


1 

T2 8- 


X 


H 


X 


X 


1 

To 


% 


1 

T2 8 


1 1 1 

32 1 5 



Note. — See ante, page 261, for remarks on this preparation, and the number of formulae repre- 
senting it. 
* Author of " A Companion to the Br. Pharmacopoeia." 
fSee Hartshorne's " Essentials," 5th ed., p. ** Parke, Davis & Co., Detroit. 



625 

JMade by Eli Lilly & Co., Indianapolis. 
^2d ed., page 430. 



ft Tinct. Chloroformi et Morphinae, B. P. 

g As given by Stokes and Blyth in " Hygiene." 



910 



DROPS IN A FLUIDRACHM. 



TABLE SHOWING THE 
NUMBER OF DROPS IN A FLUIDRACHM 

OF VARIOUS LIQUIDS, ALSO THE WEIGHT OF ONE FLUIDRACHM IN GRAINS. 

(Compare page 535.) 



Liquid. 



Acetum Opii, 
Acetum Scillse 
Acid, Acetic, 
Ac. Acetic, Dil 
Acid, Carbolic 
Ac. Hydrochloric, 
Ac. Hydrocyanic, 
Acid, Lactic, . . 
Acid, Nitric, . . . 
Ac. Nitro-hydrochl 
Ac. Phosphoric Dil 
Ac. Sulphuric, . . 
Ac. Sulph. Aromat. 
Ac. Sulph. Dil., . 
Ac. Sulphurosum, 

yEther, 

Alcohol, 

Aqua, 

Aqua Destillata, . 
Balsam of Peru, . 
Bromine, .... 
Chloroform, . . . 
Copaiba, . . . 
Creosote, .... 
Ext. Belladon. Fl., 
Ext. Buchu Fl., . 
Ext. Digitalis Fl., 
Ext. Ergotae Fl., 
Ext. Ipecac. FL, . 
Ext. Rhei Fl., . . 
Ext. Senegas FL, 
Ext. Valerianae FL 
Ext. Zingib. FL, . 
Glycerin, .... 
Hydrargyrum, 
Liq. Acidi Arsenosi 
Liq. Ferri Chloridi, 



Drops 
in f3j. 
(mix.) 



90 
68 
108 
68 
in 
70 
60 
in 
102 
76 
59 
128 
146 
60 
59 
176 
146 
60 
60 
101 
250 
250 
110 
122 
156 
150 
134 
133 
120 
158 
137 
150 
142 
67 
150 
57 
7i 



Weight 
of f 3j in 
grains. 



61 

57 

58 

55 

59 

65 

54 

66 

77 

66 

57 
101 

53 

58% 

55 

39 

44 

55 

53% 

60 
165 

80 

5i , 

56% 

57 

47% 

62 

60 

60 

61 

62 

49 

48 

68 
760 

55 

72 



Liquid. 



Liq. Iodi Compos., . . 
Liq. Potassae, . . . . 
Liq. Zinci Chloridi, . 
Oleores. Aspidii, . . . 
Oleores. Capsici, . . . 
Oleores. Cubebae, . . 
Oleum Anisi, . . . . . 
Oleum Bergamottae, . 

Oleum Cari, 

Oleum Juniperi, . . . 
Oleum Limonis, . . . 
Oleum Ricini, . . . . 
Oleum Rosae, . . . . 
Oleum Terebinthinae, 
Oleum Tiglii, . . . . 
Spt. ^Etheris Comp., . 
Spt. yEtheris Nitrosi, 
Spt. Camphorae, . . . 

Syrupus, 

Syrupus Acacise, . . . 
Syrupus Ferri Iodidi, 
Syrupus Scillse, . . . 
Syr. Scillae Comp., . . 
Syrupus Senegas, . . 
Tinctura Aconiti, . . 
Tinct. Belladonnas, 
Tinct. Benzoini Comp. 
Tinct. Cantharidis, . 
Tinct. Digitalis, . . . 
Tinct. Ferri Chlor., . 

Tinct. Iodi, ' 

Tinct. Opii, 

Tinct. Opii Camph., . 
Tinct. Opii Deodor., . 
Vin. Colchici Rad., . 
Vin. Colchici Sem., . 
Vinum Opii, 



Drops 
in f5j. 

(mix.) 



63 
62 
89 
130 
120 
123 
119 
130 
132 
148 
129 
77 
132 
136 
104 
148 
146 
143 
65 
44 
65 
75 
102 
106 
146 
137 
148 
131 
128 

150 
148 
130 
130 
110 
107 



Weight 
of f3j in 
grains. 



59 
58 

88 

52 

5i 

52 

54 

46 

50 

49 

47 

51% 

47 

45% 

50 

45 

47 

47 

72 

73 

77 

74 

70 

70 

46 

58 

48 

5i 

53 

53 

47 

53 

52 

54 

55 

54 

55 



WEIGHTS AND MEASURES. 



APOTHECARIES' or troy weight. 

Powid. Ounces. Drachms. Scruples. Grains. 

lb S 5 9 gr. 

1 = 12 = 96 = 288 = 5760 

1 = 8 = 24 = 480 

1 = 3 = 60 

1 = 20 



METRIC WEIGHTS. 



i Milligramme, 
1 Centigramme, 
1 Decigramme, 
1 Gramme, . . 

1 Kilogramme, 



0.001 


= gr- eV 


O.OI 


= gr. £ 


O.I 


= gr. i£ 


I. 


= gr. 15.432 




( fb 2.7 Troy 




\ ft) 2.2 Av. 



apothecaries' or wine measure. 
Gallon. Pints. FV ounces. Fl' dr'ms. Minims. 

o. a fs m 

1 = 8 = 128 = 1024 = 61440 

I = 16 = 128 = 7680 

1 = 8 = 480 

1 = 60 

APPROXIMATE EQUIVALENTS. 

TTljorgr.j, = .06 gramme. 

f5j or 5j, = 4- grammes. 

fsj, = 30. 

Sj, =3i- 

fSj of Glycerin, = 37- 

fSj of Syrups, .-......= 40. 



METRIC CONVERSIONS. 



9 II 



TABLE FOR CONVERTING 
APOTHECARIES' WEIGHTS AND MEASURES INTO METRIC. 

(Adapted from Maisch.) 

[Multiply all grains, or fractions of a grain, by 6479 ( or 648) for the metric equivalent 

in milligrammes. — Potter.] 



Troy Weight. 


Metric. 


Apothecaries' 
Measure. 


Fluid Grammes or Cubic Centimeters. 


Grains. 


Grammes. 


Liquids 

Lighter than 

Water.* 


Liquids of 
Specific 

Gravity of 
Water, f 


Liquids 

Heavier than 

Water.J 




Milligramme. 


m, i 


•055 


.06 


.08 


A 


.OOI 


2 


.IO 


.12 


• J 5 


1 


.0015 


3 


.16 


.18 


.24 


TU 


.002 


4 


.22 


•24 


•32 


2V 


.003 


5 


.28 


•30 


.40 


1 
T-g" 


.004 


6 


•3 2 


•36 


.48 


1 

12 


.005 


7 


•38 


.42 


•55 


tV 
1 

"8 


.006 
.008 


8 
9 


•45 
•5o 


•50 

•55 


.65 
•73 


1 


Centigramme 


10 


•55 


.60 


.80 


6 
1 


.OI 

.016 

.02 

•03 


12 


•65 


•72 


.96 


1 


15 


.80 


.90 


1.20 


J 

1 


16 
20 


.90 
1. 12 


1. 00 

1.25 


1.32 
1.60 


1 

I 


•°5 
.065 

Decigramme. 


25 
30 


1.40 
1.70 


i-55 
1.90 


2.00 
2.50 


2 


•*3 


35 


2.00 


2.20 


2.90 


3 


.20 


40 


2.25 


2.50 


3-3° 


4 


.26 


48 


2.70 


3.00 


4.00 


5 


•3 2 


5o 


2.80 


3.12 


4-15 


6 


•39 


60 (f 3 j) 


3-40 


3-75 


5.00 


7 


•45 


65 


3.60 


4.00 


5-30 


8 


•52 
•59 


72 


4.00 


4-5o 


6.00 


9 


80 


4- 5o 


5.00 


6.65 


10 


•65 


90 (f 3Jss) 


5.10 


5.60 


7-5o 




Gramme. 


96 


5-40 


6.00 


8.00 


15 


I. OO 


100 


5.60 


6.25 


8.30' 


2 °OJ) 


I.30 


I20(f^ij) 


6-75 


7-5o 


10.00 


24 


I.50 


i5o(f3ijss) 


8.50 


9-5° 


12.50 


26 


I.62 


160 


9.00 


10.00 


13-3° 


30(335) 


i-95 


i8o(f 5 iij) 


10.10 


11.25 


15.00 


40 


2.60 


210 (f^iijss) 


II.80 


13.00 


i7-5o 


50 


3.20 


24o(f3iv) 


I3-50 


15.00 


20.00 


6 °(3J) 


3-9o 


3oo (f % v) 


16.90 


18.75 


25.00 


100 


6.48 


3 3 o(f3vss) 


18.60 


20.75 


27.50 


I20(3ij) 


7.80 


36o(f3vj) 


20.25 


22.50 


30.00 


180 


11.65 


420(f3vij) 


23.60 


26.25 


35-oo 


240 ( g ss) 


i5-5o 


48o (f I j) 


27.00 


30.00 


40.00 


300 


19.40 


540 (f 3«) 


30.40 


33-75 


45.00 


360 


23-50 


600 (f 3 x) 


33-75 


37.5o 


50.00 


420 


27.20 


72o(fsxij) 


40.50 


45.00 


60.00 


480 (gj) 


31.10 


840 (f ^xiv) 


47-25 


52.50 


70.00 


960 (Jij) 


62.20 


96o(fgij) 


54.00 


60.00 


80.00 


1000 


64.79 


1000 


56.00 


62.50 


83.00 



* Lighter than water are tinctures, spirits, compound spirit of ether, sweet spirit of nitre, 
fixed and volatile oils. vEther, f 5j = grammes 2.80. 

•f Same as water are waters, liquids, decoctions, infusions, most fluid extracts, and tinctures 
made with dilute alcohol. 

X Heavier than water are syrups, glycerin, a few fluid extracts, and chloroform. Of the latter 
fSj = grammes 5.50. 



INDEX. 

The salts of the metals are usually described in the text under the titles of their metal- 
lic constituents; some few (as the Arsenates, Phosphates, etc.), also the salts of the 
alkaloids and those of active elementary substances (as the Bromides, Iodides, etc.) are 
placed under the titles of their most active constituents. Salts are therefore not men- 
tioned individually in the Index except when their places in the text are exceptional and 
do not come within either of the above rules. 



Abasia and Astasia, 604 
Abbreviations, their use, 545 

Table of, 546, 883 
Abdominal Plethora, 604 
Abies, 430 

balsamea, 503 

canadensis, 431 

excelsa, 430 
Abietic Anhydride, 449, 504 
Abortion, 604 
Abrin, 75, 175 
Abrus, 75 
Abscess, 605 

of the Liver, 733 

Mammary, 605 
Absinthe, 76 
Absinthium, 76 

Absorption by various channels, 67 
Acacia, 76 

Catechu, 251 
Accommodation of the Eye, 29 
Aceta, 565 
Acetanilid, 76 

Ammoniated, 77 

Antidotes and Antagonists, 808 

Compound, 77 
Acetates, — See the titles of their basic con- 
stituents. 
Acetone, 493 

in Urine, Test for, 869 
Acetous Preparations, 565 
Acetum, 80 
Acid, Abietic, 449 

Abric, 75 

Acetic, 80, 129 

Antidotes, etc., 808 

Aconitic, 106, 1 1 1 

Agaricic, 1 18 

Aloe'tic, 141 

Anemonic, 443 

Angelic, 499, 509, 522 

Arabic, 76 

Arsenous, 198 

Antidotes and Antagonists, 810 ' 

58 913 



Acid, Artanthic, 377 
Benzoic, 216, 273 
Boracic, 81 
Boric, 81 
Brassic, 481 
Butyric, 382 
Caffeic, 227 
Calumbic, 238 
Camphoric, 239, 241 
Camphretic, 239 
Capronic, 196 
Caprylic, 196 
Carbazotic, 104 
Carbolic, 83, 272, 291 

Antidotes and Antagonists, 808 

Gauze, 84 

Solution, 84 
Carbonic, 91, 247 

Antidotes and Antagonists, 809 
Carminic, 25, 283 
Caryophyllic, 249 
Caryophyllinic, 249 
Catechuic, 251 
Catechu-tannic, 251 
Cathartic, 479 
Cathartogenic, 479 
Cerotic, 251 
Cetraric, 152 
Chelidonic, 252, 469 
Chromic. 93 
Chrysammic, 141 
Chrysophanic, 268, 459 
Cinnamic, 21 1, 216, 492 
Citric, 367 
Coca-tannic, 277 
Copaibic, 289 
Cresylic, 83, 291 
Cubebic, 295 
Dibromogallic, 97 
Digallic, 95 
Ergotic, 310 
Ergotinic, 310 
Erucic, 481 
Eugenic, 384 



i 



9H 



INDEX. 



Acid, Euonic, 315 
Euphrastic, 315 
Filicic, 203 
Fluoric, 95 
Formic, 382 
Gallic, 95 
Gallotannic, 95 
Gambogic, 238 
Gelsemic, 326 
Gentesic, 327 
Gentianic, 327 
Glycyrrhizic, 330 
Guaiac, 334 
Guaiaconic, 334 
Guaiarec, 334 
Gurjunic, 336 
Gynocardic, 252 
Hydriodic, 353 
Hydrobromic, 221 
Hydrochloric, 97 
Hydrocyanic, 99, IOI, 442 

Antidotes and Antagonists, 809 
Hypophosphorous, 418 
Hypopicrotoxic, 424 
Igasuric, 388 
Ipecacuanhic, 358 
Isobutyric, 522 
Juglandic, 363 
Kinic, 270 
Kinotannic, 270, 365 
Kinovic, 270 
Kinovo-tannic, 270 
Lactic, 101, 397 
Lactucic, 365 
Laricic, 118 
Linoleic, 368 
Lobelic, 370 
Lupulinic, 338 
Maizenic, 526 
Malic, 213 
Mastichic, 377 
Meconic, 397 
Melassic, 462 
Methyl-salicylic, 326 
Mezereinic, 381 
Mineral, 97 

Antidotes and Antagonists, 809 
Morrhuic, 382 
Muriatic, 97 
Myristic, 384 
Nitric, 102 

Nitrohydrochloric, 102 
Nitromuriatic, 102 
Nucleinic, 160 
Oleic, 103, 395 
Ophelic, 254 

Ortho-phenol-sulphonic, 84 
Orthophosphoric, 104 
Oxalic, 50, 612 

Antidotes and Antagonists, 809 
Palmaric, 449 
Palmitic, 395 
Phenic, 83 



Acid, Phosphoric, 104, 382 

Phytolaccic, 423 

Picric, 104 

Picrotoxic, 424 

Pinic, 449 

Piperonylic, 290 

Podophyllinic, 436 

Polygonic, 436 

Protocatechuic, 436, 521 

Prussic, 99 

Punico-tannic, 332 

Pyrogallic, 97, 273 

Pyroligneous, 431 

Quercitannic, 96, 448 

Rhatania-tannic, 96, 365 

Rheotannic, 452 

Rheumic, 452 

Ricinoleic, 455 

Robustic, 333 

Rosolic, 84 

Salicylic, 273, 464 

Salicylous, 465 

Salicyluric, 465 

Sanguinarinic, 469 

Scheele's,99 

Sclerotic, 310 

Sclerotinic, 310 

Silvic, 449 

Sozolic, 84 

Sphacelinic, 310 

Stearic, ill 

Strychnic, 388 

Succinic, 143 

Sulphuric, 104 

Aromatic, 104 

Sulphurous, 105 

Tannic, 95, 325 

as an Antidote, 805 

Tartaric, 106 

Thebolactic, 397 

Tiglinic, 509 

Toxicodendric, 454 

Tropic, 213, 348 

Valerianic, 130, 338, 499, 520 

Vanillic, 521 

Vegetable, 80 

Viburnic, 525 

Xylic, 83 
Acidifiers, Urinary, 64 
Acidity, 606 
Acids, — their action, 29, 80, 97 

as Antidotes, 806 

Antidotes and Antagonists, 808 

Mineral, 97 

Organic, 25 
Acne, 606 

Rosacea, 607 
Acocanthera Ouabaio, 492 
Aconine, 106 
Aconite, 106 

Antidotes and Antagonists, 809 
Aconitine, 107 
Aconitum, 106 



INDEX. 



915 



Acorin, 233 

Acorus Calamus, 233 

Acrinyl, Sulpho-cyanate, 481 

Acrolein, 328 

Actinomycosis, 607 

Actol, 195 

Addison's Disease, 608 

Adenitis, — See Glandular Affections, 708 

Adeps, no 

Benzoinatus, 1 10 

Lanee Hydrosus, in 
Administration of Medicines, 67 
Adonidin, 112 
Adonis, in 
Adrenal Extract, 1 65 
Adynamia, 608 
yEther, 112 

Acetic, 113 
After-pains, 609 
Agalactia, 609 
Agaric, 118 
Agaricin, 118 
Agaricus, 1 18 
Agathin, 77 
Agave Americana, 141 
Agents acting on each other, 33 
Agropyrum repens, 519 
Ague, — See Intermittent Fever, 744 
Ailanthus, 120 
Airol, 219 
Alabastrine, 386 
Albau, 309 
Albolene, 416 
Albumen, 120 
Albumin, 120 

as an Antidote, 805 

in Urine, Test for, 868 

Ovi, 121, 127 

Phosphorized, 163 
Albuminates, 28 
Albuminoids, 28, 120 
Albuminuria, 609 
Albumoses, 127 
Alcohol, 128 

Amyl, 130 

Antidotes and Antagonists, 809 

Caustic, 484 

Ethyl, 128 

Methyl, 130 

Phenyl, 83, 129 
Alcoholic Preparations, 565 

strength of Bitters, 899 
Alcoholism, 135, 138, 609, 809 
Aldehyde, 129 

Acetic, 129 

Ethyl, 129, 411 

Formic, 130, 324 

Protocatechuic, 521 
Alder Bark, 96, 141 

Black, 442 

Buckthorn, 324 
Ale, 131 
Aletris, 140 



Alexins, 175 

Alkalies, their action, 30 

Antidotes and Antagonists, 809 
Alkaline Mineral Waters, 186 
Alkalinizers, Urinary, 64 
Alkaloids, 22 

Antidotes and Antagonists, 810 

Liquid, 22, 500 
Allium, 140 
Allspice, 428 
Allyl Sulphide, 140, 202 

Sulpho-cyanide, 482 
Almond, 99, 148 
Alnus, 96, 141 
Aloe Socotrina, 141 
Aloes, 141 
Aloin, 141 
Alopecia, 611 

. Areata, 855 
Alstonia scholaris, 306 
Alteratives, 30 

Uterine, 65 
Althaea, 142 
Alum, 143 

Ammonio-ferric, 318 

Antidotes and Antagonists, 810 

Curd, 127 
Alumen, 143 

Exsiccatum, 143 
Aluminum, 143 
Alumnol, 144 
Alum-root, 96 
Amanita Muscaria, 1 18 
Amaroids, 24 
Amaurosis, 61 1 
Amber, 493 
Amblyopia, 31, 61 1 
Amenorrhea, 612 
Amick's Consumption-cure, 899 
Amido-benzene, 273 
Ammonia, 144 

as an Antidote, 806 

Antidotes and Antagonists, 810 
Ammonia-alum, 143 
Ammoniacum, 144 
Ammoniated Copper, 296 

Glycyrrhizin, 330 

Mercury, 340 
Ammonio-ferric Alum, 318 

Tartrate, 318 
Ammonium, 144 

Benzoate, 216 

Carbonate, as an Antidote, 807 

P.icrate, 104 

Sulpho-ichthyolate, 496 
Ammonol, 77 
Amorphous Bodies, 557 
Amygdala, 99, 148 
Amygdalin, 99, 148, 442 
Amyl Alcohol, 130 

Chloride, 1 16 

Hydrate, 130 

Hydride, 1 16 



gi6 



INDEX. 



Amyl Nitrite, 149 

Antidotes and Antagonists, 810 
Amylamine, 382 
Amylene, 116 

Hydrate, 255 
Amyloform, 324 
Amyloid Substances, 28 
Amylum, 152, 463 

Iodatum, as Antidote, 808 
Anacyclus Pyrethrum, 447 
Analgen, 77 
Analgesics, 31 
Analgesine, 77 
Anamirta paniculata, 424 
Ananassa Sativa, 414 
Anaphrodisiacs, 31 
Anarcotine, 403 
Anasarca, — See Dropsy, 675 
Andira Araroba, 268 
Anemia, 613 

Cerebral, 643 
Anemone, 443 
Anemonin, 443, 444 
Anesthesia, 1 14, 262, 614 

Hewitt's Method, 117 

Local, 32, 280, 292, 614 

Sayre's Method, 265 

Schleich's Method, 117, 614 

Therapeutics of, 614 
Anesthetics, 32, 116, 261 

Antidotes and Antagonists, 810 

Local, 32, 280, 292, 614 

Mixtures, 1 14 

Modes of using, 265 
Anethol, 167 
Aneurism, 615 
Angelate of Butyl, 167 
Angina, — See Croup, Laryngitis, Pharyn- 
gitis, Throat, Tonsillitis, etc. 
Angina Pectoris, 615 
Anhalonium, 226 
Anhidrotics, 32 
Anilin, 273 

Red, 325 
Animal Extracts, 156 
Anise, 167 

. Star, 352 
Anisum, 167 
Anodynes, 31, 32, 595 

Dental, 44 

Local, 32 
Ant-acids, 30 
Antagonism of Drugs, 33 

Toxicological, 34 
Antagonists, 33, 804 

List of, 35 

Table of, 35 
Anthelmintics, 36, 595 
Anthemis. 167 
Anthrax, 616 
Antiabrin, 175 
Antibilious Pills, 591 
Antidote, Arsenic, 317 



Antidote, Bouchardat's, 808 

JeaunePs, 808 
Antidote-bag, 808 
Antidotes, 36, 804 

General, 808 
Anti-emetics, 49 
Anti-fat, 325, 424 
Antifebrin, 76 

Antigalactagogues, — See Galactophyga, 52 
Antikamnia, 77 
Antikol, 77 
Antilithics, 56 
Antilupin, 77 
Antimonial Powder, 168 
Antimony, 167 

Antidotes and Antagonists, 810 

Sulphurated, 168 
Antinervin, 77, 79 
Antinosin, 358 
Antiperiodics, 37 
Antiphlogistics, 37 
Antiphlogistine, 330 
Antiphthisic Serum, 182 
Antiphthisin, 514 
Antipyretics, 37, 294 
Antipyrin, 170 

Antidotes and Antagonists, 810 

Salicylate, 171, 465 
Antiricin, 175 
Antiseptic Fluid, 508 

Injection, 346 

Solutions, 84, 346 
Antiseptics, 38, 508 
Antisialics, 62 
Antispasmodics, 38 
Antitoxin, 174 

Diphtheria, 176 

Plague, 184 

Streptococcus, 182 

Syphilis, 183 

Tetanus, 179 

Tuberculosis, 180 

Typhoid, 184 

Vaccinia, 184 
Antitoxins, 174, 184 
Antivenene, 183 
Antizymotics, 39 
Antrum, Disease of, 616 
Anus, Fissured, 616 

Prolapse of, 821 
Aperients, 41, 591 
Aphonia, 617 
Aphrodisiacs, 39 
Aphthae, 617 
Apiin, 184 
Apiol, 184 

Apis mellifica, 251, 378 
Apnea, 620 
Apocynin, 1 85 
Apocynum, 185 
Apomorphine, 399, 403, 405 
Apoplexy, 618 
Apotheme, 573 



INDEX. 



917 



Apparatus for testing urine, 870 

Appetite, 618 

Approximate Measures, 535, 910 

Weights, 910 
Aqua, 185 

Carbonata, 91 

Regia, 102 
Aquae, 566 
Arabin, 76, 518 
Arbor Vitae, 504, 507 
Arbutin, 253, 325, 519 
Arctium Lappa, 366 
Arctostaphylos glauca, 519 

Uva-ursi, 519 
Argentamin, 195 
Argentol, 195 
Argentum, 190 

Antidotes and Antagonists, 818 

Compounds, 195 
Argol, 437 
Argonin, 195 
Argyria, 1 91 
Aristol, 357 
Aristolochia, 480 
Aristolochine, 480 
Arnica, 196 
Arnicin, 196 
Aromatic Fluid Extract, 277 

Powder, 277 

Sulphuric Acid, 104 

Wine, 131 
Arrow-root, 154 
Arsenate, Iron, 319 

Sodium, 198 
Arsenates and Arsenites, 198 
Arsenauro, 206, 210 
Arsenic, 198 

Antidote, 317 

Antidotes and Antagonists, 810 
Arsenite, Copper, 199 

Potassium, 198 

Strychnine, 389, 394 
Arsenum, 198 
Artemisia Absinthium, 76 

pauciflora, 471 
Arterial Transfusion, 69 
Arthritis, Rheumatoid, 618 
Asafcetida, 201 
Asagraea officinalis, 521 
Ascarides, — See Worms, 36, 333, 879 
Ascites, 619 
Asclepias, 203 
Aselline, 382 
Aseptol, 84 
Aseptolin, 85, 89 
Ash, Flowering, 377 

Prickly, 525 
Asparagin, 143, 315, 330 
Asphyxia, 92, 620 ' 
Aspidium, 203 
Aspidosperma, 203 
Aspidospermine, 203 
Assay, 563 



Astasia, 604 

Asthenia, — See Adynamia, Convalescence. 

Asthenopia, 621 

Asthma, 622 

Astigmatism, 623 

Astragalus gummifer, 518 

Astringents, 40, 64 

Intestinal, 55 

Pill, 591 

Powder, 593 

Urinary, 64 

Vegetable, 96 
Atheroma, 624 
Atropa Belladonna, 212 
Atrophy, 624 
Atropine, 213 

and Morphine, 407, 898 

Antidotes and Antagonists, 81 1 
Atrosin, 213 
Aurantiin, 204 
Aurantium, 204 
Aurin, 84 
Aurum, 205 

Authorities, List of, 603 
Ava-kava, 364 
Avena Sativa, 210 
Ayer's Ague Cure, 899 

Cherry Pectoral, 899 

Pills, 899 

Recamier Balm, 901 
Cream, 901 

Sarsaparilla, 899 

Vita Nuova, 902 
Azedarach, 211 

Azoturia, — See Urinary Disorders, 867 
Azulen, 377 



Balanitis, 624 

Baldness, — See Alopecia, 61 1, 855 

Balm, 378 

Cream, 900 

of Gilead, 503 

Recamier, 901 
Balnea, 566 
Balsam of Copaiba, 289 

of Fir, 503 

Friar's, 216 

Gurjun, 335 

of Peru, 211 

of Tolu, 211 
Balsamum Dipterocarpi, 335 

Peruvianum, 21 1 

Tolutanum, 21 1 
Bandoline, 299 
Banting Dietary, 779 
Baptisia, 212 
Baptisin, 212 
Barbaloin, 141 
Barberry, 218 
Barium Dioxide, 212 

Salts, Antidotes, etc., 811 
Bark, Blackberry, 459 



918 



INDEX. 



Bark, Casca, 250 

Chittem, 451 

Cramp, 525 

Cuprea, 270 

Elm, 519 

Honduras, 250 

Huxham's Tincture of, 271 

Oak, 96, 448 

Ordeal, 250 

Peruvian, 269 

Pitaya, 270 

Sacred, 451 

Sassy, 250 

Soap, 448 

Willow, 465 
Barley, 152, 154 
Barosma, 226 
Barosmin, 226 
Basham's Mixture, 318, 676 
Basilicon Ointment, 449 
Bassorin, 518 
Baths, 566 

Formulae, 566 
Battley's Sedative, 399 
Bay-berry, 384 
Bay Rum, 384 

Sweet, 374 
Beans, 154 
Bear-berry, 519 
Bed-sores, 624 

Bee-venom, Antidotes, etc., 811 
Beef, 122 

Peptonoids, 122 

-tea, 127 
Beer, 131 

Ginger, 530 
Beet, Sugar, 462 
Behring's Law, 174 
Belladonna, 212 

Antidotes and Antagonists, 811 
Belladonnine, 213 
Benne Oil, 481 
Benzene, 116, 217, 272 
Benzin, 216 
Benzoates, 216 
Benzoin, 216 

Benzoinated Lard, no, 216 
Benzol, 116, 217, 272 
Benzosol, 291, 294 
Benzoyl Guaiacol, 291 

Morphine, 399 

Pseudotropeine, 278 

Sulphonic-imide, 461 
Benzyl Cinnamate, 21 1 
Berberine, 218, 238, 346, 378, 412,436, 525 
Berberis, 218 
Bergamot, Oil of, 218 
Bergaptene, 218 
Beriberi, 624 
Beta-naphtol, 387 
Beta vulgaris, 462 
Betula lenta, 464, 465 
Bhang, 242 



Bibliography and References, 603 
Bichlorinated Methyl Chloride, 260 
Bichromate of Potassium, 94 

Antidotes and Antagonists, 817 
Bile, 316* 

Agents affecting, 42, 53 

Pigment in Urine, Test, 869 
Biliary Solvents, 56 
Biliousness, 345, 625 
Bilious Remittent Fever, 907 
Bind-weed, 338 
Birch, Sweet, 464, 465 
Bird-lime, 525 
Bismuth, 218 

Mixture for Children, 584 

Subgallate, 219, 358 

Subiodide, 219, 358 
Bitartrate, Nicotine, 500 

Potassium, 438 
Bites and Stings, 845 
Bitters, Action of, 238 

Alcoholic Strength of, 899 

Hostetter's, 900 

Vinegar, 902 
Bittersweet, 308 
Blackberry, 96, 459 
Black Draught, 479 

Drop, 397 

Haw, 525 

Paste, 713 
Bladder, Inflammation of, 663 

Irritable, 626 

Paralysis of, 626 
Bladder-wrack, 325 
Blancard's Pills, 317 
Blaud's Pills, 316 
Bleaching Powder, Antidotes, 813 
Blende, 527 
Blepharitis, 626 
Blistering Cerate, 244 

Collodion, 244 
Blisters, 55 
Blood as Food, 127 
Blood-root, 469 
Blood-stains, 844 
Blue Cohosh, 251 

Flag, 361 

Mass, 339 

Methylene, 380 

Ointment, 340 

PiH, 339 
Boiling, 564 
Boils, 626 
Boldine, 221 
Boldo, 221 
Boldus, 221 
Bolus, 586 
Bone Diseases, 627 

Marrow Extract, 1 60 
Boneset, 315 
Borax, 81 
Borine, 81 
Borism, 82 



INDEX. 



919 



Borneol, 27, 504 
Boroglyceride, 81, 83 
Boroglycerin, 81 
Borolyptol, 81 
Bos Taurus, 316 
Botkin's Cholera Drops, 647 
Bots, 211 

Bouchardat's Antidote, 807 
Bougies, 595 
Bovinine, 122 
Bovril, 122 
Boxwood, 412 

Brain Disorders, — See Cerebral Anemia, 
Cerebral Concussion, etc. 

Extract, 164 

Fever, — See Meningitis, Cerebro- 
spinal Meningitis, Typhoid Fever, 
Typhus Fever. 
Brandreth's Pills, 899 
Brandy, 130 
Brassica, 48 1 
Brayera, 299 
Breasts, — See Abscess, Lactation, Mastitis, 

Nipples. 
Breath, Fetid, 627 
Bright's Disease, Acute, 628 
Chronic, 629 
Diagnosis, 903 
Bromelin, 414 
Bromides, 221 

Antidotes and Antagonists, 811 

Formulae for, 693, 783 
Bromidrosis, — See Feet, 699 
Bromine and Bromides, 221 

Antidotes and Antagonists, 81 1 
Bromism, 222 
Bromoform, 221, 224 
Bronchiectasis, 629 
Bronchitis, Acute, 630' 

Capillary, 631 

Chronic, 632 
Bronchocele, — See Goitre, 710 
Bronchorrhea, 633 
Broom, 476 
Brown Mixture, 330 
Brucine, 338, 351, 389, 395 
Bruises, 634 
Bryonia, 225 
Bryonin, 225 
Bubo, 634 
Buchu, 226 

Helmbold's, 900 
Buckthorn, 324, 451 
Bulimia, 618 
Bunion, 634 
Burdock, 366 

Burnett's Disinfectant, 46,527 
Burns, 634 
Bursitis, 635 
Buttermilk, 123, 128 
Butternut, 363 
Butyl Angelate, 167 

Chloral Hydrate, 259 



Butyl Chloride, 116 
Hydride, 1 16 
Valerianate, 167 

Butylamine, 382 

Buxine, 412 

Buxus sempervirens, 412 



Cacao-butter, 230, 506 
Cachets, 592 
Cachexias, 635 
Cacodyle, 797 
Cactine, 226 
Cactus Grandiflora, 226 
Cadmium, 226 
Caffacemon, 77 
Caffea, 227 
Caffeine, 227 

Citrated, 228 
Caffenol, 77 
Caffeol, 227 
Caffeone, 227 
Cajuput, Oil of, 233 
Cajuputene Bihydrate, 233 
Cajuputol, 233 
Calabar Bean, 421 
Calabarine, 422 
Calamine, 5 2 7 

Ointment, 529 
Calamus, 233 
Calcauro, 206 
Calcination, 560 
Calcium, 234 

Chloride, Antidotes, etc., 811 

Hydrate, as an Antidote, 806 

Sulphide, 496 
Calculi, Biliary, 636 

Renal, 636 

Solvents of, 56 

Vesical, 636 
Calendula, 238 
Calomel, 340 
Calumba, 238 
Calumbin, 238 
Calx, 234 

Chlorata, 266 

Sulphurata, 496 
Cambogia, 238 

Camp Fever, — See Typhus, 863 
Camphene, 504 
Camphor, 239 

Antidotes and Antagonists, 811 

Baldrian, 520 

Bergamot, 218 

Carbolated, 239 

-chloral, 239 

-cymol, 239 

Monobromated, 239 

Naphtol, 387 

Peppermint, — See Menthol, 379 

Pulsatilla, 443 

Salicylated, 240 
Camphors, 27 



920 



INDEX. 



Camphylene, 387 
Canadian Hemp, 185 

Moonseed, 378 
Cancer, 637 

Diagnosis of, 904 

of Uterus, 87 1 
Cancrum Oris, 638 
Cannabene, 241 
Cannabin, 241 
Cannabis Indica, 241 

Antidotes and Antagonists, 811 
Cantharides, 244 
Cantharidin, 244 
Cantharis, 244 

Antidotes and Antagonists, 811 
Caoutchouc, 308 
Capsicin, 246 
Capsicum, 246 
Capsules, 566 
Caraway, 249 
Carbinol, 130 
Carbo, 247 

Animalis, 247 

Ligni, 247 
Carbohydrates, 21, 153 
Carbon, 247 

Acids, 25 

Dioxide, 91, 116, 500 

Antidotes and Antagonists, 81 1 

Disulphide, 116, 247 

Monoxide, 116, 247 

Tetrachloride, 116, 262 
Carbonated Mineral Waters, 91, 93, 187 
Carbonates, as Antidotes, 806 
Carbonei Disulphidum, 116, 247 
Carbonization, 557 
Carbuncle, 638 
Carcinoma, — See Cancer, 637 
Cardamom, 248 
Cardiac Disorders, — See Heart, 719 

Sedatives, 40 

Stimulants, 40 

Tonics, 41 
Cardialgia, — See Pyrosis, 828 
Cardine, 164 

Carditis, Diagnosis of, 904 
Carduus, 248 
Carica Papaya, 413 
Caries, 639 
Carminative, Dalby's, 399 

Dewees', 202, 372 
Carminatives, 41 
Carmine, 283 
Carnogen, 1 60 
Caroval, 298 
Carragheen, 121 
Carron Oil, 235, 237, 369 
Carthamus tinctorius, 294 
Carvene, 249 
Carum, 249 
Carvol, 249 
Caryophyllin, 249 
Caryophyllus, 249 



Casca Bark, 250 
Cascara Amarga, 250 

Sagrada, 45 1 
Cascarilla, 250 
Cascarillin, 250 
Casein, 120, 122 
Cassia acutifolia, 479 

angustifolia, 479 

Cinnamon, 277 

Fistula, 250 

Purging, 250 
Castanea, 96, 250 
Castor Oil, 455 

Emusion ; Formula, 657 
Castoria, 899 
Catalepsy, 639 
Cataplasmata, 567 
Cataract, 640 
Catarrh, Acute Nasal, 640 

Broncho-pulmonary, — See Bronchitis, 
Bronchorrhea. 

Chronic Nasal, 641 

Duodenal, 677 

Epidemic, — See Influenza, 741 

Gastric, — See Gastritis, Chronic, 707 

Genito-urinary, — See Bladder, Catarrh 
of, Cystitis, Endometritis, Gonor- 
rhea, Leucorrhea, etc. 

Intestinal, — See Dysentery, Jaundice. 

Sage's Remedy, 901 

Sanford's Cure, 901 

Summer, — See Hay Fever, 715 
Catechol, 273 
Catechu, 96, 251 
Cathartics, 41 

in Poisoning, 804 
Catharto-mannite, 479 
Caulophyllin, 251 
Caulophyllum, 251 
Caustic, Lunar, 190 

Mitigated, 190 

Potash, 437 

Soda, 483 
Caustics, 50 
Cedar, Oil of, 471 

Red, 460 

White, 507 
Celandine. 252 
Celerina, 278 
Cellulose, 153, 331 
Centaurea benedicta, 248 
Century-plant, 141 
Cephaeline, 358 
Cephaelis Ipecacuanhae, 358 
Cephalalgia, — See Headache, 716 
Cera, 251 
Cerata, 567 
Cerate, 252 

Blistering, 244 

Cantharides, 244 

Cetaceum, III 

Goulard's, 433 

Lead, Subacetate, 433 






INDEX. 



921 



Cerate, Resin, 449 

Savine, 460 

Spermaceti, III 

Theobroma, 507 
Cerates, 567, 601 

Compounding of, 601 
Ceratum, 252 

Cerebellum, Agents affecting, 43 
Cerebral Anemia, 643 

Compression, Diagnosis, 904 

Concussion, 643 
Diagnosis, 904 

Congestion, 643 

Depressants, 43 

Excitants, 43 

Softening, 644 

Vomiting, — Diagnosis, 907 
Cerebrine, 164 
Cerebrinin, 164 
Cerebro-spinal Fever, 764 
Cereus, Night-blooming, 226 
Cerium Oxalate, 252 
Cerolein, 251 
Cetaceum, ill 
Cetin, ill 
Cetraria, 152, 156 
Cetyl Palmitate, III 
Cevadilla, 521 
Cevadilline, 521 
Cevadine, 521 
Cevine, 522 
Chalk, 234 

Chalybeate Waters, 186 
Chamomile, 167 

German, 377 
Chamomilla, 167, 378 
Chancre, 644 

Diagnosis of, 904 
Chancroid, 644 

Diagnosis of, 904 
Change of Life, — See Climacteric, 650 
Chapped Hands and Lips, 645 
Charcoal, 247 

as an Antidote, 806 
Chartae (Papers), 567 
Chartulae, 592 
Chaulmoogra Oil, 252 
Cheese, 123 
Chekan, 386 
Chekanine, 386 
Chelerythrine, 252 
Chelidonine, 252 
Chelidonium, 252 
Chelidoxanthin, 252 
Chelsea Pensioner, 568, 833 
Chemical Incompatibility, 548 
Chenopodium, 253 
Cherry-laurel, 99, IOI 
Cherry Pectoral, 899 

Wild, 442 
Chestnut, 96, 250 
Chest-pains, 645 
Chian Turpentine, 503 



Chicken-pox, — See Varicella, 874 

Chilblains, 645 

Children, Dosage for, 72, 400 

Chimaphila, 253 

Chimaphilin, 253 

China, Pride of, 211 

Chinicin, 273 

Chininum Amorphum Boricum, 271 

Chinoidin, 272 

Chinolin, 253, 273 

Chinopyrin, 276 

Chinosol, 254 

Chirata, 254 

Chiratin, 254 

Chiretta, 254 

Chittem Bark, 451 

Chloral, 254 

Analogues, 255 

Antidotes and Antagonists, 81 1 

Butylic, 259 

Formidate, 259 

Hydrate, 254 
Chloralamid, 259 
Chloral -habit, 257 
Chlorates, — See the titles of their metallic 

constituents. 
Chlorides, — See the titles of their metallic 
constituents. 

in Urine, Test, 869 
Chlorinated Waters, 187 
Chlorine, 266 

as an Antidote, 807 

Antidotes and Antagonists, 812 
Chlorine-water, 266 
Chlorodyne, 261, 399 

Colli s Browne's, 899 

Formulas for, compared, 909 
Chloroform, 116, 260 

Antidotes and Antagonists, 812 

Sayre's method of using, 265 
Chlorosis, 645 
j Chlorum, 266 
Chocolate, 230, 506 
Choking, 646 
Cholagogues, 42, 53 

Pills, 591 

Purgatives, 42 
Cholera Asiatica, 646 

Diagnosis of, 905 

Infantum, 647 

Mixture (Squibb), 399, 647 

Simplex, 648 

Toxin, 516 
Cholesterin, 121 

Chondodendron tomentosum, 41 1 
Chondrus, 121 
Chordee, 648 
Chorea, 649 
Choroiditis, 650 
Chromic Anhydride, 93 

Trioxide, 93 
Chrysarobin, 268 
Chrysophan, 452 



922 



INDEX. 



Churrus, 242 

Chyluria, 650 

Cigarettes, Formulae for, 623 

Ciliary Excitants, 43 

Cimicifuga, 268 

Cimicifugin, 268 

Cinchona, 269 

Red, 270 

Rubra, 270 
Cinchonamine, 270 
Cinchonidine, 270, 272 
Cinchonine, 270, 272 
Cinchonism, 274 
Cineol, 386 
Cinnamein, 211 
Cinnamomum, 277 

Camphora, 239 
Cinnamon, 277 
Cinquefoil, 792 

Circulation, Agents affecting, 40, 66 
Cissampeline, 412 
Cissampelos Pareira, 412 
Citrates, 367, — See also the titles of their 

basic constituents. 
Citrine Ointment, 340, 341 
Citron, 367 

Citrullus Colocynthis, 285 
Citrus acris, 367 

Aurantium, 204 

Bergamia, 218 

Limonum, 367 

medica, 367 

vulgaris, 204 
Clarification, 557 
Clarke's Blood Mixture, 900 
Classification of Medicines, 29 
Claviceps purpurea, 310 
Clavus, — See Headache, 717 
Clemens' Solution, 199 
Climacteric Disorders, 650 
Cloves, 249 
Club-moss, 371 
Clysters, 577 
Cnicin, 248 
Cnicus benedictus, 248 
Coagulated Proteid, 28 
Coal-gas, Antidotes and Antagonists, 813 
Coca, 230, 277 
Cocaine, 230, 278 

Antidotes and Antagonists, 812 
Cocaine-habit, 280 
Cocamine, 277 
Cocculus Indicus, 424 
Coccus, 283 
Coccygodynia, 651 
Cochineal, 283 
Cocoa, 230 
Codamine, 397 
Codeine, 396, 399, 403, 406 
Codfish, 381 
Cod-liver Oil, 381 

Emulsion, 381, 572 
Coffea, 227 



Coffee, 227 
Cohosh, Black, 268 

Blue, 251 
Cola acuminata, 230 
Colation, 557 
Colchiceine, 283 
Colchicine, 284 

Salicylate, 288 
Colchicum, 283 

Antidotes and Antagonists, 812 
Cold Cream, in 
Coldness, 651 
Colic, Hepatic, 652 

Intestinal, 651 

Lead, 652 

Renal, 652 
Colic-root, 140, 306 
Collagen, 1 21 

Collagenes and Mucilaginous Bodies, 28 
Collapse, 652, — See also Exhaustion, 

Shock, Syncope. 
Collidine, 500 
Collodia, 568 
Collodion, 331 

Blistering, 244, 331 

Cantharidal, 244, 331 

Carbolized, 881 

Flexible, 331 

Styptic, 95, 331, 881 
Colloids, 559 
Colloxylin, 331 
Collunarium, 577 
Collyrium, 579 

Formulae for, 580 
Colocynth, 285 
Colocynthein, 285 
Colocynthin, 285 
Colocynthis, 285 
Colocynthitin, 285 
Cologne-water, 131 
Colophony, 449, 504 
Coloring Matters, 25 
Columbo, 238 
Coma, 653 

Alcoholic, 137 

Opium, 401 
Combination, Principles of, 542 
Combustibles, 550 
Comminution, 557 
Commiphora Myrrha, 385 
Compounding Medicines, 554 

a Mixture, 583 

an Ointment, 601 
Compounds, Explosive, 550 

Miscellaneous, 28 

Poisonous, 551 
Condylomata, 653 
Condy's Fluid, 46, 374 
Confectio Damocratis, 568 
Confections, 568 

Formulae for, 568 
Conhydrine, 286 
Coni'ine, 286 



INDEX. 



9 2 3 



Conium, 286 

Antidotes and Antagonists, 812 
Conjunctivitis, Catarrhal, 653 

Diphtheritic, 654 

Gonorrheal, 655 

Granular, 655 

Phlyctenular, 655 

Purulent, 656 
Conspergatives, 588 
Constipation, 656 
Constituents of Organic Drugs, 21 
Contractions, List of, 546, 883 
Contractors, Vascular, 65 
Convalescence, 657 
Convallamarin, 288 
Convallaria, 288 
Convallarin, 288 
Convolvulin, 362, 474 
Convolvulus Scammonia, 474 
Convulsions, 658 

Infantile, 658 

Puerperal, 825 
Copaiba, 289 

Emulsion, 289, 572 

Mixture, 289 
Copaifera Langsdorffii, 289 
Copper, 296 

Carbonate, as Antidote, 807 

Salts, Antidotes, etc., 812 
Coral, 235 
Cordial, Aletris, 140 

Cascara, 451 
_ Godfrey's, 399 
Coriander, 290 
Coriandrum, 290 
Corn, Indian, 152, 526 
Corn-silk, 526 
Corn-smut, 526 
Corneal Opacities, 658 
Corneitis, — See Keratitis, 749 
Cornin, 290 
Corns, 659 
Cornus, 290 
Cornutine, 310 

Corpulence, — See Obesity, 779 
Corrosive Sublimate, 340 

Antidotes and Antagonists, 812 
Coryza, — See Catarrh, Acute, 640 
Cosmoline, 415 
Coto Bark, 290 
Cotoin, 290 
Cotton, 331 

Gun, 153 

Iodized, Formulae for, 724 
Cotton-seed Oil, 331 
Couch-grass, 519 
Cough, 659, 793 

Mixtures, Formulae for, 661, 763, 794, 

799. 
Counter-irritants, 55 
Counter-irritation, 244 
Court Plaster, 121, 128 
Coxalgia, 661 



Coxe'sTiive Mixture, 168, 475 

Crab Lice, — See Pediculi, 790 

Crabs' -eyes, 235 

Cramp Bark, 525 

Cramps, — See Colic, Spasmodic Affections, 

Trismus. 
Cranesbill, 96, 328 
Cream, Cold, ill, 457 

Recamier, 901 

of Tartar, 438 
Creolin, 85, 90 
Creosol, 291 
Creosotal, 291 
Creosote, 85, 291 

Antidotes and Antagonists, 813 
Cresol, 83 
Creta, 234 

Creuse's Iron Solution, 316 
Crocq's Solution, 421 
Crocus, 294 
Croton-chloral, 259 
Croton Eleuteria, 250 

Oil, 509 

Tiglium, 509 
Croup, Catarrhal, 66 1 

Membranous, 662 
Diagnosis, 905 
Cryptopine, 397, 403 
Crystallization, 557 
Cubeb, 295 1 
Cubeben, 295 
Cubebene, 295 
Cubebin, 295 
Cuca, 230, 277 
Cucumber, Squirting, 309 

Tree, 374 
Cucurbita Pepo, 412 
Cucurbitine, 412 
Culver's Root, 366 
Cuprea Bark, 270 
Cuprum, 296 

Ammoniatum, 296 
Curare, 298 

Antidotes and Antagonists, 813 
Curarine, 298 

Cure, Keeley's Gold, 210, 900 
Cures, — See Patent Medicines, 899 
Cusso, 299 

Cutaneous Irritants, 55 
Cuttle-fish Bone, 235 
Cyanides, — See the titles of their metallic 

constituents. 
Cyanosis, 663 
Cydonin, 299 
Cydonium, 299 
Cymene, 504, 508 
Cynips Gallae tinctoriae, 325 
Cypripedin, 299 
Cypripedium, 299 
Cystitis, Acute, 663 

Chronic, 663 
Cysts, 665 
Cytisus Scoparius, 476 



924 



INDEX. 



Dalby's Carminative, 399 

Damiana, 299 

Dandelion, 503 

Dandruff, — See Pityriasis, 799 

Dangers of Incompatibility, 552 

Daphne Mezereum, 381 

Daphnin, 381 

Datura Stramonium, 488 

Tatula, 300 
Daturine, 300, 489 
Deafness, 665 

Death, Signs of, — See Asphyxia, 621 
Debility, — See Adynamia, Anemia, Con- 
valescence. 
Decantation, 558 
Decimal Weights, etc., 534 
Decocta (Decoctions), 568 
Decoloration, 558 
Deer, Musk, 383 
Deflagration, 558 
Deliquescence, 558 
Deliquescent Salts, List of, 589 
Deliriants, 43 
Delirium, 665 

Tremens, 135, 138, 666 
Delphinine, 487 
Delphinium Staphisagria, 487 
Dementia, 742 

Paralytica, 667 
Demulcents, 44 
Dengue, 667 
Dental Anodynes, 44 
Dentifrices, 44 
Dentition, 667 
Deodorants, 44 
Deposits in Urine, 870 
Depressants, Cerebral, 43 

Hepatic, 52 

Motor, 56 

Renal, 48 

Respiratory, 60 

Uterine, 65 
Dermatol, 219, 220, 358 
Desiccation, 558 
Destructive Metamorphosis, 45 
Dew-berry, 459 
Dewees' Carminative, 202, 372 
Dextrin, 152 
Dextroform, 324 
Dextrose, 378, 462 
Dhobie Itch, 668 
Diabetes Insipidus, 668 

Mellitus, 668 
Diabetin, 463, 670 
Diacetyl-morphine, 399 
Diacetyl-tannin, 97 
Diachylon Ointment, 433 

Plaster, 433 
Diagnosis, Differential, 903 
Dialysis, 559 
Dialyzed Iron, 319, 559 
Diaphoretics, 45 
Diarrhea, 670 



Diastase, 152 

Pancreatic, 413 
Dichlor-methyl Chloride, 260 
Dichloro-methane, 262 
Didama's Solution, 898 
Didymin, 162 

Diet, — See Albumin and Amylum. 
Diethylsulphon-diethyl-methane , 495 
Diethylsulphon-dimethyl methane, 493 
Diethylsulphon-methyl-ethyl-methane, 495 
Diffusate, 559 

Digestive System, Agents affecting, 30 
Digital e'in, 301 
Digitalin, 300 
Digitalis, 300 

Antidotes and Antagonists, 813 
Digitin, 301 
Digitonin, 301 
Digitoxin, 301 
Dihydro-toluidine, 382 
Dilators, Vascular, 66 
Diluents, 45, 582 
Dimethyl-amido-antipyrin, 17 1 
Dimethyl-ethyl-carbinol, 255 
Dimethyl-piperazin Tartrate, 430 
Dimethyl-xanthin, 230 
Di-oleyl-lecithin, 163 
Dionine, 399 
Dioscorea, 306 
Dioscore'in, 306 
Diospyros, 96 
Dipentene, 504 
Diphtheria, 177, 672 

Antitoxin, 176 

Diagnosis of, 905 

Laryngeal, 662 

Temperature in, 852 
Dipsomania, — See Alcoholism, Delirium 

Tremens. 
Discutients, 45 
Disinfectants, 46 

Burnett's, 46 

Condy's, 46 

Labarraque's, 46 
Disinfecting Fluid, 527 
Disinfection Oil, 85 
Dislocations, 703 
Dispensatories, 532 
Dispensing, 554 

by Physicians, 554 
Displacement, 561 
Distillation, 559 
Dita Bark, 306 
Ditaine, 306 
Ditamine, 306 
Dithymol-Iodide, 357 
Diuretics, 46 

Formulae for, 676, 868 

List of, 47 

Refrigerant, 46 

Stimulant, 47 
Diuretin, 233 
Dizziness, — See Vertigo, 875 



INDEX. 



925 



Dobell's Nasal Wash, 578, 643 
Dock, Yellow, 459 
Dog- wood, 290 

Jamaica, 430 
Domestic Measures, 535 
Donovan's Solution, 199 
Dorema Ammoniacum, 144 
Dosage of Medicines, 72 

of Official Preparations, 73 
Doses, Average, 73 

Table of, — See inside of cover. 
Dover's Powder, 358, 398 
Drastic Purgatives, 42 
Draught, 576 

Black, 479, 576 

Effervescing, 576 
Drink, 591 

Imperial, Formula, 591 
Drops, 535 

Botkin's Cholera, 647 

Table of Drops to a Drachm, 535, 
910 
Dropsy, 675 
Drosera, 306 

Drowning, — See Asphyxia, 620 
Drug-eruptions, 694 
Drug-experimentation, 19 
Drugs, 17 

Active principles, 21 

Antagonism of, 33 

Constituents of, 21 

Inorganic, 21 

Neutral principles, 24 

Organic, 21 
Dryopteris Filix-mas, 203 

Marginalis, 203 
Duboisia, 307 
Duboisine, 307 
Dulcamara, 308 
Dulcamarin, 308 
Dulcin, 462 
Duodenal Catarrh, 677 
Duotal, 291 
Dutch Liquid, 261 
Dyscrasiae, — See Cachexias, 635 
Dysentery, 677 
Dysmenorrhea, 679 
Dyspepsia, 680 
Dysphagia, 682 
Dyspnea, 683 
Dysuria, 683 



Ear Affections, 684 

Agents affecting, 52 
Earache, — See Otalgia, 784 
Eau Sedative, 145, 239 
Ebullition, 564 
Ecballium Elaterium, 309 
Ecbolics, 58 
Ecboline, 310 
Ecchymosis, 684 
Ecgonine, 277 



Eclampsia, — See Puerp. Convulsions, 825 

Ecthyma, 684 

Ectropion, 684 

Eczema, 685 

Efflorescence, 558 

Efflorescent Salts, List of, 589 

Egg-albumen, 121 

Egg-shell, 235 

Egg, Yolk of, 121 

Eggs as Food, 127 

Eights, The Three, 849 

Elastica, 308 

Elaterin, 309 

Elaterium, 309 

Elder, 468 

Elecampane, 352 

Electuaries, 568 

Electuary for Piles, 568 

Elettaria repens, 248 

Elixir, Aromatic, 205 

McMunn's, 397 

Simple, 205 

of Vitriol, 104 

Yvon's Hypnotic, 744 
Elixiria, 569 
Elm, Slippery, 519 
Elutriation, 564 
Ely's Cream Balm, 900 
Emaciation, 687 
Embrocation, 579 
Emetics, 48 

in Poisoning, 804 
Emetine, 358 
Emissions, 687 
Emmenagogues, 49 

Formulae for, 612 

Pills, 591 
Emollients, 50 
Emphysema of Lungs, 687 
Emplastra, 569 
Empyema, 688 
Emulsa, 570 
Emulsification, 571 
Emulsin, 99, 148, 442 
Emulsions, 570 
Encephaloma, — See Cancer, 637 

Diagnosis of, 904 
Endarteritis, — See Atheroma, 624 
Endermic Method, 71 
Endocarditis, 688 

Diagnosis of, 904 
Endometritis, 688 
Enemata, 577, 689 

Formulae for, 578, 689 
Enepidermic Method, 72 
Enteralgia, — See Colic, Intestinal, 651 
Enteric Fever, — See Typhoid, 861, 907 
Enteritis, 689 
Entropion, 684 
Enuresis, 690 
Enzymes, 39 
Eosote, 796 
Epidermic Method, 72 



926 



INDEX. 



Epididymitis, 690 

Epilation, — See Tinea Circinata, 854 

Epilepsy, 691 

Diagnosis of, 905 
Epispastics, 55 
Epistaxis, 693 
Epsom Salt, 372 
Epulis, — See Teeth, 850 
Equinia, — See Glanders, 708 
Erections, 687 
Ergot of Rye, 310 

Antidotes and Antagonists, 813 

of Corn, — See Ustilago, 526 
Ergota, 310 
Ergotin, 310 
Ergotine, 310 
Ergotinine, 310 
Ergotism, 311 
Ericolin, 325, 519 
Erigeron, 313 
Eriodictyon, 313 
Errhines, 50 
Eructations, 681, 702 
Eruptions caused by Drugs, etc. , 694 
Erysipelas, 694 

Toxin, 515 
Erythema, 696 
Erythrophlcein, 250 
Erythrophloeum Guinense, 250 
Erythroretin, 452 
Erythroxylon Coca, 230, 277 
Escharotics, 50 
Eserine, 421, 422 
Esophageal Affections, 696 
Essential Oils, 27 
Ethene, 1 16 

Chloride, 1 16 

Dichloride, 1 16 
Ether, 112 

Acetic, 113, 116 

Chloric, 261 

Chlorinated Muriatic, 261 

Hydriodic, 113, 116 

Hydrobromic, 113, 116, 1 17 

Methylene-di-methyl, 256 

Methylic, 116 

Nitrous, 113, I-16, 117 

Petroleum, 216 
Ethereal Oil, 113 

Preparations, 565 
Ethyl Acetate, 113 

Alcohol, 112, 128 

Aldehyde, 129, 411 

Bromide, 113, 116 

Carbamate, 256 

Chloride, 116 

Hydrate, 112, 128 

Hydride, 1 16 

Hydrosulphide, 493 

Iodide, 113 

Nitrite, 113, 150 

Oxide, 112 
Ethylate of Sodium, 484 



Ethylene Bichloride, 261 
Ethylidene Chloride, 261 

Oxide, 129 
Ethylirtes Chloral-urethan, 255 
Eucaine, 283 
Eucalyptene, 314 
Eucalyptol, 313 
Eucalyptolen, 314 
Eucalyptus, 313 
Euchlorine, 267 
Eudoxin, 219 
Eugenia aromatica, 249 

Jambolana, 363 
Eugenin, 249 
Eugenol, 249 
Euonymin, 315 
Euonymus, 315 
Eupatorin, 315 
Eupatorium, 315 
Euphormol, 81 
Euphrasia, 315 
Europhen, 357 
Euthymol, 81 
Evaporation, 564 

Spontaneous, 564 
Exalgin, 77, 80 

Exanthemata, Diagnosis of, 906 
Excipients, 571, 582, 587 
Excitants, Cerebral, 43 

Ciliary, 43 

Motor, 57 
Excoriation, — See Intertrigo, 746 
Excretion, Agents affecting, 32, 45, 46, 59, 

61, 63, 64 
Exhaustion, 697 
Exodyne, 77 
Exophthalmos, 697 
Exostosis, 697 
Expectorants, 51 
Explosive Compounds, 550 
Expression, 559 
Exsiccation, 558, 560 
Extemporaneous Pharmacy, 554 
Extract, Adrenal, 165 

Bone Marrow, 160 

Brain, 164 

Goulard's, 433 

Lymphatic, 166 

Mammary Gland, 167 

Meat, 122 

Orchitic, 162 

Ovarian, 166 

Pancreatic, 166 

Parotid, 166 

Pineal, 164 

Pituitary, 164 

Pond's, 336 

Renal, 165 

Splenic, 166 

Testicular, 156, 162 

Thymus, 160 

Thyroid, 157 

Uterine, 167 



INDEX. 



927 



Extracta, 572 

Fluida, 573 
Extractive, 573 
Extracts, 572 

Animal, 156 

Distilled, 336 
Eye, Agents affecting, 29, 31, 57, 58 

Diseases, 698 

Ointments, Formulae for, 654 

Sensibility, Agents affecting, 31 

Water, Formulae for, 654, 902 
Eye-bright, 315 
Eyelids, 698 



Fabiana imbricata, 424 
Face, 699 

Face-ache, — See Neuralgia, 773, Tic Dou- 
loureux, 854 
Fainting, — See Syncope, 847 
False Pains, 699 
Farcy, 708 
Fat, — See Obesity, 779 

Hog, no 

Wool, in 
Fatigue, — See Exhaustion, 697 
Fats and Oils, 26 

as Antidotes, 805 
Favus, — See Tinea Favosa, 855 
Febricula, — See Fever, Simple, 701 
Febrifuge, 272 
Febrinol, 78 
Feet, 699 

Fehling's Solution, 296, 869 
Fel Bovis, 316 

Tauri, 316 
Felon, — See Onychia, 780 
Fennel, 323 
Fermentation, 39 

Lactic, 463 
Ferments, 28, 39 

Agents affecting, 39 
Fern, Male, 203 

Marginal Shield, 203 
Ferratin, 319 

Ferrier's Snuff, Formula, 641, 643 
Ferrocyanide of Potassium, 99, 101 

as an Antidote, 807 
Ferrum, 316 

Dialysatum, 319, 559 

Reductum, 316 
Ferula fcetida, 201 

Galbaniflua, 325 

Sumbul, 499 
Fever, 699 

Bilious Remittent, Diagnosis, 907 

Cerebro-spinal, 764 

Enteric, — See Typhoid, 861, 907 

Hay, 715 

Hectic, 723 

Hemoglobinuric, 726 

Intermittent, 744 

Miliary, 769 



Fever, Milk, — See Lactation, 750 

Pernicious, — See Intermittent Fever, 
Remittent Fever. 

Puerperal, 826 

Relapsing, 829 

Remittent, 829 

Diagnosis of, 907 

Rheumatic, 830 

Scarlet, 835 

Diagnosis of, 906 

Simple, 701 

Spotted, — See Typhus Fever ; also 
Meningitis, Cerebro-spinal. 

Surgical, 847 

Traumatic, — See Surgical Fever, 847 

Tropical, 701 

Typhoid, 861 

Diagnosis of, 907 

Typho-malarial, — See Typhoid, 861 

Typhus, 863 

Diagnosis of, 907 

Yellow, 881 

Diagnosis of, 907 
Fibrin, 28, 120, 122 
Ficus (Fig), 323 
Filix Mas, 203 
Filtering-paper, 560 
Filtration, 560 
Fir, Balsam of, 503 

Scotch, 431, 504 

Silver, 503 
Firs, 430 
Fish-berries, 424 
Fish-poison, Antidotes, etc., 813 
Fistula, 702 

Fits, — See Apoplexy, Convulsions, Epi- 
lepsy, Hysteria, Syncope. 
Fixed Oils and Fats, 26 
Flatulence, 702 
Flavoring Agents, 582 
Flaxseed, 368 
Flea-bane, 313 

Fleming's Tincture of Aconite, 107 
Flooding, — See Hemorrhage Post-partum, 

Menorrhagia, Metrorrhagia. 
Fluavil, 309 
Fluid, Antiseptic, 508 

Condy's, 374 

Disinfecting, 527 

Extract, Aromatic, 277 

Extracts, 573 
Flushing-heats, 703 
Fly-agaric, 118 
Fceniculum, 323 
Fomentation, 579, 820 
Food, Horlick's, 153 

Mellin's, 153 

Parrish's, 419 
Foods, 61, 124, — also Albumin, Amylum. 

Producing Eruptions, 694 
Foreign Bodies, 620, 703 
Formaldehyde, 130, 324 
Formalin, 130, 324 



92! 



INDEX. 



Formamide, 259 

Formulae, Hypodermic, 897 

Formyl Iodide, 353 

Fotus, 579 

Fowler's Solution, 198 

Fox-glove, 300 

Fractures, 703 

Franciscea uniflora, 374 

Frangula, 324 

Frangulin, 324 

Frankincense, 503 

Franklinite, 527 

Fraxin, 377 

Fraxinus Ornus, 377 

Freckles, 703 

Friar's Balsam, 216 

Fuchsin, 325 

Fucus Vesiculosus, 325 

Fungi, Antidotes, etc., 813 

Furuncle, — See Boils, 626 

Fusel Oil, 130 

Fusion, 560 



Gaduin, 381 

Gadus Morrhua, 381 

Galactagogues, 5 1 

Galactophyga, 52 

Galbanum, 325 

Galena, 433 

Galla, 95, 325 

Gallipots, 602 

Gallobromol, 97 

Gall-stones, — See Calculi, Biliary, 636 

Gallus Bankiva, 12 1 

Gamboge, 238 

Antidotes and Antagonists, 813 
Gangrene, 704 

of Lungs, 758 
Garcinia Hanburii, 238 

mangostana, 377 
Garfield Tea, 900 
Gargarisma, 575 
Gargles, Formulae for, 576, 675, 795, 

854 
Garlic, 140 

Gas, Illuminating, — Antidotes, etc., 813 
Gaseous Preparations, 577 
Gases, Agents affecting, 41, 44 

Antidotes and Antagonists, 813 
Gastralgia, 704 
Gastric Dilatation, 705 

Fever, — See Fever Simple, Gastritis, 
Remittent Fever, Typhoid Fever. 

Pain, 61, 704 

Sedatives, 49, 61 

Tonics, 63 

Ulcer, 707 

Vomiting, Diagnosis, 907 
Gastritis, 706 
Gastrodynia, 704 
Gaultheria, 325, 464 



Gaultherilene, 326 

Gauze of Carbolic Acid, 84 

Gelatin, 121, 126 

as an Antidote, 805 

Capsules, 566 
Gelsemine, 326 
Gelsemium, 326 

Antidotes and Antagonists, 813 
Generative System, Agents affecting, 31, 

39,.58 
Genitive Case-endings, 896 
Gentian, 327 
Gentianin, 327 
Gentopicrin, 327 
Geranium, 96, 328 
Gigartina, 12 1 
Gin, 131 
Ginger, 530 
Glanders, 708 

Toxin, 518 
Glandular Affections, 708 

Extracts, 156 
Glass, Antidotes for, 813 

Soluble, 438, 481 
Glauber's Salt, 484 
Glaucoma, 709 
Gleet, 709 
Globulins, 28 
Glonoin, 150 
Glossitis, 710 
Glottis, Edema of, 710 
Gluco-pepsine, 413 
Glucose, 462 
Glucosides, 23 
Glucusimide, 461 
Glusidum, 461 
Gluten, 28, 122 

as an Antidote, 805 
Glutol, 324 
Glycerin, 328 

Preparations, 565 
Glycerites, 121, 329, 576 
Glycerophosphates, 421 
Glyceryl, 395 

Borate, 81 

Trinitrate, 150 
Glycocholate, Sodium, 316 
Glycocoll, 417 
Glycogen, 153 

Agents affecting its production, 53, 54 
Glyconin, 121 

Emulsion, 381 
Glycosuria, Temporary, 869 
Glycozone, 408 
Glycyrrhetin, 330 
Glycyrrhiza, 330 
Glycyrrhizin, 330 

Glycyrrhizinum Ammoniatum, 330 
Glymol, 416 
Gnoscopine, 397 
Goa-powder, 268 
Godfrey's Cordial, 399 
Goitre, 710 






INDEX. 



929 



Gold, 205 

Antidotes and Antagonists, 813 

" Bichloride," 210 

Bromide, 206 

Chloride, 206 

Cure, Keeley's, 138, 210, 900 
Golden Discovery, Pierce's, 901 

Seal, 346 
Gonorrhea, 71 1 
Gossypii Radicis Cortex, 331 
Gossypium, 331 
Goulard's Cerate, 433 

Extract, 433 
Gout, 713 

Diagnosis of, 905 
Granatum, 96, 332 

Granular Lids,— See Conjunctivitis, Oph- 
thalmia. 
Granulation, 560 
Granule, 586 
Grape, Oregon, 218 
Grass, Ribbed, 432 

Worm, 487 
Gravel-root, 315 

Graves' Disease, — See Exophthalmos, 697 
Gray Powder, 339 
Griffith's Mixture, 316 
Grindelia, 333 
Grindeline, 333 
Grippe, — See Influenza, 741 
Guaiac, 334 
Guaiacol, 291, 294 
Guarana, 229, 335 
Guaranine, 229, 231, 335 
Gum Arabic, 76, 518 

as an Antidote, 806 

Kauri, 493 

Sweet, 492 
Gumboil, — See Gums, 714 
Gum-resms, 26 
Gums, 22, 714 
Gum-tree, Blue, 313 
Gun-cotton, 153, 331 
Gunjah, 242 
Gurjun Balsam, 335 
Gutta, 309 
Guttae (Drops). 535 
Gutta-percha, 309 
Gynocardia odorata, 252 
Gypsum, 234 



Hsematoxylin, 336 
Haematoxylon, 96, 336 
Hagenia abyssinica, 299 
Hager's Tincture, 271 
Hair, 611, 715 

Washes, Formulae, 611, 715 
Hair-tonic, 611, 715 
Haller's Dictum, 19 
Halogen Elements, 266 
Hamamelin, 336 
Hamamelis, 96, 336 
59 



Hamburg Tea, 900 

Hamlin's Wizard Oil, 900 

Hands, — See Chapped Hands, 645 

Hashish, 242 

Haustus, 576 

Haw, Black, 525 

Hayah, 250 

Hayden's Viburnum Compound, 525 

Hay-fever, 715 

Head-ache, Bilious Sick, 716 

Congestive, 717 

Nervous, 717 
Hearing, 52 
Heart Affections, 719 

Dilated, 720 

Fatty, 720 

Hypertrophied, 720 

Palpitation, 721 

Valvular Disease, 721 
Heartburn, — See Pyrosis, 828 
Heart's-ease, 525 
Heat-stroke, 722 
Hectic Fever, 723 
Hedeoma, 337 



Hel 



enm,352 



000 



Hellebore, 337, 521 

American, 521 

False, in 

Swamp, 521 
Helleborein, t,^"/ 
Helleborin, 337 
Helleborus, 337 
Helmbold's Buchu, 
Hematemesis, 723 
Hematics, 61 
Hematocele, Pelvic, 723 
Hematuria, 724 
Hemeralopia, 724 
Hemicrania, 725 
Hemiopia, 726 
Hemiplegia, 726 
Hemlock, 286 

Spruce, 431 
Hemoglobinuric Fever, 726 
Hemoptysis, 727 
Hemorrhage, 728 

Intestinal, 729 

Post-partum, 729 
Hemorrhagic Diathesis, 72S 
Hemorrhoids, 730 
Hemostatics, 63 
Hemp, 241 

Canadian, 185, 241 

Indian, 241 
Henbane, 348 
Hepar Sulphuris, 496 
Hepatalgia, 731 
Hepatic Abscess, 733 

Cirrhosis, 731 

Congestion. 731 

Depressants, 52 

Diseases, 733 

Stimulants, 53 



930 



INDEX. 



Hepatic Vomiting, Diagnosis, 907 
Hepatitis, 733 
Hernia, 7*34 
Heroine, 399 
Herpes, 734 

Zoster, 735 
Hesperidin, 204, 367 
Heuchera, 96 
Hevea, 308 

Hewitt's Method of Anesthesia, 117 
Hexylamine, 382 
Hiccough, 735 
Hip-joint Disease, — See Coxalgia, 

661 
Hive Mixture, 168, 475 

Syrup, 168 
Hives, — See Urticaria, 870 
Hoang Nan, 338 
Hoarseness, — See Aphonia, 617 
Hodgkin's Disease, 760 
Hoffmann's Anodyne, 1 13, 1 18 
Hoff's Malt Extract, 153 
Hog, 413 
Holloway's Ointment, 900 

Pills, 900 
Holocaine, 283 
Homatropine, 213 
Homeopathic Practices, 547 
Homococamine, 277 
Homoisococamine, 277 
Honduras Bark, 250 
Honey, 378 
Honeys (Mellita), 580 
Hong-Pang Chong, 453 
Hooper's Female Pills, 591 
Hope's Mixture, 672 
Hops, 338 

Hordeolum, — See Eyelids, 698 
Hordeum distichum, 152 
Horehound, 377 
Horlick's Food, 153 
Horse-nettle, 486 
Hostetter's Bitters, 900 
Housemaid's Knee, — See Bursitis, 635 
Humulus, 338 

Hunger, — See Appetite, 618 
Hunyadi Water, 657 
Huxham's Tincture of Bark, 271 
Hwang-Nao, 338 
Hydragogue Diuretics, 46 

Purgatives, 42 
Hydrangea, 339 
Hydrargyrism, 342 
Hydrargyrum, 339 

Ammoniatum, 340 

Antidotes and Antagonists, 812 

cum Creta, 339 
Hydrastin, 218, 346 
Hydrastine, 346 
Hydrastinine, 346 
Hydrastis, 346 

Hydrates, — See the titles of their metallic 
constituents. 



Hydrides, — See the titles of their metallic 

constituents. 
Hydrobromates, — See the titles of their 

basic constituents. 
Hydrocele, 736 
Hydrocephalus, 736 

Acute, — See Meningitis Tubercular. 
Hydrochlorates, — See the titles of their 

basic constituents. 
Hydrocotarnine, 397 
Hydrocotyle, 348 
Hydrogen Carbonate, 91 

Dioxide, 408 

Peroxide, 408 

Sulphide, 496 

Sulphuretted, 496 
Hydroleine, 381 
Hydronaphtol, 387 
Hydrophobia, 736 

Toxin, 517 
Hydroquinone, 272, 273, 519 
Hydroscopic Substances, 558 
Hydrothorax, 736 
Hydroxymethane, 130 
Hygroscopic Bodies, 558 
Hyoscine, 348 
Hyoscyamine, 348 
Hyoscyamus, 348 

Antidotes and Antagonists, 813 
Hyperidrosis, — See Perspiration, 792 
Hypnal, 171, 255 
Hypnone, 130, 256 
Hypnotics, 54, 256, 744 
Hypochlorites, Antidotes, etc., 813 
Hypochondriasis, 737 
Hypodermic Formulae, 897 

Injections, 69 • 

Method, 69 

Solutions, 71, 897 

Tablets, 71 
Hypophosphites, 418, — See also the titles 

of their basic constituents. 
Hyposulphites, 105, — See also the titles of 
their basic constituents. 

as Antidotes, 807 
Hysteria, 737 

Diagnosis of, 905 



Ice, 188 

Iceland Moss, 121, 152 

Ichthyocolla, 121 

Ichthyol, 496, 498 

Ichthyosis, 738 

Icterus, — See Jaundice, 748 

Ignatia, 351 

Ignition, 560 

Ileus, — See Intestinal Obstruction, 746 

Ilex Paraguayensis, 229 

Illicium, 352 

Impetigo, 738 

Impotence, 738 

Incineration, 561 



INDEX. 



931 



Incompatibility, 548 

Chemical, 548 

Dangers of, 552 

Pharmaceutical, 55 1 

Rules for avoiding, 552 

Therapeutical, 552 
Incompatible Substances, 553 
India-rubber, 308 
Indian Corn, 152, 526 

Hemp, 241 

Poke, 521 

Tobacco, 370 
Indigestion, — See Dyspepsia, 680 
Indigo, Wild, 212 
Inflammation, 739 
Influenza, 741 
Infusa (Infusions), 576 
Ingluvin, 413 
Inhalations, 577 
Injection Brou, 578 
Injections, 577 

Antiseptic, 346 

Formulae, 578, 712 

Hypodermic, 69, 897 

Parenchymatous, 71 

Urethral, 578, 712 

Vaginal, 578 
Injuries, — See Bruises, Burns, Ecchymosis, 

Fractures, Sprains, Wounds. 
Inoculation, 72 
Inosit, 463 
Insanity, 742 
Insolation, — See Heatstroke, 722 ; also 

Sunstroke, 846 
Insoluble Salts, 549 
Insomnia, 743 

Integument, Absorption by, 71 
Intemperance, — See Alcoholism, Delirium 

Tremens, Opium Habit. 
Intermittent Fever, 744 
Intertrigo, 746 
Intestinal Astringents, 55 

Diseases, — See Colic, Constipation, 
Diarrhea, Duodenitis, Dysentery, 
Enteritis, Hemorrhoids, Hernia, 
Intestinal Obstruction, Intussus- 
ception, Typhlitis, Tabes Mesen- 
terica, Worms. 

Obstruction, 746 

Parasites, — See Worms, S79 
Intussusception, 747 
Inula, 352 
Inulin, 196, 352 
Inunction, 72 
Iodides, 352 
Iodine, 352 

as an Antidote, 807 

Antidotes and Antagonists, 814 

Carbolated, 352 

Disulphide, 496 
Iodism, 354 
Iodized Cotton, 724 

Phenol, 352 



Iodoform, 353 
Iodol, 358 
Iodophen, 358 
Iodothyrin, 159 
Iodum, 352 
Ipecacuanha, 358 

Antidotes and Antagonists, 814 
Ipomcea Jalapa, 362 
Iridin, 361 
Iris, 361 
Irish Moss, 121 
Irisin, 361 
Iritis, 747 
Iron, 316 

as an Antidote, 807 

Antidotes for, 814 

Dialyzed, 319, 559 

and Manganese, 374 

Pills, 591 
Irritability, 747 
Irritants, Cutaneous, 55 
Ischuria, — See Urinary Disorders, 867 
Isinglass, 121 

Isobutyl-orthocresol Iodide, 357 
Isococamine, 277 
Isonandra Gutta, 309 
Iso-naphtol, 387 
Itch, — See Scabies, 834 
Itching, — See Lichen, Prurigo, Pruritus, 

Pediculi, Scabies, Urticaria, etc. 
Itrol, 196 
Ivy, Poison, 454 

Jaborandi, 426 

Jaboridine, 426 

Jaborine, 426 

Jalap, 362 

Jalapin, 362, 474 

[ambul, 363 

James' Powder, 168 

Jamestown Weed, 488 

Jamun, 363 

Japaconitine, 106 

Jasmine, Yellow, 326 

lateorhiza palmata, 238 

Jaundice, 748 

Javelle Water, Antidotes, etc., 813 

Teaunel's Antidote, 808 

Jequirity, 75 

Tervine, 521 

Joint Affections, 748 

Juglans, 363 

Juniper, 363 

Juniperin, 363 

Juniperus communis, 363 

Oxycedrus, 364 

Sabina, 460 

Virginiana, 460 

Kairin, 273 
Kairolin, 273 
Kalium, 437 
Kalmia latifolia, 378 



932 



INDEX. 



Kamala, 364 

Kaputin, 78 

Kavahin, 364 

Kava-kava, 364 

Kawin, 365 

Keeley Gold Cure, 610, 900 

Kefir, 124 

Keratitis, 749 

Kermes Mineral, 168 

Ketone, 130 

Kidneys, Diseases of, — See Albuminuria, 
Bright's Disease, Calculi, Colic Renal, 
Diabetes, Dropsy, Gout, Hematuria. 

Kino, 96, 365 

Kinoin, 365 

Kino-red, 365 

Kinovin, 270 

Koch's Lymph, 511 

Kola, 230 

Kolanin, 230 

Kombe arrow-poison, 491 

Koomiss, 123 

Koussin, 299 

Kousso, 299 

Krameria, 96, 365 

Kumysgen, 123 

Kumyss, 123, 131 

Kurung Oil, 437 



Labarraque's Solution, 46, 266 
Antidotes, etc., 813 

Labor, 749 

Lac Sulphuris, 495 

Lactation, 750 

Lactocin, 365 

Lactopeptine, 413 

Lactophenin, 416 

Lactopicrin, 365 

Lactose, 463 

Lactuca virosa, 365 

Lactucarium, 365 

Lactucerin, 365 

Lactucin, 365 

Lactyl-para-phenetidin, 416 

Ladies' Slipper, 299 

Lady Webster's Pill, -142 

La Fayette's Mixture, 289 

Lallemand's Specific, 714 

Lanolin, in 

Lanthopine, 397 

Lapathin, 459 

Lappa, 366 

Larch, 1 18, 503 

Lard, no 

Benzoinated, no, 216 
Oil, no 

Largin, 196 

Larix Europaea, 503 

Laryngismus Stridulus, 751 

Laryngitis, 751 

Laryngotomy, 753 

Latin in Prescriptions, 541 



Latin Genitive Case-endings, 896 

Numerals, 895 

Participles, 896 

Phrases and Terms, 541, 883, 897 
Table of, 883 

Prepositions, 897 

Pronunciation, 896 

Verbs, 896 
Laudanine, 397 
Laudanosine, 397 
Laudanum, 397 
Laurel, Cherry, 99 

Mountain, 378 
Laurocerasus, 99 
Lavandula, 366 
Lavender, 366 
Laveran's Formula, 276 
Laville's Gout Mixture, 285, 900 
Laxatives, 41, 593 
Lead, 433 

Colic, 652 

Plaster, 433 

Salts, — Antidotes, etc., 814 

Sugar of, 433 

Water, 433 

and Laudanum, 435 

White, 433 
Lecithin, 121, 163 
Leek, 140 
Lemon, 367 

Lentigo, — See Freckles, 703 
Leopard's Bane, 196 
Leprosy, 753 
Leptandra, 366 
Leptandrin, 366 
Lettuce, 365 
Leucocythemia, 754 
Leucolin, 253 

Leucoma, — See Corneal Opacities, 658 
Leucomaines, 23 
Leucorrhea, 754 
Leukemia, 754 
Levigation, 564 
Levulose, 378, 463 
Lice, — See Pediculi, 790 
Lichen, 755 
Lichenin, 152 

Licoperdon giganteum, 367 
Lignum Vitae, 334 
Lily-of-the-Valley, 288 
Lily, Water, 395 

Pond, 96 
Lime, 234, 367 

Antidotes and Antagonists, 814 

Chlorinated, 266 

Kinovate, 270 

Sulphurated, 496 

Water, 235 
Limon, 367 
Linimenta, 578 

Liniments, Formulae, 235, 369, 579 
Linseed, 368 
Lint, Boracic, 81 






INDEX. 



933 



Linum, 368 

Lips, — See Chapped Lips, 645 

Lip-salve, Red, 507 

Liquid-ambarorientalis, 492 

Liquids, Normal, 575 

Liquores, 579 

Liquorice Root, 330 

Wild, 75 
Listerine, 82 
Litharge, 433 
Lithernia, 755 
Lithium, 369 

Benzoate, 216 
Lithontriptics, 56, 237 
Liver, — See Hepatalgia, etc., 731 
Liver of Sulphur, 496 
Lixiviation, 561 
Lobelacrin, 370 
Lobelia, 370 

Antidotes and Antagonists, 814 
Lobelin, 370 
Lobeline, 370 
Lochia, — See Labor, 749 
Lock-jaw, — See Tetanus, 179, 852 
Locomotor Ataxia, 756 
Loeffler's Solution, 675 
Loganin, 388 
Logwood, 96, 336 
Lotion, 579 

Black, of Mercury, 341 

Boracic, 81 

Evaporating, 741 

Yellow, of Mercury, 341 
Loxopterygium Lorentzii, 204 
Lozenges, 600 
Lugol's Solution, 352 
Lumbago, 757 

Lumbrici, — See Worms, 36, 333, 879 
Lung Diseases, 758 

Gangrene of, 758 
Lupulin, 338 
Lupuline, 3^8 
Lupus, 758 
Lycetol, 430 
Lycopodium, 371 
Lyctonine, 106 
Lymphadenoma, 760 
Lymphangitis, 760 
Lymphatic Extract, 166 
Lysidin, 430 
Lysol, 85, 90 



Mace, 384 

Maceration, 561 

Macis, 384 

Macrotin, 268 

Magendie's Solution, 399, 89S 

Magenta, 325 

Magma, 562 

Magnesia, 372 

as an Antidote, 806 
Magnesium, 372 



Magnesium Borocitrate, 82, 637 

Silicate, 481 
Magnolia, 374 
Magnolin, 374 
Maize, 152, 154, 462, 526 
Malakin, 78, 465 
Malaria, 760 
Male Fern, 203 
Mallein, 518 

Mallotus philippinensis, 364 
Malt, 152 

Extract, 152, 155 
Hoff's, 153 
Maltum, 152 
Mammary Abscess, 605 

Gland Extract, 167 
Manaca, 374 
Mandrake, 436 
Manganauro, 206 
Manganese, 374 
Mangano-ferri Peptonatus, 374 
Manganum, 374 
Mangifera indica, 376 
Mango, 376 
Mango-fruit, 377 
Mangosteen, 377 
Mania, 761 

Puerperal, 827 
Manna, 377 
Mannit, 377 
Mannite, 332 
Manzanita, 519 
Marasmus, — See Atrophy, Emaciation, 

Tabes Mesenterica. 
Marc, 574 
Margarin, no, 381 
Marginal Shield Fern, 203 
Marigold, 238 
Marjoram, Wild, 407 
Marrubiin, 377 
Marrubium, 377 
Marsh-mallow, 142 
Marsh Rosemary, 96 
Mass, Blue, 339 

of Copaiba, 289 

of Ferrous Carbonate, 316 

of Mercury, 339 

Vallet's, 316 
Massae, 580 
Mastic, 377 
Mastiche, 377 
Mastichin, 377 
Mastitis, 762 
Mastodynia, 762 

Masturbation, — See Emissions, 687; Sper- 
matorrhea, 841 
Mate, 229 

Materia Medica, 17, 75 
Matico, 377 
Matricaria, 377 
May Apple, 436 
McMunn's Elixir of Opium, 397 
Meadow Anemone, 443 



934 



INDEX. 



Meadow Saffron, 283 
Measles, 763 

Diagnosis of, 906 

False, — See Roseola, 834 

Temperature in, 852 
Measures, Antagonistic, 33 

Antidotal, 36 

Apothecaries', 533 

Approximate, 535 

British Imperial, 534 

Domestic, 535 

Metric, 534 

and Weights, 532, 910 

Wine, 533 
Meat Diet, 125 

Extracts, 122 

-juices, 122 
Meconidine, 397 
Meconin, 397 
Meconoiosin, 397 
Medicines, Administration of, 67 

Classification of, 29 

Dosage of, 72 

Patent, 899 
Medulline, 164 
Meerschaum, 481 
Mel, 378 
Melachol, 419 

Melaleuca Leucadendron, 233 
Melancholia, 763 

Puerperal, 827 
Melia Azedarach, 211 
Melissa, 378 
Mellin's Food, 153 
Mellita, 580 

Meniere's Disease, — See Vertigo, 875 
Meningitis, Cerebral, 764 

Cerebro-spinal, 764 

Spinal, 765 

Tubercular, 766 
Menispermin, 424 
Menispermum, 378 

Cocculus, 424 
Menopause, — See Climacteric, 650 
Menorrhagia, 766 
Menstrual Disorders, 767 
Menstruum, 561 
Mentagra, 767 
Mentha arvensis, 379 

canadensis, 379 

piperita, 379 

viridis, 380 
Menthol, 27, 379 
Mercaptan, 493 
Mercaptol, 493 
Mercauro, 206, 210 
Mercurio-vegetal, 374 
Mercury, 339 

Antidotes and Antagonists, 812, 814 

Vegetable, 374 
Mesenteric Disease, — See Tabes Mesen- 

terica, 849 
Metabolism, Agents affecting, 30 



Metadioxybenzol, 449 

Metallic Salts, Antidotes, etc. , 814 

Metamorphosis, Destructive, 45 

Methacetin, 416 

Methane, 116 

Methene Chloride, 1 16 

Methol, 130 

Methyl-acetanilid, 77 

Methyl Alcohol, 116, 130 

Bromide, 1 16 

Chloride, 116, 261 

Bichlorinated, 260 

Coniine, 286 

Creosol, 291 

Ether, 116 

Ether of Protocatechuic Aldehyde, 
521 

Hydrate, 130 

Pyrocatechin, 291 

Salicylate, 326, 465 

Terchloride, 260 
Methylal, 1 1 6, 256 
Methylated Spirit, 130 
Methylene Bichloride, 262 

Blue, 380 
Methylene-dimethyl Ether, 256 
Methysticin, 364 
Metric Prescriptions, 544 

System of Weights, etc., 534 

Table for Conversions, 91 1 
Metritis, Acute, 767 
Metrorrhagia, 768 
Mezcaline, 226 
Mezereon, 381 
Mezereum, 381 

Antidotes and Antagonists, 815 
Mica Panis, 588 
Microbe-killer, 901 
Microbes, Agents affecting, 38, 46 

in Water, 188 
Migraine, — See Hemicrania, 725 
Migranin, 78, 171 
Miliaria, 768 
Miliary Fever, 769 
Milk as an antidote, 805 

as a food, 123, 128; See also Aga- 
lactia, 609, and Lactation, 750 

of Asafetida, 202 

Condensed, 123 

Desiccated, 123 

Papaw, 414 

Peptonized, 123 

Sugar of, 463 

of Sulphur, 495 

Substances excreted in, 750 
Milk-fever, — See Lactation, 750 
Mindererus, Spirit of, 145 
Mineral Green, 199 

Waters, 91, 185 
Mint, 380 

Miscarriage, — See Abortion, 604 
Mistletoe, 525 
Misturae, 580 



INDEX. 



935 



Mixture, A. C. E., 114 

Antimonial and Saline, 741 

Basham's, 318, 676 

Bismuth, for Children, 584 

Brown, 330 

Chalk, 235 

Clarke's, 900 

Copaiba, Compound, 289 

Cough, Formulae, 661, 763, 794, 799 

Coxe's Hive, 168, 475 

Diarrhea, 399 

Ferro-saline, 319 

Griffith's, 316 

Hope's, 672 

Iron, Aromatic, 319 
Compound, 316 
Laxative, 319 

Lafayette's, 289 

Laville's, 285, 900 

Liquorice, Compound, 330 

Magnesia and Asafetida, 202, 372 

Nussbaum's, 1 14 

Potassium Citrate, 438 

Quinine, 584, 746 

Rhubarb and Soda, 452 

Saline, 741 

Schleich's, 1 14 

Scudamore's, 714 

Squibb's, 399 

Vienna, 1 14 
Mixtures, 580 

Anesthetic, 1 14 

Compounding of, 583 

Substances suitable to, 580 
Moccasin-plant, 299 
Molasses, 463 
Mole, — See Nevus, 777 
Mollities Ossium, — See Bone Diseases, 

627, Rachitis, 828 
Monk's-hood, 106 • 

Monsel's Solution, 318 
Moonseed, Canadian, 378 
Morbilli, — See Measles, 763 
Morphine, 396, 398, 402 

and Atropine, 407, 898 

Antidotes and Antagonists, 815 

Habit, 781 

Tests for, 400 
Morrhuae Oleum, 381 
Morrhuine, 382 
Morrison's Pills, 238, 901 
Moschus, 383 
Mosquitoes, 845 
Motor Depressants, 56 

Excitants, 57 
Mouth, Absorption by, 67 

Diseases, — See Aphthae, Cancrum 
Oris, Gums, Parotitis, Ptyalism, 
Stomatitis, Toothache, Tongue. 

Washes, Formulae, 715 
Mucilages, 584 
Mucilagines, 584 
Mucilaginous Bodies, 28 



Mucus in Urine, Test for, 870 

Mullein, 524 

Mumps, — See Parotitis, 789 

Muscae Volitantes, 769 

Muscarine, 119 

Antidotes and Antagonists, 815 

Muscular Disorders, — See Atrophy, Chorea, 
Hydrophobia, Laryngismus, Lumbago, 
Myalgia, Pleurodynia, Rheumatism, 
Tetanus, Torticollis. 

Mushrooms, Antidotes, etc., 815 

Musk, 383 

Mustard, 481 

Myalgia, 769 

Mydriasis, 57, 214 

Mydriatics, 57 

Myelitis, 769 

Mykose, 310 

Myopia, 770 

Myotics, 58 

Myrcia, 384 

Myrica, 96 

cerifera, 25 1 

Myricin, 251 

Myristica, 384 

Myristicol, 384 

Myronate, Potassium, 482 

Myrosin, 481 

Myrrh, 385 

Myrrhin, 385 

Myrrhol, 385 

Myrtle, 96, 251, 386 

Myrtol, 386 

Myrtus communis, 386 
Chekan, 386 

Myxedema, 770 



Nails, Ingrowing, 770 
Napelline, 106, 107 
Naphtalene, 386 
Naphtalin, 273, 386 
Naphtol, 387 

Camphorated, 387, 388 
Narceine, 397, 403 
Narco-hypnotics, 54 
Narcosis, 401 
Narcotics, 58 

Antidotes and Antagonists, 815 
Narcotine, 396, 400, 403 
Nasal Affections, 770 
Natrium, 483 
Nausea, 771 
Necrosis, 771 
Nectandra, 412 
Nepenthe, 399 
Nephritis, Acute, 903, — See also Bright's 

Disease, 628 
Nervous Affections, 771 

Exhaustion, — See Neurasthenia, 776 

System, Agents affecting, 31, 32, 38,. 

39,43>56,57, 58 
I Nervousness, 772 



936 



INDEX. 



Neuralgia, 773 

Ovarian, 785 
Neurasthenia, 776 
Neuritis, 777 
Neurodin, 78 
Nevus, 777 

Nicotiana Tabacum, 499 
Nicotianin, 500 
Nicotine, 500 

Antidotes and Antagonists, 819 

Bitartrate, 500 
Niemeyer's Pill, 799 
Nightmare, 778 
Nightshade, Black, 308 

Deadly, 212 

Woody, 308 
Night Sweats, — See Hectic Fever, Per- 
spiration, Phthisis. 
Nipples, Sore, Fissured, 778 
Nitrates, — See the titles of their metallic 
constituents. 

Antidotes and Antagonists, 817 
Nitre, 438, 483 

Chili, 483 . 

Sweet Spirit of, 113 
Nitrites, 150, — See also the titles of their 

metallic constituents. 
Nitro-benzene, 273 

-benzol, 149 

Antidotes, etc., 815 

-glycerin, 150 

Antidotes, etc., 815 
Nitrous Ether, 113, 116 

Oxide, 116 

Antidotes, etc., 815 
Nodes, 778 
Normal Liquids, 575 

Salt Solution, 485, 840 
Norway Spruce, 430 
Norwood's Tincture, 522 
Nose-bleed, — See Epistaxis, 693 
Nosophen, 358 
Nucin, 363 
Nuclein, 160 
Numerals, Latin, 895 
Nutgall, 96, 325 
Nutmeg, 384 
Nux Vomica, 388 

Antidotes and Antagonists, 815 
Nyctalopia, 724 
Nymphaea, 96 

Odorata, 395 
Nymphomania, 778 



Oak -bark, 96, 448 
Oak, Dyer's, 325 
Poison, 454 

White, 448 
Oat, 154, 210 
Obesity, 779 
Odontalgia, 779 
Official Operations, 556 



Official Preparations, 565 
Oil of Allspice, 428 

of Almond, Bitter, 148 
Expressed, 149 

of Amber, 493, 504 

of Anise, 167 

of Anthemis, 167 

of Aurantium Cortex, 205 
Flores, 205 

of Bay, 384 

Benne, 481 

of Bergamot, 218 

of Betula, 27, 465 

of Birch, 465 

of Cade, 364 

of Cadinum, 364 

of Cajuput, 233 

Camphor, 239 

Camphorated, 240 

of Caraway, 249 

Carron, 235, 237,369 

of Carum, 249 

of Cassia, 277 

Castor, 455 

of Caryophyllus, 249 

of Cedar, 471 

Chamomile, 167 

Chaulmoogra, 252 

of Chenopodium, 253 

of Cinnamon, 277 

of Cloves, 249 

Cod-liver, 381 

of Copaiba, 289 

of Coriander, 290 

of Cotton-seed, 331 

Croton, 509 

of Cubeb, 295 

Disinfection, 85 

of Erigeron, 313 

Essential, 27 

Ethereal, 113 

of Eucalyptus, 44, 314 

of Fennel, 324 

of Fleabane, 313 

Fusel, 130 

of Gaultheria, 325, 465 

of Gossypium-seed, 331 

Hamlin's Wizard, 900 

of Hedeoma, 2,37 

of Hemlock, 432 

Hydrated, 381 

Jecoris Aselli, 381 

of Juniper, 363 

Kurung, 437 

Lard, 1 10 

of Lavender-flowers, 366 

of Lemon, 367 

of Linseed, 368 

of Linum, 368 

of Mace, 384 

of Mentha Piperita, 379 

of Mentha Viride, 380 

of Mirbane, 149 



INDEX. 



937 



Oil of Morrhua, 381 

of Mustard, Volatile, 482 
of Myrcia, 384 
of Myristica, 384 
of Myrtle, 386 
of Neroli, 205 
of Nutmeg, 384 
Olive, 395 

of Orange flowers, 205 
of Orange-peel, 205 
of Origanum, 407 
of Pennyroyal, 2,27 
of Peppermint, 379 
Phosphorated, 418 
of Pimenta, 428 
.of Pinus Silvestris, 431, 504 
of Pix Liquida, 431 
of Pongamia, 437 
of Ricinus, 455 
of Rose, 457 
of Rosemary, 458 
of Rue, 459 
of Ruta, 459 
of Sabina, 460 
Salad, 395 
of Sandalwood, 470 
of Santal, 470 
of Sassafras, 474 
of Savine, 460 
of Scotch Fir, 431, 504 
Sequah's, 902 
of Sesamum, 481 
of Sinapis, volatile, 482 
of Spearmint, 380 
of Spruce, 432 
St. Jacob's, 107, 902 
Sweet, 395 

of Succinum, 493, 504 
of Tabacum, 500 
of Tanacetum, 502 
of Tansy, 502 
of Tar, 431 
Teel, 481 

of Terebinthina, 503 
of Theobroma, 230, 506 
of Thuja, 504, 507 
of Thyme, 507 
of Tiglium, 509 
of Tobacco, 500 
of Turpentine, 503 

as an Antidote, 806 
of Valerian, 520 
Volatile, 27 

of Wintergreen, 325, 465 
Wizard, 900 
Wood, 335 
Oils, as Antidotes, 805 
and Fats, 26 
Essential, 27 
Expressed, 559 
Fixed, 26 
Hydrocarbon, 27 
Nitrogenous, 27 



Oils, Oxygenated, 27 
Sulphuretted, 27 
Volatile, 27 
Ointment, 252 

Antipruritic, 602 
Basilicon, 449 
Blue, 340 
Boracic, 81 
Calamine, 529 
of Carbolic Acid, 84 
Citrine, 340, 341 
Diachylon, 433 
Holloway's, 900 
Pagenstecker's, 655 
of Rose Water, 1 1 1 
Spermaceti, in 
of Tannic Acid, 95 
Tar, 431 

White Precipitate, 340 
Ointments, 600 

Compounding, 601 
Formulae for, 602 
Olea Europsea, 395 
Oleaginous Preparations, 565 
Oleata, 584 
Oleates, 103, 584 
Olein, no, 381, 395 
Oleoresina, 584 
Oleo-resins, 26, 584 
Olive, 395 
Onion, 140 
Onychia, 780 

Operations, Pharmaceutical, 557 
Ophthalmia, 781 

Opisthotonos, — See Tetanus, 852 
Opium, 396 

Antidotes and Antagonists, 816 
Denarcotized, 397 
Deodorized, 397 
Habit, 781 
Opodeldoc, 472 
Orange, 204, 367 
Blossom, 901 
Orchitic Extract, 162 
Orchitis, 783 
Ordeal Bark, 250 
Oregon Grape, 218 
Organic Acids, 25 
Origanum, 407 
Orphol, 219 

Ortho-dihydroxy-benzene, 273 
Orthoform,.283 
Oryza sativa, 152 
Ossein, 121 
Otalgia, 784 
Otitis, 784 
Otorrhea, 784 
Ouabain, 492 
Ovarian Extract, 166 
Neuralgia, 785 
Tumors, — See Cysts, 665 
Ovaritis, 785 
Ovis Aries, in 



938 



INDEX. 



Oxaluria, 786 

Ox-gall, 316 

Oxides, 408, — See also the titles of their 

metallic constituents. 
Oxidizers, 550 
Oxyethyl-acetanilid, 416 

-chinolin, 273 
Oxygen, 408 
Oxymel, 378, 580 
Oxymethyl-acetanilid, 416 
Oxytocics, 58 
Oxyuris Vermicularis, 36 
Oyster-shell, 235 
Ozena, 786 
Ozone, 408 



Pagliari's Styptic, 728 
Pain, 406, 787 

Gastric, 63 

Remedies relieving, 31 
Pain-killer, Perry Davis', 901 
Pains, After-, 609 

Chest, 645 

False, 699 
Paint, Unna's, 329 
Paints, 585 

Palmitate of Cetyl, in 
Palmitin, 395 
Pancoast's Styptic, 728 
Pancreas, Agents affecting, 59 
Pancreatic Extract, 166 
Pancreatin, 413 
Pancreatine, 164 
Pancreopepsine, 413 
Pannus, — See Corneal Opacities, 658 
Panopepton, 122 
Pansy, 525 
Papain, 413, 415 
Papaiva, 413 
Papaver somniferum, 396 
Papaverine, 397 
Papaw Milk, 414 
Papayotin, 413 
Paper, Filtering, 560 
Papers (Chartse), 567, 592 
Papine, 397 
Papoid, 414, 415 
Para Rubber, 309 
Paraconi'ine, 286 
Paracoto Bark, 290 
Paracotoin, 290 
Paraldehyde, 130, 41 1 
Paralysis, 788, 843 

Agitans, 789 

of the Bladder, 626 
Para-acetphenetidin. 416 
Para-amidophenol, 465 
Para-dihydroxy-benzene, 273 
Paramenispermin, 424 
Paramorphine, 396 
Paraphenetol Carbamide, 462 
Paraphimosis, — See Phimosis, 795 



Paraplegia, — See Paralysis, 788, 843 

Parasiticides, 59 

Paregoric, 397 

Pareira, 41 1 

Parenchymatous Injection, 71 

Paresis, — See Paralysis, 788, 843 

Parigenin, 473 

Parilla, Yellow, 378 

Parillin, 473 

Paris Green, 199 

Paronychia, 780 

Parotid Extract, 166 

Parotitis, 789 

Parrish's Chemical Food, 419 

Parsley, 184 

Participles, Latin, 896 

Parvoline, 500 

Parvule, 586 

Pasque-flower, 443 

Passiflora Incarnata, 412 

Passion-flower, 412 

Paste, Black, 713 

Unna's, 329 

Vienna, 437 
Pasteur's Inoculation, $IJ 
Pastilles, 600 
Patent Medicines, 899 
Paullinia Cupana, 229, 335 

curare, 298 
Pavy's Solution, 869 
Pearson's Solution, 198 
Peas, 154 
Pectin, 448 
Pediculi, 790 
Pelletierine, 332 
Pellitory, 447 
Pellotine, 226 
Pelosine, 412 
Pemphigus, 790 
Pencils, 595 
Penis, — See Chancre, Chancroid, Chordee, 

Gleet, Gonorrhea, Phimosis, Urethra. 
Pennyroyal, 337 
Pennywort, 348 
Pental, 118 
Pepo, 412 
Pepper, African, 246 

Black, 428 

Cayenne, 246 

Water, 436 
Peppermint, 379 
Pepper-vine, 428 
Pepsin, 412 
Pepsinum, 412 
Peptenzyme, 413 
Peptogenic Milk Powder, 413 
Pepto-mangan, 374 
Peptones, 28, 124 
Peptonoids, 122 
Perchloride of Iron, 316 
Percolation, 561 
Pericarditis, 790 

Diagnosis of, 904 



INDEX. 



939 



Periostitis, 791 
Peritonitis, 791 

Puerperal, 827 

Tubercular, 791 
Permanganate of Potassium, 374 

as an Antidote, 376, 807 
Pernicious Fever, — See Intermittent Fever, 

Remittent Fever. 
Peronine, 399 
Peroxide, Barium, 212 

Hydrogen, 408 
Perry Davis' Pain-Killer, 901 
Persimmon, 96 
Perspiration, 792 
Pertussis, 793 
Peruvian Bark, 269 
Petrolatum, 415 
Petroleum Ether, 216 

Ointment, 415 
Petroselinum sativum, 184 
Peumus Boldo, 221 
Phaeoretin, 452 
Phagedena, — See Chancre, Chancroid, 

Gangrene, Ulcers. 
Pharmaceutical Incompatibility, 551 

Operations, 557 

Preparations, 565 

Rules, 556 
Pharmaceutists, — Their objectionable prac- 
tices, 546, 554, 577 
Pharmacodynamics, 17 
Pharmacology, 17 
Pharmacopoeias, List of, 531 
Pharmacy, 17, 531 

Extemporaneous, 554 

Official, 556 

Rules for neophytes, 556 
Pharyngitis, 794 
Phaseo-mannit, 463 
Pheasant's Eye, ill 
Phenacetin, 416 

Antidotes and Antagonists, 816 
Phenatol, 78 
Phenazone, 170 
Phenocoll Hydrochloride, 417 
Phenol, 83, 272 

Camphor, 84 

Iodized, 84, 352 * 

Sodique, 84 
Phenolid, 78 
Phenols, 84 
Phenopyrin, 17 1 
Pheno-resorcin, 84 
Phenosalyl, 84, 91 
Phenyl, 272 

Alcohol, 8^, 129 

Hydride, 217 

Salicylate, 464 
Phenyl-acetamide, 76 

Ammoniated, 77 
Phenyl-dimethyl-pyrazolon, 170 
Phenyl-methyl-acetone, 130, 256 
Phimosis, 795 



Phlebitis, 795 

Phlegmasia Alba Dolens, 795 
Phlegmon, 796 
Phloridzin, 442 
Phlorol, 291 
Phosphates, 418 
Phosphide, Zinc, 418 
Phosphites, 418 
Phospho-albumen, 163 
Phosphorus, 417 

Antidotes and Antagonists, 816 
Photophobia, 796 
Phthisis, 796 

Temperature in, 851 
Physiological Antagonism, 34 
Physostigma, 421 

Antidotes and Antagonists, 817 
Physostigmine, 421 
Phytolacca, 423 
Phytolaccin, 423 
Phytoline, 424 
Pichi, 424 
Picoline, 500 
Picrcena excelsa, 447 
Picrates, 104 
Picroglycion, 308 
Picropodophyllin, 436 
Picrotoxin, 424 

Antidotes and Antagonists, 817 
Pierce's Favorite Prescription, 901 

Golden Discovery, 901 
Pigmenta, 585 
Piles, 568, 730 
Pill, Anaphrodisiac, 590 

Anti-bilious, 591 

Aperient, 591 

Astringent, 590 

Ayer's, 899 

Blancard's, 317 

Blaud's, 316 

Blue, 339 

Brandreth's, 899 

Cathartic, Compound, 285 
Vegetable, 285 

Chalybeate, 316 

Cholagogue, 59 1 

Emmenagogue, 591 

Ferruginous, 316, 591 

Holloway's, 900 

Hooper's, 591 

Iron, 591 

Lady Webster's, 142 

Lapactic, 142 

Morrison's, 238, 901 

Niemeyer's, 799 

Plummer's, 168, 170 

Tanjore, 845 

Tonic, 591 
Pill-making, 586 
Pill-mass, 580, 586 
Pills, 585 

Coated, 590 

Excipients for, 587 



940 



INDEX. 



Pills, Formula for, 590 

Official, 585 

Process of making, 586 

Substances suitable for, 588 
Pilocarpidine, 426 
Pilocarpine, 426 

Antidotes and Antagonists, 817 
Pilocarpine-phenyl-hydroxide, 85 
Pilocarpus, 426 
Pilulse, 585 
Pimenta, 428 
Pimpinella Anisum, 167 
Pimples, — See Acne, 606 
Pine, Prince's, 253 

Yellow, 503 
Pineal Extract, 164 
Pineapple, 414, 415 
Pinene, 386, 504 
Pines, 430 
Pinipicrin, 507 
Pinites succinifer, 493 
Pink, Carolina, 487 
Pink-root, 487 

Demarara, 487 
Pinus, 430 

australis, 503 

Canadensis, 431 

palustris, 431, 503 

sylvestris, 504 

Taeda, 503 
Piper, 428 

an gusti folium, 377 

cubeba, 295 

methysticum, 364 

nigrum, 428 
Piperazin, 429 
Piperidin, 428 
Piperin, 428 
Pipsissewa, 253 
Piscidia, 430 
Piscidin, 430 
Pissenlit, 503 
Pistacia Lentiscus, 377 

Terebinthus, 503 
Pitaya Bark, 270 
Pitch, 430 

Pituitary Extract, 164- 
Pityriasis, 799 
Pix, 430 

Liquida, 413 
Plague, Bubonic, 800 
Planat's Tincture, 425 
Plantago, 432 
Plantain, 432 
Plaster, Adhesive, 449 

Anodyne, 57° 

Cantharidal, 244 

Capsicum, 246 

Counterirritant, 570 

Court, 121 

Diachylon, 433 

Isinglass, 121 

Pitch, 431 



Plaster, Resin, 449 

Strengthening, 317 

Vesicating, 570 

Warming, 244, 431 
Plasters, 569 

Formulae for, 570 
Plethora, 800 

Abdominal, 604 
Pleurisy, 800 

Diagnosis of, 906 
Pleurisy-root, 203 
Pleuritis, 800 
Pleurodynia, 801 
Pleuro-pneumonia, 802 
Plum, 442 
Plumbism, 434 
Plumbum, 433 
Plummer's Pills, 168, 170 
Pneumonia, 802 

Diagnosis of, 906 
Podophyllin, 436 
Podophyllitoxin, 436 
Podophyllum, 436 
Poison Ivy, 454 

Nut, 388 

Oak, 454 

Antidotes and Antagonists, 817 

Sumach, 454 
Poisoning, t>Z, 803, — See also the several 
poisons under their titles in Part I. 

Antidotes and Antagonists, 33, 804 

Treatment of, — Indications for, 33 
General Principles of, 803 
Poisonous Compounds, 551 
Poisons, Energetic, 803 
Poke-berry, 423 
Poke, Indian, 521 
Poke-root, 423 
Polygala Senega, 478 
Polygonum, 436 
Polyporus fomentarius, 118 

officinalis, 1 18 . 
Polypus, 819 

Polyuria, — See Diabetes Insipidus, 668 
Pomade de Bareges, 800 
Pomegranate, 96, 332 
Pond Lily, 96 
Pond's Extract, 336* 
Pongamia, 437 
Poplar, 464 
Poppy, White, 396 
Populus, 464 
Porphyrization, 564 
Porphyroxin, 397, 469 
Porrigo Capitis, — Tinea Tonsurans, 856 
Porter, 131 
Port Wine, 131 
Potash, 437 

'Antidotes, etc., 817 
Potassa, 437 

cum Calce, 437 

Sulphurata, 496 
Potassio-ferric Tartrate, 318 



INDEX. 



941 



Potassium, 437 

Alum, 143 

Bichromate, 94, 817 

Cyanide, 99, 101, 813 

Ferro cyanide, 99, 101, 807 

Myronate, 482 

Nitrate, 438, 817 

Nitrite, 150 

Permanganate, 374, 376, 807 

Silicate, 438, 481 

Tartraborate, 82, 637 
Potato, 154, 308 

Spirit, 130 
Potentilla Sarmentosa, 792 
Potus, 591 
Poultices, 567, 820 

List of Br. Official, 567 
Powder, Antimonial, 168 

Aromatic, 277 

Bleaching, Antidotes, 813 

Dover's, 358, 398 

Effervescing, 438 

Gray, 339 

James', 168 

Liquorice, 330, 479 

Purgative, 362 

Seidhtz, 438 

Tully's. 398 
Powders, 591 

Formulas for, 593 

Substances suitable to, 592 
Prairie Flower, 902 
Precipitant Solutions, Table of, 550 
Precipitate, White, 340 

Red, 340 
Precipitation, 562 
Pregnancy, Disorders of, 820 

Vomiting of, 877 
Premna tatiensis, 510 
Preparations, 565 

Official, 73, 565 
Prepositions, Latin, 896 
Prescription, Pierce's Favorite, 901 

Writing, 537 

Latin Phrases used, 541, 883, 897 
Prescriptions, 536 

Abbreviations in, 545 

Analysis of, 538 

Blanks for, 548 

Contractions, 545, 883 

Filling of, 554 

Latin Phrases used, 541, 883, 897 

Metric, 544 

Renewals, 546 

Table of Doses, — See cover. 

Tonic, 608, 613, 777 

Use of Latin in, 541 
Prickly Heat, — See Miliaria, 768 
Pride of China, 211 
Prince's Pine, 253 
Principles in Drugs, 21 

Bitter, 24 

in Extracts, 573 



Principles, Neutral, 24 
Prinos, 442 

Proctitis, — See Rectum, 828 
Prodigiosus Toxin, 515 
Prolapsus Ani, 821 

Uteri, 821 
Pronunciation, 896 
Propyl Oxide. 381 
Propylamine, 197 
Prosopalgia, — See Neuralgia, Odontalgia, 

Tic Douloureux. 
Prostate, Hypertrophied, 821 
Prostatitis, 821 
Prostatorrhea, 822 
Protargol, 196 
Protectives, 59 
Proteid, Coagulated, 28 
Protein, 120 

Bodies, 28 
Protonuclein, 161 
Protopine, 397 
Protoveratridine, 521 
Protoveratrine, 521 
Prune, 442 
Prunum, 442 
Prunus Amygdalus, 148 

domestica, 442 

Laurocerasus, 99 

Serotina, 442 

Virginiana, 99, 442 
Prurigo, 822 
Pruritus, 822 
Pseudaconitine, 106 
Pseudo-jervine, 521 
Pseudo-morphine, 397 
Pseudotropine, 348 
Psoriasis, 824 
Pterocarpus marsupium, 365 

santalinus, 47 1 
Pterygium, 824 
Ptomaines, 23 
Ptosis, 824 

Ptyalism, 61, 343, 825 
Puccine, 469 
Puerperal Convulsions, 825 

Disorders, 826 

Fever, 826 

Mania, 827 

Melancholia, 827 

Peritonitis, 827 
Puff-ball, 367 
Pulmonary Sedatives, 59 
Pulsatilla. 443 

Antidotes and Antagonists, 817 
Pulse, 827 

and Temperature, 852 
Pulveres, 591 
Pulverization, 564 
Pulvis Doveri, 358 

Purgans, 362 
Pumpkin-seed, 412 
Punica Granatum, 332 
Purgatives, 41 



942 



INDEX. 



Purging Agaric, Il8 

Cassia, 250 
Purpura, 827 

Pus in Urine, Test for, 870 
Pustule, Malignant, — See Anthrax, 616 
Pustules, — See Anthrax, Ecthyma, Erup- 
tions, Impetigo, Variola. 
Pustulants, 55 
Pyemia, 839 
Pyramidon, 17 1 
Pyrethrine, 447 
Pyre thrum, 447 
Pyretine, 78 
Pyridine, 273, 500 
Pyrocatechin, 272, 273, 431 
Pyrogallol, 97, 273 
Pyrrol, 358 
Pyrosis, 828 

Pyroxylin, 153, 331, 568 
Pyrozone, 408 



Quaker Button, 388 

Quantities, Prescription, Table of, — See 

Cover. 
Quassia, 447 
Quassin, 447 
Quebrachine, 203 
Quebracho, 203 
Queen's Delight, 487 

Root, 487 
Quercin, 448 
Quercitrin, 448, 457 
Quercus Alba, 96, 448 

Lusitanica, 325, 448 

Tinctoria, 448 
Quicksilver, 339 
Quillaja, 448 
Quinalgen, 78, 254 
Quince-seed, 299 
Quinetum, 272 
Quinicine, 270, 273 
Quinidine, 270, 272 
Quinine, 270, 271 

Antidotes and Antagonists, 817 

Hypodermically, 275 

Mixtures, 584, 746 

Solutions of, 582 

Substitutes for, 272 
Quinoidin, 272 
Quinolin, 253 
Quinone, 273 
Quinosol, 254 
Quinquinina, 272 
Quinsy,— See Tonsillitis, 857 



Rabies, — See Hydrophobia, 736 

Toxin, 517 
Rachitis, 828 

Radam's Microbe-killer. 901 
Radway's Ready Relief, 901 

Resolvent, 901 



Raspail's Eau Sedative, 145, 239 

Raspberry, 459 

Rat-pastes, Antidotes, etc., 817 

Ratsbane, 817 

Raw Beef, 127 

Recamier Balm, etc., 901 

Rectum, Absorption by, 68 

Diseases of, 828 

Prolapse of, 821 

Ulceration of, 829 
Red Gum, — See Strophulus, 846 

Rose, 96, 457 
References and Bibliography, 603 
Refrigerants, 60 
Relapsing Fever, 829 
Remittent Fever, 829 

Diagnosis of, 907 
Renal Depressants, 48 

Extract, 165 
Renewals of Prescriptions, 546 
Resin, 25, 449, 504 

Cerate, 449 

Plaster, 449 
Resina, 449, 504 
Resinae, 593 
Resinol, 431 
Resins, 25, 593 

Pharmaceutical, 26 

True, 26 
Resorcin, 85, 272, 449 

Antidotes and Antagonists, 817 
Respiration, — See Bronchitis, Croup, Dysp- 
nea, Emphysema, Pneumonia. 

Agents affecting, 50, 59, 60 

Artificial, 620 
Respiratory Depressants, 60 

Stimulants, 60 

Tract, Absorption by, 68 
Restoratives, 61 
Retina, Affections of, 830 
Retinol, 431 
Revalenta Arabica, 901 
Rhamnoxanthin, 324 
Rhamnus Frangula, 324 

Purshiana, 451 
Rhaphidophora vitiensis, 5 10 
Rhatanine, 365 
Rhatany, 96, 365 
Rheum, 451 
Rheumatism, Acute, 830 

Chronic. 832 

Diagnosis of, 905 

Gonorrheal, 833 

Muscular, 834 
Rheumatoid Arthritis, 618 
Rhinacanthin, 453 
Rhinacanthus, 453 

Rhinitis, — See Catarrh Acute Nasal, In- 
fluenza, Nasal Affections. 
Rhoeaaine, 397 
Rhubarb, 451 
Rhus, 453, 454 

Antidotes and Antagonists, 817 



INDEX. 



943 



Rice, 152, 154 
Ricin, 175, 455 
Ricinine, 455 
Ricinolein, 455 
Ricinus communis, 455 
Rickets,— See Rachitis, 828 
Rigors, — See under Fever, 699 
Ring-worm, — See Dhobie Itch, 

Tinea, 854 
Risus sardonicus, 390 
Roasting, 563 
Rochelle Salt, 438 
Rosa, 96, 457 
Rosanilin, 325 
Rose, 96, 457 

Attar of, 457 

Honey of, 378, 458 
Roseine, 325 
Rosemary, 96, 458 
Roseola, 834 
Rosmarinus, 458 
Rottlera, 364 
Rottlerin, 364 
Rough-on-rats, 817 
Rubber, India, 308 
Rubefacients, 55 
Rubeola, — See Measles, 763 
Rubidium, 458 
Rubijervine, 521 
Rubini's Tincture, 239 
Rubus, 96, 459 
Rue, 459 
Rules for Incompatibility, 553 

for Pharmaceutists, 556 
Rum, 131 

Bay, 384 
Rumex, 459 
Rumicin, 459 

Rupia, — See Pemphigus, 790 
Russian Spirit, 833 
Ruta, 459 
Rye, 154, 310 



Sabadine, 521 
Sabadinine, 521 
Sabina, 460 

Antidotes and Antagonists, 81! 
Saccharin, 461 
Saccharum, 462 

Lactis, 463 
Sacred Bark, 451 
Safflower, 295 
Saffron, 294 

American, 294 

Meadow, 283 
Saffron-tea, 295 
Safrol, 239, 474 
Sage, 468 

Sage's Catarrh Remedy, 901 
Sago, 154 
Sal-ammoniac, 145 



668 



Salbromalide, 77 

Salfene, 78 

Salicin, 464 

Salicylate, Para-amidol, 465 

Physostigmine, 422 

Sodio-Theobromine, 233 
Salicylates, 465 
Salicyl-bromalide, 77 
Salicyl-para-phenetidin, 465 
Saligenin, 465 
Saline Mineral Waters, 186 

Purgatives, 42 
Salipyrin, 171, 465, 468 
Saliva, Agents affecting, 61 
Salivation, 61, 343, 825 
Salix, 464 

Nigra, 464 
Salol, 464, 467 
Salophen, 465, 468 
Salt, common, 483 

as an Antidote, 807 

Epsom, 372 

Glauber's, 484 

Rochelle, 438 
Saltpetre, 438 

Antidotes and Antagonists, 817 

Chili, 483 
Salt-rheum, — See Eczema, 685 
Salts, Deliquescent, List of, 589 

Efflorescent, List of, 589 

Insoluble, 549 

Metallic, Antidotes, etc., S14 
Salve, Red Lip, 507 
Salvia, 468 
Salviol, 468 
Sambucus, 468 
Sandal-wood, 470 

Oil, 470 
Sand-brier, 486 
Sanford's Catarrh Cure, 901 
Sanguinaria, 469 

Antidotes and Antagonists, 81S 
Sanguinarine, 469 
Sanitas, 46, 504 
Sanose, 122 
Santalum Album, 470 

Citrinum, 470 

Rubrum, 471 
Santonica. 471 
Santonin, 471 
Sapo, 472 
Sapogenin, 478 
Saponification, 472 
Saponin, 251, 448, 478 
Saprol, 85 
Sarcinse, 834 

Sarcocele, — See under Cancer, Testicles. 
Sarsaparilla, 473 

Ayer's, 899 
Sassafras, 474 

Swamp, 374 
Sassy Bark, 250 
Saunders, Red, 471 



944 



INDEX. 



Savine, 460 

Antidotes and Antagonists, 818 
Saxin, 462 

Sayre's Method for Chloroform, 265 
Scabies, 834 

Scald-head, — See Eczema, Tinea. 
Scalds, 634 
Scammonium, 474 
Scammony, 474 
Scarlet Fever, 835 

Diagnosis of, 906 
Temperature in, 851 
Scheele's Acid, 99 

Green, 199 
Schleich's Method of Anesthesia, 117 

Solutions, 114 
Sciatica, 836 
Scilla, 475 
Scillin, 475 
Scillipicrin, 475 
Scillitin, 475 
Scillitoxin, 475 
Scirrhus, — See Cancer, 637 

Diagnosis of, 904 
Sclererythrin, 310 
Scleroderma, 837 
Scleromucin, 310 
Sclerosis, 837 
Scleroxanthin, 310 
Scoparin, 476 
Scoparius, 476 
Scopolamine, 348 
Scopoleine, 348 
Scopolia carniolica, 348 
Scorbutus, — See Scurvy, 838 
Screaming, — See Nightmare, 778 
Scrofulosis, 838 
Scudamore's Mixture, 714 
Scurvy, 838 
Scutellaria, 478 
Scutellarin, 478 
Sea-sickness, 839 
Sea-wrack, 325 
Seborrhea, 839 
Secale cereale, 310 
Secaline, 526 
Sedative, Battley's, 399 
Sedatives, 61 

Cardiac, 40 

Gastric, 49, 593 

General, 49 

Pulmonary, 59 

Urinary, 64 

Uterine, 65 

Vascular, 65 

Vesica], 66 
Seidlitz Powder, 438 
Seigel's Syrup, 901 
Senega, 478 
Senegin, 478 
Senna, 479 
Sennacrol, 479 
Sennapicrin, 479 



Separation, 562 

Septicemia, 839 

Sequah's Oil, 902 

Prairie Flower, 902 

Serpentaria, 480 

Serpent-venom, Antidotes, etc., 818 

Serum, Antiphthisic, 182 
Antitoxic, 175 
Artificial, 777 

Serum-therapy, 176 

Sesamum, 481 

Sevum, in 

Shampoo Mixtures, 715 

Sheep, in 

Shells, 230 

Sherry Wine, 131 

Shingles, — See Herpes Zoster, 735 

Shock, Surgical, 840 

Sialogogues, 61 

Sickness at Stomach, — See Nausea, Sea- 
sickness, Vomiting. 

Sick-room, 840 

Siddhi, 242 

Silicates, 481 

Silicious Mineral Waters, 187 

Silver, 190 

Antidotes and Antagonists, 818 
Compounds, 195 

Sinalbin, 481 

Sinapine, 481 

Sinapis, 48 1 

Singultus, — See Hiccough, 735 

Sinigrin, 482 

Sinistrin, 475 

Skin, Agents affecting, 32, 40, 44, 50, 55, 
59,63 
as an Absorbent, 71 

Skin Diseases, — See Acne, Anthrax, Bed- 
sores, Boils, Burns, Carbuncle, Chapped 
Hands and Lips, Chilblains, Condylo- 
mata, Dhobie Itch, Ecchymosis, Ecthy- 
ma, Eczema, Eruptions, Erysipelas, Ery- 
thema, Freckles, Herpes, Herpes Zoster, 
Ichthyosis, Impetigo, Intertrigo, Lep- 
rosy, Lichen, Lupus, Mentagra, Miliaria, 
Nevus, Onychia, Pemphigus, Perspira- 
tion, Phlegmon, Pityriasis, Prurigo, Pru- 
ritus, Psoriasis, Roseola, Scabies, Sclero- 
derma, Seborrhea, Strophulus, Sycosis, 
Syphilis, Tinea, Ulcers, Urticaria, Warts, 
Wen. 

Skull-cap, 478 

Sleep, Abnormal, — See Delirium, Insom- 
nia, Nightmare, Somnambulism. 

Slippery Elm Bark, 519 

Smallpox, — See Variola, 875 
Diagnosis of, 906 

Smart-weed, 436 

Smell, Agents affecting, 62 

Smilacin, 473 

Smilax, 473 

Snake-root, Black, 268 
Virginia, 480 



INDEX. 



945 



Sneezing, 841 

Agents producing, 50. — See also Ca- 
tarrh, Hay Fever, Influenza. 
Soaloin, 141 
Soap, 472 

as an Antidote, 806 

Bark, 448 
Soda, 483 

Antidotes and Antagonists, 818 

Caustic, 483 

Chlorata (Chlorinated), 266 

Water, 91, 93 
Sodio-Theobromine Salicylate, 233 
Sodium, 483 

Benzoate, 216 

Bisulphite, 105 

Borate, 81 

Hyposulphite, 105 

as an Antidote, 807 

Nitrite, 150 

Phosphate, 157, 418, 421 

Silicate, 481 

Sulphite, 105 

Sulpho-carbolate, 84 

Taurocholate, 316 

Tetraborate, 82 
Solanine, 308 
Solanum Carolinense, 486 

Dulcamara, 308 
Solid Preparations, 565 
Soloid, 597 

Soluble Substances, 581 
Solution, 562 

Aids to, 582 

Alkaline Cupric Tartrate, 296 

Antiseptic, 84, 346 

Circulatory, 562 

Clemens', 199 

Creuse's, 316 

Crocq's, 421 

Didama's, 898 

Donovan's, 199 

Fehling's, 296 

Fowler's, 198 

Glass, 481 

Labarraque's,46, 266 

Loeffler's, 675 

Lugol's, 352 

Magendie's, 399, 898 

Monsel's, 318 

Normal Salt, 485, 840 

Pavy's, 869 

Pearson's, 198 

Quinine, 582 

Saturated, 562 

Villate's, 298, 639 

Vleminck's, 668 
Solutions (Liquores), 579 

Hypodermic, 71, 897 

Precipitant, Table of, 550 

Schleich's, 1 14 

Stock, 556 
Solutol, 85 

60 



Solvents, 563 
Solved, 85 
Somatose, 123 
Somnal, 255 
Somnambulism, 841 
Sorbefacients, 45 
Sores, 864 

Bed, 624 
Sorghum, 462 
Sorrel, 459 
Soz-albumin, 514 
Sozodont, 902 
Spanish Flies, 244 
Sparteine, 476 
Spasmodic Affections, 841 
Spearmint, 380 
Specific Gravity and Volume, 536 

Table of, 908 
Spermaceti, ill 
Spermatorrhea, 841 
Spermine, 164 
Sphacelotoxin, 310 
Spigelia, 487 
Spina Bifida, 842 
Spinal Concussion, 842 

Congestion, 842 

Inflammation, — See Meningitis, Mye- 
litis, etc. 

Irritation, 843 

Paralysis, 843 

Softening, 843 
Spirit of Mindererus, 145 

Methylated, 130 

Perfumed, 131 

Potato, 130 

Proof, 130 

Rectified, 130 

Russian, 833 

Wood, 130 
Spirits (Spiritus), 594 
Splenic Affections, 843 

Extract, 166 
Spongia Usta, 838 
Spongio-piline, 820 

Spotted Fever, — See Typhus Fever, Men- 
ingitis Cerebro-spinal. 
Sprains, 843 
Spruces, 430 
Sprue, 843 
Spunk, 118 

Squamae, — See Ichthyosis, Pityriasis, Pso- 
riasis, etc. 
Squaw-root, 251 
Squibb's Mixture, 399, 647 
Squill, 475 

St. Ignatius' Bean, 351 
St. Jacob's Oil, 107, 902 
St. Mary's Thistle, 248 
St. Vitus' Dance, — See Chorea, 649 
Stains, 844 
Stammering, 844 
Staphisagria, 487 
Starch, 152,463 



946 



INDEX. 



Starch as an Antidote, 805, 808 

Star-wort, 140 

Statice, 96 

Stavesacre, 487 

Stearin, no 

Sterility, 844 

Sternutatories, 50 

Stigmata Maydis, 526 

Stillingia, 487 

Stimulants, 62 

Cardiac, 40 

Diffusible, 62 

Hepatic, 53 

Local, 63 

Pancreatic, 59 

Respiratory, 60 

Vascular, 66 
Stings, 845 
Stock Solutions, 556 
Stokes' Liniment, 579 
Stomach, Absorption by, 67 

Diseases, — See Dyspepsia, Gastralgia, 
Gastric Ulcer, Gastritis, etc. 
Stomachics, 63 
Stomatitis, 845 
Stone, — See Calculi, 56, 636 
Storax, 492 
Strabismus, 846 
Straining, 557 
Stramonium, 488 

Antidotes and Antagonists, 818 
Strangury, — See Cystitis, Dysuria. 
Stricture, — See Rectum, 828 

Urethral, 866 
Strontium Salts, 490 
Strophanthin, 49 1 
Strophanthus glabrus, 492 

hispidus, 491 
Strophulus, 846 
Strychnine, 338, 351, 389 

Antidotes and Antagonists, 815 
Strychnos Ignatii, 351 

Gautheriana, 338 

Nux Vomica, 388 
Sturgeon, 121 
Stye, — See Eyelids, 698 
Styptic Collodion, 95,- 331, 881 
Styptics, 63, 728 
Styracin, 492 
Sty rax, 492 

Benzoin, 216 
Styrol, 492 
Sublimation, 563 
Substances, Amyloid, 28 

best given alone, 553 

difficult to combine in pill, 588 

suitable for mixtures, 581 

suitable for pills, 588 

suitable for powders, 592 

unsuited to pill-form, 589 
Succinum, 493 
Sucrol, 462 
Sudorifics, 45 



Suet, in 
Sugar, 462 

of Lead, 433 

of Milk, 463 

in Urine, — See Diabetes Mellitus, 668 
Tests for, 869 
Sulphates, — See the titles of their basic 
constituents. 

as Antidotes, 807 
Sulphides, 495 
Sulphites, 105 
Sulpho-carbolates, 84, 90 
Sulpho-cyanate, Acrinyl, 481 
Sulpho-cyanide, Allyl, 482 
Sulpho-ichthyolates, 496 
Sulphonal, 493 

Antidotes, etc., 818 
Sulphur, 495 

Antidotes and Antagonists, 819 
Sulphurated Antimony, 168 

Lime, 496 

Potassa, 496 
Sulphuretted Hydrogen, 496 
Sulphurous Mineral Waters, 186 
Sumach, 453 
Sumbul, 499 
Sun-dew, 306 

Sunstroke, 846, — see also Heat-stroke, 722 
Suppositoria, 594 
Suppositories, Formulae, 595 

Official in Br. Phar., 596 
Suppuration, 846 
Surgeon's Agaric, 118 
Surgical Fever, 847 
Sus scrofa, 413 
Svapnia, 397 
Swallowing, — See Dysphagia, Esophageal 

Affections. 
Swamp Sassafras, 374 
Sweet Bay, 374 

Flag, 233 

Gum, 492 
Swertia Chirata, 254 
Swift's Specific, S. S. S., 902 
Sycosis, 847 

Sydenham's Laudanum, 397 
Syncope, 847 
Synovitis, 847 
Syntonin, 124 
Syphilis, 848 

Diagnosis, — See Chancre, 904 
Syrup, Siegel's, 901 

Mrs. Winslow's Soothing, 399 
Syrupi (Syrups), 596 



Tabacum, 499 

Tabellae, 597 

Tabes Mesenterica, 849 

Table of Antagonistic Drugs, 35 

Drops in a Drachm, etc., 535, 910 
Latin Words, Phrases, etc., 883 
Metric Conversion, 91 1 and cover. 



INDEX. 



947 



Table, Precipitant Solutions, 550 

Prescription Doses and Quantities, — 
See cover. 

Specific Gravities and Volumes, 908 
Tables of Differential Diagnosis, 903 

of Weights and Measures, 533, 910 
Tablets, 597 

Compressed, List of, 597 

Hypodermic, List of, 71, 597 

of Nitroglycerin, 150 
Tabloid, 597 
Tag Alder, 141 
Tamarind, 502 
Tamar-Indien, 479, 902 
Tamarindus, 502 
Tanacetin, 502 
Tanacetum, 502 
Tannigen, 97 
Tannin, 95 

as an Antidote, 805 
Tansy, 502 

Tapeworms, 36, 203, 333, 879 
Tapioca, 154 
Tar, 431 
Tar- water, 431 
Taraxacerin, 503 
Taraxacin, 503 
Taraxacum, 503 
Tartar, Cream of, 438 

Crude, 437 

Emetic, 168 

Antidotes and Antagonists, 819 
Tartraborate of Potassium, 82, 637 
Tartrate, Ammonio ferric, 318 

Antimony and Potassium, 168 

Potassio-ferric, 318 

Potassium and Sodium, 438 
Tartrates, 106 
Taste, Agents affecting, 64 

Disordered, 850 
Taurocholate of Sodium, 316 
Tea, 229 

■ Boneset, 315 

Flaxseed, 369 

Garfield, 900 

German Breast, 143 

Hamburg, 900 

Linseed, 369 

Saffron, 295 

Tansy, 502 

Worm, 487 
Teel Oil, 481 
Teeth, 850 

Agents affecting, 44 
Teething, — See Dentition, 667 
Temperature in Disease, 850 

Drugs affecting, 37 
Tenesmus. — See Dysentery, 677 
Teni9e, 36, 203, 333, 879 
Teniafuges, 36 
Terebene, 504 
Terebinthene, 504 
Terebinthina, 503 



Terpenes, 27 
Terpilene, 504 
Terpin, 504 
Terpinene, 504 
Terpinol, 504 
Testa Prseparata, 235 
Testicles, 852 
Testicular Juice, 156, 162 
Testing, 563 
Tests for Morphine, 400 

for Urinary Constituents, 868 
Tetanus, 179, 852 
Tetraborate, Sodium, 82 
Tetrachloride, Carbon, 116, 262 
Tetra-hydromethyl-chinolin, 273 
Tetra-hydro-parachinanisol, 273 
Tetra-hydroparamethyl-oxychinolin, 273 
Tetra-iodo-pyrrol, 358 
Tetra-methyl-Thionine Chloride, 380 
Tetronal, 495 

Tetter, — See Herpes, Pityriasis, Psoriasis. 
Thallin, 273 
Thea sinensis, 227 
Thebaine, 396, 403 
Theine, 227, 231 
Theism, 229 

Theobroma Cacao, 230, 506 
Theobromine, 229, 231, 506 
Therapeutical Incompatibility, 55 2 
Therapeutics, 17 

Applied, 18, 604 

Empirical, 18 

Natural, 18 

Rational, 19 

Special, 603 
Theriaca, 463 
Thermodin, 78 
Thermometer, Clinical, 850 
Thimble-berry, 459 
Thiol, 496, 499 
Thirst, 853 

Agents allaying, 60 
Thistle, Blessed, 248 

St. Mary's, 248 
Thompson's Eye-water, 902 

Tincture, 418 
Thorn-apple, 488 
Thorough-wort, 315 

Throat, — See Aphonia, Croup, Diphthe- 
ria, Laryngitis, Pharyngitis, Scarlet 
Fever, Tonsillitis, etc. 

Sore, 853 
Thrush,— See Aphthae, 617 
Thuja, 507 
Thujetin, 507 
Thujin, 507 

Thus Americanum, 503 
Thyme, Garden, 507 
Thymene, 508 
Thymol, 508 
Thymus (gland) Extract, 160 

vulgaris, 5°7 
Thyreo-antitoxin, 159 



94 8 



INDEX. 



Thyreoidin, 159 

Thyroid Extract, 157 

Tic Douloureux, 854 

Tiglii Oleum, 509 

Tin, Antidotes and Antagonists, 819 

Tinctura Pyrexialis, 271, 276 

Tmcturae (Tinctures), 597 

Tincture, Fleming's, 107 

Hager's, 271 

Huxham's, 271 

Norwood's, 522 

Planat's, 425 

Rubini's, 239 

Thompson's, 418 

Warburg's, 271, 276 
Tinea Circinata, 854 

Decalvans, 855 

Favosa, 855 

Imbricata, 855 

Sycosis, — See Mentagra, 767 

Tonsurans, 856 

Versicolor, 856 
Tinnitus Aurium, — See Ear, 684 
Tobacco, 499 

Antidotes and Antagonists, 819 

Indian, 370 

Symptoms, — See Amaurosis, Ner- 
vousness. 
Toe-nails, — See Nails, Ingrowing. 
Tokelau Ringworm, 855 
Tolene, 211 
Toluene, 461 
Toluifera Pereirae, 211 

Balsamum, 21 1 
Tomato, 308 
Tonga, 510 
Tongine, 510 
Tongue, 856 

Absorption by, 67 
Tonics, 61 

Cardiac, 41 

Formulae, 608, 613, 777 

Gastric, 63 

Hair, 715 

Nerve, 773, 777, 783 

Pill for Women, 591 

Uterine, 65 

Vascular, 65 

Vesical, 66 
Tonsillitis, 857 
Tonsils, Enlarged, 857 

Ulcerated, 858 
Toothache, — See Odontalgia, 779 
Toothrash, — See Strophulus, 846 
Torrefaction, 563 
Torticollis, 858 
Torulaa, — See Sarcinse, 834 
Toxalbumins, 510, 514 
Toxemia, 858 

Toxicological Antagonism, 34 
Toxicology, 17, ^2> &°3 
Toxin, Cholera, 516 

Erysipelas, 515 



Toxin, Prodigiosus, 515 

Rabies, 517 

Tuberculosis, 5 1 1 
Toxins, 510 

Tracheitis, — See Croup, 661 
Trachoma, — See Conjunctivitis, Granular, 

655 ; Ophthalmia, 781 
Tragacantha, 518 
Transfusion, 69 

Traumatic Fever, — See Surgical Fever. 
Traumaticin, 309 
Treacle, 463 
Tree of Heaven, 120 
Tremor, 858 
Tri-bromo-methane, 221 
Trichiniasis, 859 
Trichloraldehyde, 254 
Trichophytosis capitis, — See Tinea, 854 
Trihydroxy-benzene, 97, 273 
Trikresol, 85, 90 

Trimethylamine, 197, 198, 310, 338, 381 
Trimethyl-ethylene, 1 18 

-xanthin, 227 
Trinitrin, 150 
Trinitrophenol, 104 
Trional, 495 
Trismus, 859 
Triticin, 519 
Triticum, 152, 519 
Trituration, 563 
Triturationes, 598 
Triturations, their advantages, 599 

of Elaterin, 309 

Formulae, 600 

of Mercury, 341, 599 
Troches, 600 
Trochisci, 600 
Tropacocaine, 277, 278 
Tropa'in, 278 
Tropeius, 213 

Tropical Fruit-Laxative, 479 
Tropin, 213 
Trypsin, 413 
Tubercular Laryngitis, 752 

Meningitis, 766 

Peritonitis, 79 1 
Tuberculin, 511 
Tuberculin-R, 513 
Tuberculocidin, 514 

Tuberculosis, 859, — See also Tubercular 
Laryngitis, etc. , above ; also Lupus, 
Phthisis, Scrofulosis, Tuberculous 
Affections. 

Acute, 859 

Antitoxin, 180 
Tuberculous Affections, 860 
Tully's Powder, 398 
Tumenol, 496, 499 
Tumors, 860 

Diagnosis of, 904 

Uterine, 872 
Turnera aphrodisiaca, 299 
Turpentine, 1 16, 503 



INDEX. 



949 



Turpentine as an Antidote, 806 

Antidotes and Antagonists, 819 
Turpeth Mineral, 341 
Tympanites, 861 
Typhlitis, 861 
Typhoid Fever, 861 

Diagnosis of, 907 

Temperature in, 851 
Typho-malarial Fever, — See Typhoid. 
Typhus Fever, 863 

Diagnosis of, 907 
Tyrotoxicon, Antidotes, etc., 819 

Ulcers and Sores, 864 

of Rectum, 829 

of Stomach, 707 

of Tonsils, 858 

of Uterus, 873 
Ulmus, 519 
Umbelliferon, 325 
Umbrella tree, 374 
Unguenta, 600 
Unguentum, 252 
Urea, Agents affecting, 53, 54 

in Urine, Test for, 869 
Uremia, 866 
Ureometers, 869 
Urethan, 256 
Urethral Stricture, 866 

Injections, 578, 712 
Urethritis, 867 
Urginea maritima, 475 
Uric Acid Diathesis, — See Lithemia, 755 
Urinary Acidifiers, 64 

Alkalinizers, 64 

Astringents, 64 

Disorders, 867 

Sedatives, 64 
Urine, Articles coloring, 868 

Deposits in, 870 

Examination of, 868 
Urotropin, 430 
Ursone, 325, 519 
Urticaria, 870 
Ustilago, 526 
Uterine Affections, 871 

Alteratives, 65 

Cancer, 87 1 

Congestion, 871 

Depressants, 65 

Displacements, 872 

Extract, 167 

Hypertrophy, 871 

Prolapse, 821 

Tonics, 65 

Tumors, 872 

Ulceration, 873 
Uva Ursi, 519 
Uvula, 873 

Vaccination, 873 
Vaginismus, 874 



Vaginitis, 874 

Valerene, 520 

Valerian, 299, 520 

Valerianate, Butyl, 167 

Valerianates, 520 

Valerol, 338, 520 

Vallet's Mass, 316 

Van Buskirk's Sozodont, 902 

Vanilla, 521 

Vao, 298 

Vapores (Vapors), 577 

Vaporization, 564 

Varicella, 874 

Varicocele, 874 

Varicosis, 874 

Variola, 875 

Diagnosis of, 906 
Vascular Contractors, 65 

Dilators, 66 

Sedatives, 66 

Stimulants, 66 

Tonics, 65 
Vaselin, 415 

Vegetable Drugs, their Constituents, 17 
Veins, — See Phlebitis, Phlegmasia, Vari- 
cosis. 

Transfusion by, 69 
Velatine, 276 
Vellarine, 348 
Venice Turpentine, 503 
Venom, Insect, Antidotes, 8ll 

Serpent, Antidotes, etc., 818 
Venous Medication, 69 
Veratralbine, 522 
Veratrine, 522 
Veratroidine, 522 
Veratrum Album, 521 

Sabadilla, 521 

Viride, 521 

Antidotes and Antagonists, 819 
Verbascum, 524 
Verbs, Latin, 896 
Verdigris, 297 
Vermicides, 36 
Vermifuges, 36, 333, 879 
Veronica Virginica, 366 
Verruca, — See Warts, 878 
Vertigo, 875 

Vesica] Tonics and Sedatives, 66 
Vesicants, 55 
Viburnin, 525 
Viburnum, 525 
Vienna Paste, 437 
Villate's Solution, 298. 639 
Vina (Wines), 131, 602 
Vinegar, 80 

Bitters, 902 
Vinegars (Aceta), 565 
Vinum, 130 
Viola Cucullata, 525 

Tricolor, 525 
Violet, 525 
Violine, 525 



95o 



INDEX. 



Viscura, 525 

Visions, Agents producing, 66 

Vita Nuova, 902 

Vitellus, 121 

Vitriol, Elixir of, 104 

Vleminck's Solution, 668 

Volatile or Essential Oils, 27 

Volkmann's Antiseptic Fluid, 508 

Vomiting, 876 

of Pregnancy, 877 

Diagnosis of, 907 
Vulva, 878 
Vulvitis, 878 



Wade's Bougies, 595 
Wafers, 592 
Wahoo, 315 

Walker's Vinegar Bitters, 902 
Walnut, White, 363 
Warburg's Tincture, 271, 276 
Warming-plaster, 244, 431 
Warner's Safe Cure, 902 
Warts, 878 
Wash, 579 

Black, 341 

Hair, 611, 715 

Lead and Opium, 580 

Mouth, 715 

Nasal, 578, 643 

Yellow, 341 
Washing, 565 

Waste, Agents promoting, 45 
Wasting, — See Atrophy, Emaciation. 
Water, 45, 185 

of Carbolic Acid, 84 

Carbonated, 91, 93 

Cherry-laurel, 99, 101 

Cologne, 131 

of Crystallization, 558 

Distilled, 185 

Eye, Thompson's, 902 

Hunyadi, 657 

Javelle, Antidotes, etc., 813 

Lavender, 366 

Lead, 433, 435 

Lime, 235 

Oxygenated, 408 

Sedative, 145, 239 

Soda, 91,93, 185 

Tar, 431 
Water-brash, — See Pyrosis, 828 

-lily, 395 

-pepper, 436 
Waters (Aquae), 566 

Mineral, 91, 185 

Nomenclature, 185 
Wax, 251 

Myrtle, 96, 251 
Waxes, 26 

Weakness, — See Adynamia, Exhaustion. 
Weight of a Drachm in Grains, 910 
Weights and Measures, 532, 910 



Weights and Measures, Apothecaries', 
533, 9io 

British Pharmacopceial, 533 

Metric, 534, 910 

Table for Converting, 91 1 
Wen, 879 
Wheat, 152, 154 
Whiskey, 130 
White of Egg, 127 
White-leg, — See Phlegmasia, 795 
White-swelling, — See Joints, Synovitis. 
Whitlow, — See Onychia, 780 
Whooping-cough, — See Pertussis, 793 
Willow, 464 
Wine, 130 

Wines (Vina), 131, 602 
Winslow's (Mrs.) Soothing Syrup, 399 
Winterberry, 442 
Wintergreen, 325, 464 
Witch-hazel, 96, 336 
Wolf's-bane, 106 
Wolff's Formula, 123 
Wood Oil, 335 

Spirit, 130 
Wool- fat, in 
Woorara, 298 

Words and Phrases, Latin, 883, 897 
Worm-grass, 487 
Worms, 36, 3^3, 879 
Wormseed, 253 

Levant, 471 
Worm Tea, 487 
Wormwood, 76 
Wounds, 880 

Poisoned, Antidotes, etc., 819 
Writers' Cramp, — See Spasmodic Affec- 
tions, 841 
Wry-neck, — See Torticollis, 858 

Xantho-puccine, 346 
Xanthoxyline, 525 
Xanthoxylum, 525 
Xeroderma, — See Ichthyosis, 738 
Xeroform, 219 



Yam, Wild, 306 
Yellow Fever, 881 

Diagnosis of, 907 
Yerba Santa, 313 
Yolk of Egg, 121, 127 
Yvon's Hypnotic Elixir, 744 

Zea, 526 

Mays, 152, 462, 526 
Zinc, 527 

Phosphide, 418 

Salts, Antidotes, etc., 819 
Zincite, 527 
Zincum, 527 
Zingiber, 530 
Zona, — See Herpes Zoster, 735 



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MEDICAL AND SCIENTIFIC PUBLICATIONS. 13 



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* MEDICAL AND SCIENTIFIC PUBLICATIONS. 15 

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MEDICAL AND SCIENTIFIC PUBLICATIONS. 23 

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MEDICAL AND SCIENTIFIC PUBLICATIONS. 25 

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MEDICAL AND SCIENTIFIC PUBLICATIONS. 27 

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Their Application to Various Diseases of the Body. A Manual for Students, Nurses, 
and Physicians. By Kurre W. Ostrom, from the Royal University of Upsala, 
Sweden, Instructor in Massage and Swedish Movements in the Hospital of the 
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ates in Medicine, etc. Fourth Edition, Enlarged. 105 Illustrations, many of which 
were drawn especially for this purpose. i2mo. Cloth, $1.00 

" In this volume the author gives an excellent description of the methods of massage and 
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Packard's Sea Air and Sea Bathing. 

By John H. Packard, m.d. Cloth, .40 

Parkes. Hygiene and Public Health. 
A Practical Manual. By Louis C. Parkes, m.d., d.p.h. (Lond. Univ.), Lecturer 
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Chelsea, London, etc. Sixth Edition, Enlarged and Revised. 80 Illustrations. 
i2rno. In Press. 

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The Elements of Health. 

An Introduction to the Study of Hygiene. Illustrated. Cloth, $1.25 

Phillips. Spectacles and Eyeglasses. 

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Second Edition, Revised and Enlarged. 49 Illustrations. i2mo. Cloth, $1.00 

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MEDICAL AND SCIENTIFIC PUBLICATIONS. 29 

The Physician's Visiting List. 

Published Annually. Fiftieth Year (1901) of its Publication. 

Hereafter all styles will contain the interleaf or special memoranda page, except 
the Monthly Edition, and the sizes for 75 and 100 Patients will come in two volumes 
only. 

REGULAR EDITION. 

For 25 Patients Weekly. Tucks, pocket and pencil, Gilt Edges, $1.00 

5 o " " " " " " " 1.25 

1 f Tan. to Tune ) ,, 

5° 2voIs - J July to Dec.} 

75 •• " 2 vols. ]T t t0 £ me l " 2-oo 

1 ° I July to Dec. j 

1 f Tan. to Tune | ,, ,-,',. 

100 " " 2 vols. \ J T , . f, [ " " " " " 2.25 

( July to Dec. J ? 

Perpetual Edition, 

without Dates and with Special Memorandum Pages. 

For 25 Patients, Interleaved, Tucks, Pocket, and Pencil, $1.25 
For 50 Patients, Interleaved, Tucks, Pocket, and Pencil, $1.50 

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Can be commenced at any time and used until full. Requires only one writing 
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Extra Pencils 

will be sent, postpaid, for 25 cents per half dozen. 

JlUr This list combines the several essential qualities of strength, compactness, 
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Potter. A Handbook of Materia Medica, Pharmacy, and Thera- 
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Including the Action of Medicines, Special Therapeutics of Disease, Official and 
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(Lond.), Professor of the Principles and Practice of Medicine and Clinical Medicine 
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Reese's Medical Jurisprudence and Toxicology. 

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Regis. Mental Medicine. 

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MEDICAL AND SCIENTIFIC PUBLICATIONS. 31 

Richardson. Long Life 
and How to Reach It. By J. G. Richardson, formerly Professor of Hygiene, Uni- 
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Richardson's Mechanical Dentistry. 

A Practical Treatise on Mechanical Dentistry. By Joseph Richardson, d.d.s. 
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Roberts. Fractures of the Radius. 

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Richter's Inorganic Chemistry. 
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Robinson. Latin Grammar of Pharmacy and Medicine. 

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Sansom. Diseases of the Heart. 

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82 P. BLAKISTON'S SON &* CO.' S 

Sayre. Organic Materia Medica and Pharmacognosy. 

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Smith. Electro-Chemical Analysis. 

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Smith. Dental Metallurgy. 

A Manual. By Ernest A. Smith, f.cs., Assistant Instructor in Metallurgy, Royal 
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MEDICAL AND SCIENTIFIC PUBLICATIONS. 33 

Smith. Wasting Diseases of Infants and Children. 

By Eustace Smith, m.d., f.r.c.p. , Physician to the East London Hospital for 
Children, etc. Sixth Edition, Revised. Cloth, $2.00 

Starling. Elements of Human Physiology. 

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Starr. The Digestive Organs in Childhood. 

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The Hygiene of the Nursery. 

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Stearns. Lectures on Mental Diseases. 

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Stevenson and Murphy. A Treatise on Hygiene. 

By Various Authors. Edited by Thomas Stevenson, m.d., f.r.c.p., Lecturer on 

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Stewart's Compend of Pharmacy. 

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Outlines of Practical Histology. 

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34 P. BLAKISTON'S SON 6- CO: S 

Stohr. Text-Book of Histology, Including the Microscopical 
Technic. 292 Illustrations. 

By Dr. Philipp Stohr, Professor of Anatomy at University of Wiirzburg. Author- 
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Sturgis. Manual of Venereal Diseases. Seventh Edition. 

By F. R. Sturgis, m.d., Sometime Clinical Professor of Venereal Diseases in the 
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Sutton's Volumetric Analysis. 

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With 116 Illustrations. 8vo. Just Ready. Cloth, $5.00 

Swain. Surgical Emergencies. 

Together with the Emergencies Attendant on Parturition and the Treatment of Poison- 
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Cornwall Hospital, England. Fifth Edition. 149 Illustrations. i2mo. 

Cloth, $1.75 

Swanzy. Diseases of the Eye and their Treatment. 

A Handbook for Physicians and Students. By Henry R. Swanzy, a.m., m.b., 
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Eye and Ear Infirmary ; Ophthalmic Surgeon to the Adelaide Hospital, Dublin. 
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Symonds. Manual of Chemistry 

for Medical Students. By Brandreth Symonds, a.m., m.d., Assistant Physician 
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Cloth, $ 2. 00 

Taft. Index of Dental Periodical Literature. 

By Jonathan Taft, d.d.s. 8vo. Cloth, $2.00 



MEDICAL AND SCIENTIFIC PUBLICATIONS. 35 

Tanner's Memoranda of Poisons 

and their Antidotes and Tests. By Thos. Hawkes Tanner, m.d. Seventh Edition, 
Revised by John J. Reese, m.d., late Professor of Medical Jurisprudence and Toxi- 
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Taylor. Practice of Medicine. 

By Frederick Taylor, m.d., Physician to, and Lecturer on Medicine at, Guy's 
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Cloth, $4.00 

Taylor and Wells. Diseases of Children. Illustrated. 

A Manual for Students and Physicians. By John Madison Taylor, a.b., m.d., 
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Elwyn and the Vineland Training Schools for Feeble-minded Children ; Neurologist 
to the Howard Hospital, etc.; and William H. Wells, m.d., Adjunct Professor of 
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With Numerous Illustrations. Second Edition, Revised and Enlarged. Octavo. 
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Temperature Charts 

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Occupation, Name, etc. Put up in pads ; each .50 

Tessier. Pneumotherapy and Inhalation Methods. 
See Cohen, Physiologic Therapeutics, page 10. 

Thorington. Retinoscopy. Fourth Edition. 

(The Shadow Test) in the Determination of Refraction at One Metre Distance with 
the Plane Mirror. By James Thorington, a.m., m.d., Adjunct Professor of Dis- 
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Refraction and How to Refract. Second Edition. 

With 200 Illustrations, most of which are made from Original Drawings, and 
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opia ; Myopia. V. Astigmatism or Curvature Ametropia ; Tests for Astigma- 
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Thorne. The Schott Methods of the Treatment of Chronic Dis- 
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With an Account of the Nauheim Baths and of the Therapeutic Exercises. By W. 
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Third Edition, Revised and Enlarged. Octavo. Cloth, $1.7$ 



36 P. BLAKISTON'S SON &- CO.' S 

Tomes' Dental Anatomy. 

A Manual of Dental Anatomy, Human and Comparative. By C. S. Tomes, d.d.s. 
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Dental Surgery. 

A System of Dental Surgery. By John Tomes, f.r.s. Fourth Edition, Thor- 
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pages. Cloth, $4.00 

Treves. German-English Medical Dictionary. 
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i2mo. Half Russia, $3.25 

Physical Education : Its Effects, Value, Methods, etc. 8vo. 

Cloth, .75 
Tuke. Dictionary of Psychological Medicine. 

Giving the Definition, Etymology, and Synonyms of the Terms used in Medical Psy- 
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Mental Disorders, together with the Law of Lunacy in Great Britain and Ireland. 
Edited by D. Hack Tuke, m.d., ll.d., Examiner in Mental Physiology in the Uni- 
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" A comprehensive, standard book." — The British Medical Journal. 

"It is vastly more than a Dictionary. It is an elaborate and complete Encyclopaedia of 
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Journal. 

"We believe that the student might obtain a better knowledge of insanity from this work than 
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Traube. Physico-Chemical Methods. 

By Dr. J. Traube, Privatdocent in the Technical High School of Berlin. Author- 
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MEDICAL AND SCIENTIFIC PUBLICATIONS. 37 



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41 



JUST READY, O NE VOLUME 

A Cyclopedia of Practical 
Medicine and Surgery 

A CONCISE REFERENCE BOOK, ALPHABETICALLY 

ARRANGED 

OF 

medicine, surgery, obstetrics, materia medica, therapeutics, 

and the various specialties, with particular 

reference to diagnosis and treatment 

COMPILED UNDER THE EDITORIAL SUPERVISION OF 

GEORGE M. GOULD, MJX AND WALTER L. PYLE, M.D, 

Author of " An Illustrated Dictionary of Medicine; " Assistant Surgeon Wills Eye Hospital; formerly 

Editor " Philadelphia Medical Journal," etc. Editor " International Medical Magazine/' etc. 

AND SEVENTY-TWO SPECIAL CONTRIBUTORS 



WITH MANY ILLUSTRATIONS 



LARGE SQUARE OCTAVO. TO CORRESPOND WITH GOULD'S " ILLUSTRATED 
DICTIONARY." FULL SHEEP OR HALF DARK-GREEN LEATHER, $10.00; 
WITH THUMB INDEX, $H.00; HALF RUSSIA, THUMB INDEX, $12.00, NET 

The great success of Dr. Gould's "Illustrated Dictionary of Medicine " suggested 
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trustworthy handbook in the broad field of general information that the Dictionary is 
in the more special one of the explanation of words and the statement of facts. The 
aim has been to provide in a one-volume book all the material usually contained in 
the large systems and much which they do not contain. Instead of long discursive 
papers on special subjects there are short, concise, pithy articles alphabetically 
arranged, giving the latest methods of diagnosis, treatment, and operating — a working 
book in which the editors and their collaborators have condensed all that is essential 
from a vast amount of literature and personal experience. 

The illustrations have been selected with care, only those having been used that are 
of practical value ; no effort has been made to overload the book with useless pictures. 

The seventy-two special contributors — the names of whom are given on the 
following page — have been selected from all parts of the country in accordance 
with their fitness for treating special subjects about which they may be considered 
expert authorities. They are all men of prominence, teachers, investigators, and 
writers of experience, who give to the book a character unequaled by any other work 
of the kind. 

V LARGE DESCRIPTIVE CIRCULAR UPON APPLICATION 

42 



GOULD AND PYLE'S 

CYCLOPEDIA OF MEDICINE 



LIST OF CONTRIBUTORS 



Samuel W. Abbott, A.M., M.D., Boston. 

James M. Anders, M.D., LL.D., Phila. 

Joseph D. Bryant, M.D., New York. 

James B. Bullitt, M.D., Louisville. 

Charles H. Burnett, A.M., M.D., Phila. 

J. Abbott Cantrell, M.D., Philadelphia. 

Archibald Church, M.D., Chicago. 

L. Pierce Clark, M.D., Sonyea, N. Y. 

Solomon Solis-Cohen, M.D., Philadelphia. 

Nathan S. Davis, Jr., M.D., Chicago. 

Theodore Diller, M.D., Pittsburg. 

Augustus A. Eshner, M.D., Philadelphia. 

J. T. Eskridge, M.D., Denver, Col. 

J. McFadden Gaston, A. B., M.D., Atlanta, 
Ga. 

J. McFadden Gaston, Jr., A.M., M.D., At- 
lanta, Ga. 

Virgil P. Gibney, M.D., New York. 

George M. Gould, A.M., M.D., Phila. 

W. A. Hardaway, A.M., M.D., St. Louis. 

John C. Hemmeter, M.B., M.D., Baltimore. 

Barton Cooke Hirst, M.D., Philadelphia. 

Bayard Holmes, M.D., Chicago. 

Orville Horwitz, B.S., M.D., Philadelphia. 

Daniel E. Hughes, M.D., Philadelphia. 

James Nevins Hyde, A.M., M.D., Chicago. 

E. Fletcher Ingals, A.M., M.D., Chicago. 

Abraham Jacobi, M.D., New York. 

William W. Johnston, M.D., Washington, 
D. C. 

Wyatt Johnston, M.D., Montreal. 

Allen A. Jones, M.D., Buffalo. 

William W. Keen, M.D., LL.D., Phila. 

Howard S. Kinne, M.D., Philadelphia. 

Ernest Laplace, M.D., Philadelphia. 

Benjamin Lee, M.D., Philadelphia. 

Charles L. Leonard, M.D., Philadelphia. 

James Hendrie Lloyd, A.M., M.D., Phila. 

J. W. MacDonald, M.D. (Edin.), F.R.C.S. 
Ed., Minneapolis. 

L. S. McMurtry, M.D., Louisville. 

G. Hudson Makuen, Philadelphia. 

43 



Matthew D. Mann, M.D., Buffalo. 

Henry O. Marcy, A.M., M.D., LL.D., 

Boston. 
Rudolph Matas, M.D., New Orleans. 
Joseph M. Mathews, M.D., Louisville. 
John K. Mitchell, M.D., Philadelphia. 
Harold N. Moyer, M.D., Chicago. 
John H. Musser, M.D., Philadelphia. 
A. G. Nicholls, M.D., Montreal. 

A. H. Ohmann-Dusmesnil, M.D., St. 
Louis. 

William Osier, M.D., Baltimore. 

Samuel O. L. Potter, A.M., M.D., M.R. 

C.P. (London), San Francisco. 
Walter L. Pyle, A.M., M.D., Philadelphia. 

B. Alexander Randall, A.M., M.D., Phila. 
Joseph Ransohoff, M.D., F.R.C.S. (Eng.), 

Cincinnati. 
Jay F. Schamberg, A.M., M.D., Phila. 
Nicholas Senn, M.D., LL.D., Chicago. 
Richard Slee, M.D., Swiftwater, Pa. 
S. E. Solly, M.D., M.R.C.S., Colorado 

Springs, Col. 
Edmond Souchon, M.D., New Orleans. 
Ward F. Sprenkel, M.D., Philadelphia. 
Charles G. Stockton, M.D., Buffalo. 
John Madison Taylor, A.M., M.D., Phila. 
William S. Thayer, M.D., Baltimore. 
James Thorington, A.M., M.D., Phila. 
Martin B. Tinker, M.D., Philadelphia. 
James Tyson, M.D., Philadelphia. 
J. Hilton Waterman, M.D., New York. 
H. A. West, M.D., Galveston, Texas. 
J. William White, M.D., PH.D., Phila. 
Reynold W. Wilcox, M.A., M.D., LL.D., 

New York. 
George Wilkins, M.D., Montreal. 
DeForest Willard, M.D., Philadelphia. 
Alfred C. Wood, M.D., Philadelphia. 
Horatio C. Wood, M.D., LL.D., Phila. - 
Albert Woldert, Ph.G., M.D., Phila. 
James K. Young, M.D., Philadelphia. 



Deaver's Surgical Anatomy 

A Treatise on Human Anatomy 
in its Application to the Practice 
of Medicine and Surgery & <£> 

By JOHN B. DEAVER, M.D. 

Surge on-in- Chief to the German Hospital, Philadelphia ; Surgeon to the Children's Hospital; 

Consulting Surgeon to St. Agnes', St. Timothy's, and Germantown 

Hospitals; formerly Assistant Professor of Applied 

Anatomy, University of Pennsylvania, etc. 

In Three Royal Octavo Volumes, containing about Four Hundred and Fifty Full-page Plates, 
nearly all from dissections made for the purpose 



Handsome Cloth, $21.00 ; Full Sheep, $24.00; Half Green Morocco, 
Marbled Edges, $24.00 ; Half Russia, Gilt, Marbled Edges, $27.00 net. 



SYNOPSIS OF CONTENTS 

VOLUME L— Upper Extremity— Back of Neck, Shoulder, and Trunk— Cranium— Scalp- 
Face. 

VOLUME IL— Neck— Mouth, Pharynx, Larynx, Nose— Orbit— Eyeball— Organ of Hearing- 
Brain — Female Perineum — Male Perineum. 

VOLUME HI.— Abdominal Wall— Abdominal Cavity— Pelvic Cavity— Chest— Lower Ex- 
tremity. 

The book is designed to aid the general practitioner and surgeon in his 
everyday work. The text is excellently clear, succinct, and systematically^ arranged, 
and contains a wealth of illustrations far in advance of the usual text-book. It is not 
intended merely for the surgeon — though to him it will prove invaluable — but for the 
general physician, who, while called upon to cope with innumerable emergencies and 
special cases, has not the means or the hospital facilities by which he can readily 
acquaint himself with every phase of anatomy — superficial and deep — as applied to 
disease and the most modern methods of treatment of injuries. 

To the specialist it will prove of great value. The anatomy of the head and 
neck, the spinal cord, the organs of sense, and the throat appeals directly to the 
ophthalmologist, aurist, rhinologist, laryngologist, and neurologist, while those sections 
devoted to the abdomen and pelvic cavity will give the gynecologist and specialist 
on diseases of the urinary organs, rectum, etc., material regarding the relations of the 
parts and the operations thereon, unique in many ways, and in a manner never before 
so exactly and concisely stated. To those devoted to these specialties it will prove a 
supplement to other text-books that omit special anatomy, and which do not attempt 
to show the applied anatomy* 

44 



Deaver's Surgical Anatomy 



The illustf ations, which at the first glance appear as the prominent feature of 
the book — but which in reality do not overshadow the text — consist of a series of 
pictures absolutely unique and fresh. They will bear comparison from an artistic point 
of view with any other work, while from a practical point of view there is no other 
volume or series of volumes to which they can be compared. When originally an- 
nounced, the book was to contain two hundred illustrations. As the work of prepara- 
tion progressed, this number gradually increased until it is estimated that there will now 
be more than four hundred full-page plates, many of which contain more than one 
figure. With the exception of a few minor pictures made from preparations in the 
possession of the author, they have all been drawn by special artists from dissections 
made for the purpose in the dissecting-rooms of the University of Pennsylvania. Their 
accuracy cannot be questioned, as each drawing has been submitted to the most careful 
scrutiny. 

From The Medical Record, New York, 

u The reader is not only taken by easy and natural stages from the more superficial to the 
deeper regions, but the various important regional landmarks are also indicated by schematic 
tracing upon the limbs. Thus the courses of arteries, veins, and nerves are indicated in a way that 
makes the lesson strikingly impressive and easily learned. No expense, evidently, has been 
spared in the preparation of the work, judging from the number of full-page plates it contains, not 
counting the smaller drawings. Most of these have been ' drawn by special artists from dissections 
made for the purpose in the dissecting-rooms of the University of Pennsylvania.' In summing up 
the general excellences of this remarkable work, we can accord our unqualified praise for the 
accurate, exhaustive, and systematic manner in which the author has carried out his plan, and we 
can commend it as a model of its kind, which must be possessed to be appreciated/' 

From The Philadelphia Medical Journal. 

" Many members of the profession to whom Dr. Deaver is well known either personally or by 
reputation as a surgeon, writer, teacher, and practical anatomist, have awaited the appearance of 
his Surgical Anatomy with the expectation of finding in it a guide in this difficult branch of medi- 
cine of much more than ordinary practical value, and their expectations will not be disappointed/' 

From The Journal of the American Medical Association. 

" In order to show its thoroughness, it is only necessary to mention that no less than twelve 
full-page plates are reproduced in order to accurately portray the surgical anatomy of the hand, 
and it is doubtful whether any better description exists in any work in the English language." 

From The Southern California Practitioner. 

" Aside from the merit of this great work, it will be a delight to the lover of books. Its gen 
eral make-up shows the highest development of the book-making art. The bibliophile, when 
holding one of these volumes in his hands, would be as careful with it as though he were handling 
an infant, and to drop it would cause him the keenest pain. The illustrations, the print, and the 
paper and binding are each and all delightful in themselves, and yet the text is concise and clear, 
and taken with the illustrations make a remarkably good substitute for the dissecting-room. To 
have these three volumes on his library shelves will be a source of pride and joy and profit to 
every practitioner. Dr. Deaver has in these volumes conferred a boon upon the medical profession 
which has, at least, never been surpassed by any one." 

From The New Orleans Medical and Surgical Journal. 

" While the needs of the undergraduate have been fully kept in view, it has been the aim of 
the author to provide a work which would be sufficient for reference for use in actual practice. We 
believe the book fulfils both requirements. The arrangement is systematic and the discussion of 
surgical relations thorough/' 

j^^ Large Descriptive Circular will be sent upon application 

45 



Hemmeter* Diseases of the Stomach* Second 
Edition, Enlarged* Illustrated* 

Their Special Pathology, Diagnosis, and Treatment. With Sections on Anatomy, 
Analysis of Stomach Contents, Dietetics, Surgery of the Stomach, etc. By John 
C. Hemmeter, m.d., philos.d., Professor in the Medical Department of the 
University of Maryland ; Consultant to the University Hospital ; Director of the 
Clinical Laboratory, etc. Second Revised Edition. With Colored and other 
Illustrations. Octavo. 890 pages. 

Cloth, $6.00; Leather, $7.00; Half Russia, $8.00 

*%* The rapid sale of the first edition of this book has encouraged the author to 
revise it very thoroughly and to add much new material (about 100 pages) and a num- 
ber of new illustrations. About two-thirds of the book has been actually reconstructed. 
The section on Dietetics will be found particularly useful. 

" A second enlarged and revised edition appearing in a little over a year from the date of the 
original publication speaks for the popularity and value of the work. This book easily occupies 
the first place among its sort in the English language and is particularly free from that enthusiastic 
hobby riding which is not unknown among gastro-enterologists. The' bibliographical references 
are very full and complete, and the work is one of the highest order as well as one of the utmost 
practical value." — Chicago Medical Recorder. 

" This edition of Hemmeter's work on ' Diseases of the Stomach ' contains much new and 
important material. The following articles have been added : Hypertrophic stenosis of the pylorus, 
obstruction of the orifices, the use and abuse of rest and exercise in the treatment of digestive dis- 
eases. Part of the chapter on motor insufficiency, electro-diaphany, hemorrhage from the stomach, 
and the articles on gastroptosis and enteroptosis have been entirely rewritten. The present edition 
will undoubtedly gain as many friends as the first edition." — The Medical Record, New York. 

" Dr. Hemmeter certainly provides a book which is well worthy of a careful study. ... It 
treats of many subjects in an original manner, and is not only based on a considerable personal 
experience, but takes due notice of the labors of other well-known workers in this field." — British 
Medical Journal. 

" Completely scientific, modern, accurate, and creditable. . . . We commend it." — Journal 
of the American Medical Association. 

"We know of no work from which the physician may gain more information than this." — 
Australian Medical Gazette. 

" The consideration of the general methods of clinical examination of the stomach is thor- 
oughly adequate. ' ' — Boston Medical and Surgical Journal. 

" We part from Dr. Hemmeter's book with the sense that it embodies the best knowledge of 
the time." — London Lancet. 

" We wish to express unqualified approval of the tendency which is shown to emphasize the 
simple and more practical methods of diagnosis." — New York Medical Journal. 

" The best contemporary treatise on diseases of the stomach which we possess, not only in 
America, but in the whole world." — Prof. L. Boas, of Berlin. 



In Preparation by the same Author 

Diseases of the Intestines* Original Illustrations 

A Complete, Systematic Treatise, Including the Surgical Aspects of the Subject 

46 



Gordinier* The Gross and Minute Anatomy 
of the Central Nervous System* Colored 
Illustrations* 

By H. C. Gordinier, a.m., m.d., Professor of Physiology and of the Anatomy 
of the Nervous System in the Albany Medical College ; Member American Neuro- 
logical Association. With 48 Full-page Plates and 213 other Illustrations, a 
number of which are printed in Colors and many of which are original. Large 
8vo. Cloth, $6.00 ; Sheep, $7.00 ; Half Russia, $8.00. 

*^* It is universally acknowledged that for a proper comprehension of the normal 
and abnormal activities of an organ a thorough knowledge of its anatomy is absolutely 
essential. This is particularly true of diseases of the central nervous system, for in no 
other way can the disease symptoms be explained. Without this knowledge, clinical 
and pathologic observations are of little avail. This book is not a theoretic and tech- 
nical student's book, but a useful working supplement to all works upon general practice 
and neurology, and as such is destined to mark an epoch in medical literature. 

" This is an excellent book on a fascinating subject, and the author deserves the thanks of the 
English-speaking medical world for his labor in getting it up. There are works enough on general 
anatomy, and dry enough they are, as we all remember only too well; but the anatomy of the 
nervous system alone is another matter entirely, for it is one of the most interesting of all subjects 
of medical study, at the same time that it is one of the most difficult. For both of these reasons 
the subject is deserving of a treatise by itself, and should not be briefly discussed in a few pages 
of a general work on anatomy, or in an introductory chapter of a treatise on diseases of the ner- 
vous system." — Medical Record \ New York. 

" The author has made an honest attempt to place in the hands of the English student a 
comprehensive and accurate text-book, devoid of the many intricacies of modern thought and 
speculation. For the average man the work will appeal strongly ; the facts that he can use are 
readily found." — The Journal of Nervous and Mental Diseases, New York. 

" Throughout the book the descriptions of the gross and minute anatomy are, as a rule, clear, 
objective, and as easy of comprehension as could be expected of so difficult a subject. The state- 
ments are most of them quite didactically made, but this we consider an advantage rather than a 
defect, especially in a text-book for students as well as practitioners. . . . The chapter on 
cerebral localization is carefully written, and gives the most recent results on the subject." — The 
American Journal of Insanity, Baltimore. 

" Represents much painstaking research, and bears also the stamp of original investigation. 
It is unusually well written, and the illustrations, many of which are original, are well chosen. It 
is destined to take its place among the standard books of its class." — New York Medical Journal. 

" This book will be welcomed by teachers, practitioners, and students. It will save teachers 
and writers on the nervous system the necessity of accompanying their lectures and books on 
diseases of the nervous system with chapters on anatomy. It is really the first thoroughly system- 
atic work on the anatomy of the central nervous system that has appeared in the English language. 
The work is the more necessary because diseases of the central nervous system are becoming more 
and more recognized, and because the works on general anatomy do not pretend to describe the 
minute anatomy of the central nervous system. Authors of books on neurology recognize the fact 
that their readers cannot understand the descriptions of the diseases of the central nervous system 
without a knowledge of the anatomy of the parts involved. The subject is a difficult one at best, 
but the student who will make an earnest effort to master the details cannot fail to do so with the 
aid of this work. The author's descriptions are clear, concise, comprehensive, and profusely and 
beautifully illustrated." — Pacific Ale die al Journal, San Francisco. 

" As there can be no accurate understanding of the diseases of the nervous system without a 
thorough knowledge of the anatomy, it is no wonder that the average practitioner is as ignorant of 
neurology as is unfortunately the case. The present volume is a praiseworthy attempt to remove 
the approach that has thus far rested upon English and American neurology." — Boston Medical 
and Surgical Journal. 

" We commend Gordinier's chapter on cerebral localization. This will be especially helpful to 
clinicians, although all the views expressed in it are not yet outside of the domain of controversv. 
We should like to say more about Gordinier's book, but space forbids. It is handsomely printed 
and copiously illustrated, and we can recommend it as a good text-book of nervous anatomy." 
— Philadelphia Medical Journal. 

47 



JUST READY 

PRACTICAL GYNECOLOGY 

A Modern Comprehensive Text-Book 
By E. E. MONTGOMERY, M.D. 

Professor of Gynecology, Jefferson Medical College? Gynecologist to the Jefferson Medical 

College and St. Joseph's Hospitals? Consulting Gynecologist to 

the Philadelphia Lying-in Charity 

WITH FIVE HUNDRED AND TWENTY-SEVEN 
ILLUSTRATIONS 

Nearly all of which have been Drawn and Engraved Specially for this 
"Work, for the most part from Original Sources 

OCTAVO, 819 PAGES 
CLOTH, $5.00; LEATHER, $6.00 ; HALF RUSSIA, $7.00 



EXTRACT FROM THE PREFACE 

This work has been under consideration for the past fifteen years, and much of it 
has been several times rewritten. An effort has been made to make it a comprehensive 
work upon the subject, giving the experience and methods of the most careful men, 
while my own experience has been utilized to indicate that which I have found most 
useful and worthy of acceptance. 

Each general subject is considered with reference to its influence upon the entire 
genital tract, and the work is divided into sections rather than chapters. This course, 
although a departure from the ordinary text-book arrangement, is that which experience 
has demonstrated to be most effective in impressing the subject upon the student, and 
would seem to me preferable to him who uses the book to refresh his knowledge upon 
some particular subject. The illustrations are arranged solely with the purpose of 
rendering clear the text and to promote the work of diagnosis and treatment. For the 
excellence and character of the illustrations I am greatly indebted to the generosity of 
the publishers and to the skill and patience of their artists, Messrs. Shannon and Von 
du Lancken. To the kindly oversight of Dr. Robert L. Dickinson is due much of the 
exactness of the drawings. Acknowledgment is due Miss Eleanor A. Cantner for her 
ability in the preparation of preliminary sketches and of the index. 

Should it be the means of lightening the work of the student, of making more 
clear the pathway of the busy practitioner, and, most of all, of benefiting suffering 
women through improved methods of diagnosis and treatment, I shall feel well repaid 
for the many days and nights of labor which it has cost. 

48 



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